Standard Calculation Of Children Dose Can Be Wrong

Children dose

Medical prescription of drugs in adults is one very simple task. An adult is believe to be persons above 14 years of age. In other definition, a person that weighs above 35kg. This two standards have been use to extrapolate children dose. Unfortunately, these two parameters gives us different doses. For example, a 14 years old slim girl weighing less than 35kg may be given a small dose if we use weight to extrapolate. On the other hand, same person will get a higher dose if we use age to.
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Drug manufacturers normally use adults to prepare drugs. It is from there they calculate for children. The reason is that the conditions necessary to carry out research on dose requirements in children is very high. To save cost, time and energy, they use different methods to calculate children dose. There are other parameters use in calculating dose from standard adult dose. Another example is body surface area (B.S.A). All these three methods have their own disadvantages. There is no guarantee safe and effective dosing recommendation except where experiment have been carried out.

Age

A neonate is persons below 15kg, a child is between 15kg-25kg and a semi adult as person between 25kg-35kg. But the major organs in the body responsible for the pharmacokinetics (adsorption, distribution, metabolism and excretion) of drugs develop at different pace. Depending on a child's genetic makeup, some have delay development of their internal organs. Since most prescriber cannot know which organ is not developing as it ought to, they may give the calculated dose. If the organ that is suppose to act in the drug is weak, it can either lead to toxicity or reduce bio-availability.
The above can also lead to alter pharmacodynamics. If the organs in the body are not develop to handle the drug, the drug can harm the baby or in some cases render the drug useless. However one must state very clearly that these issues may occur but unknown to the prescriber or even the mother. The reason being that children may not know exactly what they are feeling or how to say it. In some cases, the effect may be asymptomatic for the mean time.

Weight

A child with an adult weight will require high dose of the drug for an even wide distribution of the drugs in the body. But, that may not be without negative effect. A 5 years old child with an adult weight definitely does not have a fully developed organs that will work on the pharmacokinetics of the drugs. An adult dose to a child with such a weight may only put stress on the organs. The end effect may be delay effect or toxic effect. Maybe long term effect can be damage to organs in the body.

Body Surface Area

A fat child will definitely have the BSA of an adult. The effect may be similar with that of a child with an adult weight.

Calculating Children Dose

Developmental growth affects pharmacokinetics and exposure-response relationships. Dose adjustment may be determined by differences in pharmacokinetics, pharmacodynamics, disease state or a combination of factors. The major factors to consider when prescribing for children should be based on variability in age, gender, body composition, functionality of the liver and kidney including the maturation of enzymes. These variables have little effects in adults. These effects on adults have been studied during clinical trials and little adjustment need be carried out by prescriber. Fortunately, these needed adjustment have been documented for the prescriber to use on adult.
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Talking of enzymes in the body, some enzymes are lacking at birth. Other are in abundance at birth. If these enzymes are required for drug pharmacokinetics, it may either work against it or for the drug. Since adult dose have been use, this should affect the dose. For example, because of the enzyme responsible for metabolism of digoxin is not available at same quantity like that of the adult, it require a higher dose in children. This is not the case with vaccines as they do not require dose adjustment. From the above example, it is clear that it is wrong to use assumption in calculating the dose of children as children are not small adults the way they were considered some years ago when we knew little about their makeup. Dosing should be work on the pharmacokinetics and pharmacodynamics data, developmental growth and disease state. The way mode of administration, pharmaceutical formulations and delivery devices can easily be predicted from adult cases. That does not rule out the fact that differences can still be recorded.
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