Guidelines for Writing Medication Doses
Write medication doses using standardized formats that include the total daily dose in mg/kg/day, the frequency of administration (e.g., "divided every 8 hours" or "q8h"), the route (IV/PO/IM), and the maximum daily dose not to exceed adult dosing. 1
Standard Dose Writing Format
The most widely accepted format across major guidelines includes these essential components in order:
- Total daily dose per kilogram: Express as "mg·kg⁻¹·d⁻¹" or "mg/kg/day" 1
- Route of administration: Clearly specify IV, PO, IM, or SC 1
- Frequency: Use either "divided every X hours" or standard abbreviations (q8h, q12h, BID, TID, QID) 1
- Maximum dose ceiling: Always state "not to exceed [adult dose]" for pediatric dosing 1
Examples from Major Guidelines
Pediatric antibiotic dosing should be written as: "Vancomycin 40 mg·kg⁻¹·d⁻¹ IV in 2 or 3 equally divided doses" or "Vancomycin 15 mg/kg/dose IV q6h" 1
Adult dosing can be simplified to: "Vancomycin 30-60 mg/kg/day IV in two to four divided doses" 1
Alternative acceptable format: "Ceftriaxone 100 mg/kg/day IV/IM in 1 dose" or "Gentamicin 3 mg·kg⁻¹·d⁻¹ IV/IM in 3 equally divided doses" 1
Critical Safety Elements
Avoid Decimal Point Errors
Write methotrexate and other high-risk medications in uppercase letters with the dose spelled out in full to prevent confusion between 2.5 mg and 25 mg tablets. 1
Specify Concentration for Liquid Medications
For liquid formulations, include both the dose in mg/mL and the volume: "Amoxicillin 125 mg (5 mL of 125/31 suspension) PO three times daily" 1
Loading Dose vs Maintenance Dose
When applicable, clearly distinguish between loading and maintenance regimens: "Teicoplanin 6-12 mg/kg/dose IV q12h for three doses, then 6-12 mg/kg/dose once daily" 1, 2
Frequency Notation Standards
Acceptable Abbreviations
- q8h, q12h, q24h: Every 8,12, or 24 hours 1
- BID, TID, QID: Twice, three times, or four times daily 1
- QD: Once daily (though "once daily" is preferred to avoid confusion with QID) 1
Explicit vs Implicit Timing
For critical medications or when adherence is a concern, use explicit timing (e.g., "at 7 AM and 7 PM") rather than implicit intervals (e.g., "every 12 hours"), as explicit instructions improve patient understanding. 3
Duration Specification
Always include treatment duration on the prescription: "7-10 days" or "continue for at least 2 days after signs and symptoms resolve" 1, 4
For infections requiring extended therapy, specify: "≥6 weeks" for osteomyelitis or "4-6 weeks" for complicated bacteremia 1, 5
Route-Specific Considerations
Intravenous Administration
Specify infusion time for IV medications: "Ceftriaxone should be administered intravenously by infusion over a period of 30 minutes, except in neonates where administration over 60 minutes is recommended" 4
Intramuscular Injections
For IM dosing, note injection technique: "Inject well within the body of a relatively large muscle; aspiration helps to avoid unintentional injection into a blood vessel" 4
Common Pitfalls to Avoid
Never write doses without specifying the maximum adult dose for pediatric patients, as this is the most common source of overdosing errors. 1
Do not use ambiguous abbreviations like "U" for units (write "units"), "μg" (write "mcg"), or trailing zeros (write "5 mg" not "5.0 mg"). 1
Avoid writing only the per-dose amount without frequency (e.g., "500 mg" alone is incomplete; write "500 mg PO q8h"). 1, 6
For weight-based dosing, always verify the calculated dose does not exceed the standard adult maximum, particularly for antibiotics where pediatric per-kilogram doses often exceed adult total daily doses. 1