Asia Pacific Journal of Pediatric and Child Health

Abstract Ref Number = APCP1239

Poster Presentation

IMPACT OF DEVICES USED FOR ADMINISTERING PARACETAMOL LIQUID ON DOSING ERRORS IN THE PEDIATRIC POPULATION

Preeti Kachroo Bhagat,Kamran Siddiqui,Oscar Della Pasqua GlaxoSmithKline Consumer Healthcare Consumer Healthcare R D, GlaxoSmithKline Consumer Healthcare, Singapore Clinical Pharmacology Modelling Simulation, GlaxoSmithKline, Uxbridge, UK

Background : Parents/caregivers administering liquid pediatric paracetamol may encounter a range of dosing units (eg, milliliter, teaspoon, dropperful) and devices. This review was conducted to evaluate the impact of dosing units and device characteristics on the potential for dosing errors when administering liquid paracetamol to children. Material : This is a narrative review of clinical trials, systematic reviews, meta-analyses, surveys, and guidelines identified via PubMed (through 11/29/2017). Results : Limited parental health literacy increases risk of errors during dosing of pediatric paracetamol. Inconsistencies between the label’s instructions and markings on dosing devices can confuse even highly educated parents. To address this, the US Food and Drug Administration published nonbinding recommendations in 2011 stating that units of measure on provided dosing devices should match those in the dosing instructions. Teaspoons or tablespoons as dosing units can inadvertently endorse use of nonstandardized kitchen spoons as measuring devices; the capacity of kitchen teaspoons ranges from 1.5?9.0 mL. In a US study of 287 parents with children <9 years of age, liquid medications were 30 times more likely to be given with a kitchen spoon if dosages were specified in teaspoons or tablespoons versus milliliters. In 2015, the American Academy of Pediatrics (AAP) recommended dosing liquid medications exclusively using milliliters. AAP guidance also states that syringes are the preferred dosing device, as they provide more precise doses, but calibrated cups and spoons marked in milliliters are acceptable alternatives. The World Health Organization recommends using the measuring device provided with the formulation. Conclusions : The optimal device for measuring oral liquid paracetamol is clearly calibrated and consistent with labeled dosing instructions. Caregivers should be instructed to always read the instructions before use and to measure liquid medicines accurately using an appropriate, standardized device to avoid underdosing, which can diminish efficacy, or overdosing, which may cause toxicity.

Keywords: acetaminophen pediatric misdosing paracetamol