What are the common medications used in pediatric patients?

Common Medications Used in Pediatric Patients

The most commonly used medications in pediatric patients include antibiotics (particularly amoxicillin), analgesics, antipyretics, antihistamines, and various medications for specific conditions like asthma, mental health disorders, and infections. 1

Antibiotics

• Amoxicillin is the preferred antibiotic for many pediatric infections, particularly for respiratory tract infections, with dosing of 90 mg/kg/day in 2 doses for most common infections 1, 2
• For presumed bacterial pneumonia in children under 5 years old, amoxicillin (90 mg/kg/day in 2 doses) is the first-line treatment 1
• For beta-lactamase producing organisms, amoxicillin-clavulanate is recommended (amoxicillin component 90 mg/kg/day in 2 doses) 1
• For children with penicillin allergies, macrolides such as azithromycin (10 mg/kg on day 1, followed by 5 mg/kg/day once daily on days 2-5) can be used 1
• For severe infections requiring IV therapy, ampicillin (150-200 mg/kg/day), ceftriaxone (50-100 mg/kg/day), or cefotaxime (150 mg/kg/day) may be used 1

Antimicrobials for Specific Infections

• For Streptococcus pneumoniae infections with MICs for penicillin <2.0 μg/mL, ampicillin (150-200 mg/kg/day) or penicillin (200,000-250,000 U/kg/day) is preferred 1
• For methicillin-susceptible Staphylococcus aureus, cefazolin (150 mg/kg/day) or oxacillin (150-200 mg/kg/day) is recommended for parenteral therapy 1
• For culture-negative endocarditis in pediatric patients, combination therapy with ampicillin-sulbactam (300 mg/kg/day) plus gentamicin (3 mg/kg/day) is recommended 1

Emergency Medications

• For pediatric emergencies, medications should be readily available in appropriate dosages and formulations 1
• Sedatives commonly used in pediatric emergencies include:
  • Benzodiazepines like lorazepam (0.05-0.1 mg/kg PO/IM/IV) for mild to moderate agitation 1
  • Antipsychotics such as risperidone (0.5-2 mg) or olanzapine (2.5-5 mg) for acute agitation 1, 3

Mental Health Medications

• For acute agitation in pediatric patients, medication selection should be based on the suspected etiology of agitation 1
• For psychiatric causes of agitation, antipsychotics are preferred, with olanzapine 2.5-5 mg recommended for adolescents (13 years and older) 1, 3
• When discontinuing SSRIs like citalopram in young patients, a gradual dose reduction over several weeks is recommended to avoid withdrawal syndrome 4

Procedural Sedation and Analgesia

• Medications for procedural sedation in pediatric patients include etomidate, fentanyl/midazolam, ketamine, methohexital, pentobarbital, and propofol 1
• Selection of specific sedation medications depends on patient characteristics, the procedure being performed, and clinician experience 1
• For anxiolytic use in pediatric patients undergoing imaging procedures, hydroxyzine syrup is an approved option that facilitates administration to children who have difficulty swallowing tablets 5

Dosing Considerations

• Pediatric medication dosing is not simply a "small adult" dose but requires consideration of the child's age, size, and organ maturity 6, 7
• Dosing for infants and children must account for differences in pharmacokinetics compared to adults 8, 9
• Children generally require higher doses of medications on a mg/kg basis than infants or adults to achieve the same effect 10
• The most common pivotal dosing strategy in pediatric drug development is titration to target response (33% of programs), followed by pharmacokinetic/pharmacodynamic studies (30%) 9

Special Considerations

• For patients with renal impairment, medication doses often need to be reduced, such as hydroxyzine which should be reduced by half 5
• Medications like hydroxyzine should be avoided in patients with severe hepatic impairment due to increased sedating effects 5
• When treating pediatric patients with combination therapy, careful monitoring is required, particularly when combining medications with sedative properties 1, 3

Common Pitfalls to Avoid

• Failure to adjust doses based on age and weight can lead to under or overdosing in pediatric patients 6, 7
• Using adult formulations for children without proper compounding or dilution can result in dosing errors 6
• Not accounting for differences in drug metabolism and clearance between infants, children, and adolescents can lead to unexpected drug effects 8, 7
• Combining sedative medications without appropriate monitoring can result in excessive sedation and respiratory depression 1, 3