What is the augmenting dose for a 19 kilogram patient with impaired renal function or other conditions requiring dose adjustment?

From the Guidelines

To augment a medication dose for a 19kg child, I would recommend calculating the dose based on the child's weight using the appropriate mg/kg formula for the specific medication, considering the therapeutic index and maximum recommended dose, as seen in the guidelines for medication dosing in children 1. When determining the appropriate dose, it's crucial to consider the child's weight and the specific medication being used. For example, if prescribing meropenem, the dose for infants ≥3 months of age and children is 20 mg/kg every 8 hours, as indicated in the clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection 1. For a 19kg child, this would mean a dose of approximately 380mg every 8 hours. Some key points to consider when augmenting doses in children include:

• Weight-based dosing is essential due to the different pharmacokinetics in children compared to adults, as their organ systems, particularly the liver and kidneys, are still developing 1.
• Always check the maximum recommended dose to ensure safety, as some medications have absolute dose caps regardless of weight.
• Reassess the dose as the child grows, as weight changes can significantly impact appropriate dosing.
• Consider the therapeutic index of the medication, as some require more precise weight-based dosing due to narrow therapeutic windows. It's also important to note that the guidelines for medication dosing in children may vary depending on the specific medication and the child's condition, as seen in the guidelines for preventing opportunistic infections among HIV-infected persons 1. However, the most recent and highest quality study should always be prioritized when making a definitive recommendation, in this case, the clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection 1.

From the FDA Drug Label

Table 1 (12 weeks) n 40 kg Recommended Dosage for Pediatric Patients Aged 3 Months and Older and Weight Less than 40 kg Ear/Nose/Throat Skin/Skin Structure Genitourinary Tract Mild/ Moderate 500 mg every 12 hours or 250 mg every 8 hours 25 mg/kg/day in divided doses every 12 hours or 20 mg/kg/day in divided doses every 8 hours Severe 875 mg every 12 hours or 500 mg every 8 hours 45 mg/kg/day in divided doses every 12 hours or 40 mg/kg/day in divided doses every 8 hours

For a 19kg patient, the augmenting dose would be:

• For mild/moderate infections: 25 mg/kg/day in divided doses every 12 hours or 20 mg/kg/day in divided doses every 8 hours
• For severe infections: 45 mg/kg/day in divided doses every 12 hours or 40 mg/kg/day in divided doses every 8 hours Using the weight of 19kg, the dose would be:
• Mild/moderate: 19kg * 25mg/kg/day = 475mg/day, or 19kg * 20mg/kg/day = 380mg/day
• Severe: 19kg * 45mg/kg/day = 855mg/day, or 19kg * 40mg/kg/day = 760mg/day Given the options, the dose for a 19kg patient would be approximately 475mg/day for mild/moderate infections or 855mg/day for severe infections, divided into doses every 12 hours 2.

From the Research

Augmenting Dose for 19kg

• The optimal dose for a 19kg patient is not explicitly stated in the provided studies, but we can look at the dosing strategies mentioned in the studies to get an idea of how to approach this.
• According to 3, weight-based dosing is still challenging due to poor awareness and adherence, and the correct circumstances in which weight-based dosing is of clinical relevance need to be considered.
• The study 4 mentions that for children with community-acquired pneumonia, a lower dose of amoxicillin (35-50 mg/kg/d) was noninferior to a higher dose (70-90 mg/kg/d), but this study does not provide a specific dose for a 19kg patient.
• Another study 5 discusses the properties and usage of oral amoxicillin and amoxicillin-clavulanic acid, but does not provide a specific dose for a 19kg patient.
• The study 6 recommends that patient weight be included on all medication prescriptions, which suggests that dosing should be individualized based on patient weight.
• The study 7 compares the bioavailability of different amoxicillin formulations, but does not provide information on dosing for a specific weight.

Dosing Considerations

• When determining the dose for a 19kg patient, it is essential to consider the specific medication, the patient's condition, and the recommended dosing strategy, as mentioned in 3.
• The dose may need to be adjusted based on the patient's weight, as well as other factors such as age, renal function, and liver function, as discussed in 5.
• It is crucial to consult the prescribing information for the specific medication and to consider the latest developments in weight-based dosing, as recommended in 3.