Many medicines used in children
are not licensed for such use. This does not mean that they should not be used,
but that the pharmaceutical com-pany has not sought a license from the
regulatory authorities. Hence, many medicines in children are used off label, i.e. they are used at a
dif-ferent dose, route, age, or indication than specified within the product
license. It is important that medicines are used in children in relation to the
scientific evidence available. In certain circumstances this may involve off
label use.
Certain diseases, e.g. cystic
fibrosis, or clinical conditions, e.g. shock, may affect drug metabolism. Both
liver and renal failure delay drug elimination, and so require dosage
reduction.
Most medicines taken by a
breastfeeding mother are safe for her infant. Mothers should not be discouraged
from breastfeeding because of uncer-tainty about possible toxic effects. The British National Formulary (BNF) for
children gives detailed information regarding
which medicines to avoid.1
Medication errors are a
significant problem in children. In particular, ten-fold errors have been associated with significant mortality and
morbidity, especially in the very
young. All health professionals will
commit a medica-tion error during their career! Medication errors include:
•
Incorrect dose: commonest error and also the type
most likely to be associated with a
fatality. Knowledge of the child’s actual weight and checking of dose
calculation is vital, especially on the neonatal unit and with parenteral
medicines.
•
Incorrect drug: second most common type of error
and also associated with significant
fatalities.
•
Incorrect route: this is a particular problem with
IT drugs. This is a procedure for
specialists and great care should be taken when drugs are to be given this way!
Other
errors: include incorrect
rate of administration, duplicate dosing,
and administration of the drug to the wrong patient.
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