Medicines experts are calling for a review of the 50-year-old guidelines on prescribing antibiotics to children, warning that the rise in overweight and obese youngsters may mean that some get a less than adequate dose.
While they stress that there is no evidence that children are suffering as a result of under-treatment, they say there should be better guidance than the rule of thumb that has applied for half a century.
Since the 1960s, doctors have worked on the principle that a big child is equal to half an adult, a small child is equal to half a big child and a baby is equal to half a small child, say a group of doctors and scientists in the British Medical Journal.
The problem lies with the prescription of oral penicillin, such as amoxicillin which is widely used against bacterial infections in children. They make up 4.5m of the total 6m annual antibiotic prescriptions for children.
But the dosing guidelines in the doctors' prescribing bible, the British National Formulary for Children (BNFC), are mainly based on age – with an assumption of the likely weight of the child in a certain age band – and children's weight has increased over the decades since the mid-60s when the guidance was formalised.
The BNFC dosing bands are: birth to 1 year (10kg); 2 years (13kg); 5 years (18kg); and 10 years (30kg). However the Health Survey for England 2009 puts the average weight today of a 5-year-old at 21kg and a 10-year-old weighs in at 37kg, which suggests that average weights today are up to 20% higher than in 1963.
If children get less than the dose they need, there is a possibility that their infection will not clear up easily. It also raises the risk of antibiotic resistance developing. If the bug is not successfully eliminated by the antibiotic, it may mutate into a new form that is resistant to the drug – and be passed on to other children.
Dr Paul Long, senior lecturer in pharmacognosy at King's College London, who is one of the authors, said: 'We were surprised at the lack of evidence to support the current oral penicillins dosing recommendations for children, as it is such a commonly used drug. Children's average size and weight are slowly but significantly changing, so what may have been adequate doses of penicillin 50 years ago are potentially not enough today.
"It is important to point out that this study does not provide any clinical evidence that children are receiving sub-optimal penicillin doses that lead to harm, and we want to reassure parents of that. But what we are saying is that we should ensure that children with severe infections who need these antibiotics the most are still receiving an effective dose …
"If we want to be sure that we are treating childhood bacterial infections effectively, the evidence base behind these prescribing guidelines needs to be improved, and the recommended doses reviewed accordingly."
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