What is the recommended dose of Syr Maltofer (Iron (III) hydroxide polymaltose) for a 6-month-old baby?

Maltofer Syrup Dosing for 6-Month-Old Infants

Direct Dosing Recommendation

For a 6-month-old infant with iron deficiency anemia, administer Maltofer (iron polymaltose) syrup at 3 mg/kg/day of elemental iron, given between meals for optimal absorption. 1, 2

Treatment Context and Duration

• Treatment duration: Continue iron supplementation for 2 months after hemoglobin normalizes, totaling approximately 3 months of treatment 2, 3
• Timing of administration: Give between meals to maximize absorption, though this may increase gastrointestinal side effects 2, 3
• Follow-up monitoring: Recheck hemoglobin after 4 weeks of treatment; an increase of ≥1 g/dL confirms iron deficiency anemia and indicates treatment is working 1, 2

Prevention vs. Treatment Dosing

For Prevention (Healthy Infants):

• Breastfed term infants: 1 mg/kg/day if complementary foods provide insufficient iron after 6 months 1, 3
• Preterm or low birthweight infants: 2-4 mg/kg/day (maximum 15 mg/day) starting at 1 month of age 1, 3

For Treatment (Iron Deficiency Anemia):

• All infants with confirmed IDA: 3 mg/kg/day regardless of feeding method 1, 2

Practical Calculation Example

For a 6-month-old weighing 7 kg with iron deficiency anemia:

• Daily dose: 7 kg × 3 mg/kg = 21 mg elemental iron per day 1, 2
• Maltofer syrup concentration: Check product label (typically 10 mg/mL elemental iron)
• Volume needed: Approximately 2.1 mL daily if using 10 mg/mL concentration

Critical Pitfalls to Avoid

• Do not use preventive doses (1 mg/kg/day) for treating confirmed anemia - this underdoses and delays recovery 1, 2, 3
• Avoid giving with milk or calcium-rich foods - these significantly reduce iron absorption 1
• Do not stop treatment when hemoglobin normalizes - continue for 2 additional months to replenish iron stores 2, 3
• Limit cow's milk to <24 oz (720 mL) daily - excessive milk consumption is a leading cause of iron deficiency in this age group 1, 4

Dietary Adjuncts to Enhance Treatment

• Add vitamin C-rich foods (fruits, vegetables, juice) with iron administration to improve absorption 1, 4
• Introduce iron-fortified cereals (2+ servings daily) and pureed meats after 6 months 1, 4
• Ensure adequate complementary foods to address underlying nutritional deficiency 1

When Treatment Fails

If hemoglobin does not increase by ≥1 g/dL after 4 weeks despite compliance:

• Check serum ferritin: ≤15 μg/L confirms iron deficiency; >15 μg/L suggests another cause 1, 2
• Evaluate for other causes: Consider MCV, RDW, and other laboratory tests 1, 2
• Assess compliance: Verify parents are administering medication correctly and consistently 1

Special Considerations for Maltofer

While the provided evidence focuses on ferrous sulfate, iron polymaltose complex (Maltofer) is generally dosed equivalently at 3 mg/kg/day for treatment of iron deficiency anemia 1, 2. The polymaltose formulation may have better gastrointestinal tolerability compared to ferrous sulfate, though the therapeutic dose remains the same for treating confirmed anemia.