peds dosing questions

[badasshairday]

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My GF is working on an assignment for school and she thinks her assignment is hinting at dosing a chewable form of Amox for a kid with strep pharyngitis. The question stipulates that the kid (37kg) doesn't like to swallow pills, liquids make him gag, but he does take a chewable vitamin qday.

I'm thinking, just give the kid pennacillin 0.9million units IM x1 and be done with it. But she thinks she should use a chewable.

EDIT:
Actually I think we found chewable form on Epocrates. So since the kid is 37kg, and the dose is 50mg/kg qday, he would need 1850mg qday. But the max does states it is 1000mg/dose. So would we dose it 900mg bid to get close to 1850mg qday, or just do straight 1000mg qday since this is the max "dose."

Argh! There are only 125, 200, 250, 400mg doses forms. So it would be 4 tabs of 250mg CHewable PO bid. This would be 1000mg two times a day. Does that sound right? Or is 2 tabs of 400mg CH PO bid for a total of 1600mg per day despite needing 1850mg per day?

I guess I'm confused about qday vs. q24 hr. q24 hr means you can only give the med 1x per day. But if it says qday, can we break it up to bid/tid/qid/etc?

 

[turkeyjerky]

wtf kind of assignment is this? I say give the kid the shot--if he wants to play hardball, you gotta play it too. Or you could just mix the liquid in w/ pudding or applesauce or something. God, this reminds me of why I hated peds so much.

 

[werd]

yeah this seems like a weird assignment. the best answer is don't sweat the details. treatment dose amox for adults is 1500-2000mg/day, so this kid will basically get adult dosing (really a higher mg/kg than adults get). use four 250's bid or two 400's bid. also, the reason many kids get amox instead of penicillin for strep throat is bc it tastes good. even if this kid "gags on liquids" many kids like the taste of amox liquid. werd.

 

[OveractiveBrain]

I guess I'm confused about qday vs. q24 hr. q24 hr means you can only give the med 1x per day. But if it says qday, can we break it up to bid/tid/qid/etc?

If it says "qDay" it means "once per day" not "you can break it up as you like." That is simple pharmacology. The dose is designed to be taken, get through first pass liver metabolism, peak and stay there until the next dosing. Breaking up a "qDay dose" into "multiple-times-a-day dose" may actually equal NO DRUG in the system (first-pass metabolism) or NO EFFECT (metabolism exceeds dosing to reach a therapeutic level).

q24hrs is a super specific way of saying "this drug absolutely needs to be given at 804 am every day" while qDay says "so long as this guy gets his meds between 6am and 9am, along with all the other pills hes taking, that's fine."

They both REALLY mean the same thing, though you can use the 24hr designation to convey to nursing that it is scheduled (like vanc dosing q12 hrs, not biD). Beyond that biD = q12, Qday = q24, tid = q8, qiD = q6 for any realistic purpose. If you want to convey that severity of medication administration or that this person HAS GOT TO GET IT AT THIS HOUR, you should probably just tell them...

 

[badasshairday]

If it says "qDay" it means "once per day" not "you can break it up as you like." That is simple pharmacology. The dose is designed to be taken, get through first pass liver metabolism, peak and stay there until the next dosing. Breaking up a "qDay dose" into "multiple-times-a-day dose" may actually equal NO DRUG in the system (first-pass metabolism) or NO EFFECT (metabolism exceeds dosing to reach a therapeutic level).

q24hrs is a super specific way of saying "this drug absolutely needs to be given at 804 am every day" while qDay says "so long as this guy gets his meds between 6am and 9am, along with all the other pills hes taking, that's fine."

They both REALLY mean the same thing, though you can use the 24hr designation to convey to nursing that it is scheduled (like vanc dosing q12 hrs, not biD). Beyond that biD = q12, Qday = q24, tid = q8, qiD = q6 for any realistic purpose. If you want to convey that severity of medication administration or that this person HAS GOT TO GET IT AT THIS HOUR, you should probably just tell them...

Right, but for this situation it says max dose of 1000mg/dose, but the it should be dosed at 50mg/kg qday. The kid needs 1850mg based on his weight of 37kg. As suggested above, we should give 2 tabs of 400mg bid or else we would be going over the max dose if we gave it qday.

 

[OveractiveBrain]

I guess I'm confused about qday vs. q24 hr. q24 hr means you can only give the med 1x per day. But if it says qday, can we break it up to bid/tid/qid/etc?

I only answered this question.

 

[Rendar5]

Shot of bicillin up the butt or give him an adult dose since he's greater than 30kg (though in the case of amox, kids reach adult dosing by 20kg). Standard adult dose is 800mg BID. or if you've got something like augmentin 875mg BID is a common dose. Don't ask me why pharmacists picked such an arbitrary number.