Doses of penicillin used for children have remained to be the same for fifty years. These doses should be reviewed as teenagers are becoming heavier. Teenagers being exposed to inappropriate doses of penicillin could be at higher risk of failed treatment and development of antibiotic resistance.
Each year only in UK, oral penicillins such as amoxicillin are extensively prescribed to children with bacterial infections. It accounted for nearly four and half million of total annual prescriptions for antibiotics given to treat childhood bacterial infections. The dosage administering to children depended on body weight, but did not include the increase in body mass of children over time.
The existing dosing guidelines for children are defined in the British National Formulary for Children. Doses based on the age of children was first recommended in fifties, stated experts from King’s College London and St George’s, University of London. Subsequent to an amendment in the guidelines observed in 1963, there had been no alteration in the list till now.
On the basis of age bounding guidelines executed in 1963, the weight of a child aged five and ten was eighteen kg and thirty kg, correspondingly. However, according to the Health Survey for England 2009, the average weight of a child aged five and ten has risen to twenty-one kg and thirty-seven, suggesting average weights are up to twenty percent higher than in 1963.
Therefore, taking into account this variation, many children were in fact being exposed to less than optimal levels of medicines which may sooner or later cause sub-therapeutic concentrations. Additionally, dosages of penicillin for adults have been revised on the basis of weight fluctuations but child dosages were yet to be reviewed.
According to Dr Paul Long, a medicines expert from King’s College London who was part of the review team, they were surprised at the lack of evidence to support the current oral penicillins dosing recommendations for children, as it is such a commonly used drug. Children’s average size and weight are slowly but significantly changing.
Therefore what may have been adequate doses of penicillin fifty years ago are potentially not enough today. It is important to point out that this study does not provide any clinical evidence that children are receiving sub-optimal penicillin doses that lead to harm, and they want to reassure parents of that. The study was published in the British Medical Journal.
But what they are saying is that it should be ensured that children with severe infections who need these antibiotics the most are still receiving an effective dose. In the long-term they are concerned that under-dosing could lead to penicillin-resistance in both individuals and wider communities, concluded Dr Long.