DOSE REQUIREMENTS

Dose Requirements

Medication doses often are based on the body weight of neonates, infants, and children, for example, milligrams per kilogram of body weight per day to be given in one or more portions daily.

However, certain drugs, including antineoplastic agents, may be given based
on body surface area, example-milligrams per square meter in 1 or more doses daily. 

In either case, the total amount of weight-
or surface area-based individual or daily dose in a pediatric patient, especially an adolescent, should not exceed the amount of drug indicated in an adult patient.

A challenge in managing pediatric drug therapy is to understand the effects of obesity on a population that relies on
weight-based dosing.

According to the Centers for Disease Control
and Prevention, the prevalence of overweight and obese children in
the United States nearly doubled from 15% during 1976 to 1980 to more than 30% during 1999 to 2002.

Using ideal body weight versus total body weight to calculate a weight-based dose or to determine body surface area can result in a large variance in obese patients.

Pharmacokinetic studies needed to study the effects of obesity on drug distribution, protein binding, and clearance and to identify whether dosing should be adjusted according to total body weight or ideal body weight to achieve consistent drug exposure for individual drugs.

Additionally, the highest drug dose recommend for a child is the maximum dose approved for adults.

However, determining the highest dose of certain drugs for use in children without a known maximum dose for adults
(e.g, intravenous immunoglobulin, infliximab, rituximab, and liposomal
amphotericin B [AmBisome]) can be difficult.

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