Amoxicillin dosing in newborns

[crossurfingers]

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All the sources that I have looked into state that the maximum is 30mg/kg/day. A doctor writes a script for an 8 pound 2 week old baby for Amoxicillin 250mg/5ml- 1/2 teaspoon po BID for 10 days. We verified the dose with the doctor, who said yes, they do use 80mg/kg/day even for someone that young. Would you feel comfortable dispensing that even with the doctor's ok?

 

[ItsOverZyvox]

Yup... 70mg-80mg/kg is needed to attain high enough level for otitis media or pneumonia in children. The pediatrician knows what he/she is doing.

Amox is a safe drug any ways.

 

[crossurfingers]

So you don't think there's any need to go with the 30mg/kg/day dose listed for newborns due to the differences in drug clearance? I know that I've seen 80mg/kg/day, just not given for newborns.

 

[ItsOverZyvox]

So you don't think there's any need to go with the 30mg/kg/day dose listed for newborns due to the differences in drug clearance? I know that I've seen 80mg/kg/day, just not given for newborns.

I know my comfort level and I know why 30mg/kg/day doesn't work. You tell me why high dose Amox is bad for this patient? Also, have you looked beyond your traditional drug info...PI, PDR, Lexi.. and actually looked up high dose Amox in Neonates?

 

[VCU07]

All the sources that I have looked into state that the maximum is 30mg/kg/day. A doctor writes a script for an 8 pound 2 week old baby for Amoxicillin 250mg/5ml- 1/2 teaspoon po BID for 10 days. We verified the dose with the doctor, who said yes, they do use 80mg/kg/day even for someone that young. Would you feel comfortable dispensing that even with the doctor's ok?

The percent of this dose actually swallowed and absorbed should be low...

 

[ItsOverZyvox]

The percent of this dose actually swallowed and absorbed should be low...

What if it was Ampicillin 80mg/kg IV?

 

[VCU07]

What if it was Ampicillin 80mg/kg IV?

Reasonable.

 

[ItsOverZyvox]

so, playing devil's advocate, if I'm the prescribing pediatrician in a busy practice, I get paged from a local pharmacist who refuses to fill the script, how do I respond? Will I have enough patience to educate the pharmacist or intern or will I just yell, "Fill it as written!!"

 

[VCU07]

so, playing devil's advocate, if I'm the prescribing pediatrician in a busy practice, I get paged from a local pharmacist who refuses to fill the script, how do I respond? Will I have enough patience to educate the pharmacist or intern or will I just yell, "Fill it as written!!"

I can understand the MD being pissed, but it's about education. I've made mistakes as a pharmacist (as a new Pharmacist I have been very stubborn and by the book as well), I think we all have, but I learn from them and apply for the next time a similar situation comes up.

 

[Old Timer]

so, playing devil's advocate, if I'm the prescribing pediatrician in a busy practice, I get paged from a local pharmacist who refuses to fill the script, how do I respond? Will I have enough patience to educate the pharmacist or intern or will I just yell, "Fill it as written!!"

Depends on how the pharmacist calls... If the call is just to question the dose, most docs will take the time to educate. If it's a "I'm not filling it, cause your overdosing you *****... you get the fill it ass-hole answer, well because the pharmacist is an ass-hole....

 

[ItsOverZyvox]

Depends on how the pharmacist calls... If the call is just to question the dose, most docs will take the time to educate. If it's a "I'm not filling it, cause your overdosing you *****... you get the fill it ass-hole answer, well because the pharmacist is an ass-hole....

Good answer.