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Abstract
Objectives Inaccurate antibiotic dosing can lead to treatment failure, fuel antimicrobial resistance and increase side effects. The British National Formulary for Children (BNFC) guidance recommends oral antibiotic dosing according to age bands as a proxy for weight. Recommended doses of amoxicillin for children were increased in 2014 ‘after widespread concerns of under dosing’. However, the impact of dose changes on British children of different weights is unknown, particularly given the rising prevalence of childhood obesity in the UK. We aimed to estimate the accuracy of oral amoxicillin dosing in British children before and after the revised BNFC guidance in 2014.
Setting and participants We used data on age and weights for 1556 British children (aged 2–18 years) from a nationally representative cross-sectional survey, the Health Survey for England 2013.
Interventions We calculated the doses each child would receive using the BNFC age band guidance, before and after the 2014 changes, against the ‘gold standard’ weight-based dose of amoxicillin, as per its summary of product characteristics.
Primary outcome measure Assuming children of different weights were equally likely to receive antibiotics, we calculated the percentage of the children who would be at risk of misdosing by the BNFC age bands.
Results Before 2014, 54.6% of children receiving oral amoxicillin would have been underdosed and no child would have received more than the recommended dose. After the BNFC guidance changed in 2014, the number of children estimated as underdosed dropped to 5.8%, but 0.5% of the children would have received too high a dose.
Conclusions Changes to the BNFC age-banded amoxicillin doses in 2014 have significantly reduced the proportion of children who are likely to be underdosed, with only a minimal rise in the number of those above the recommended range.
- Amoxicillin
- Oral Penicillin
- Children
- Antibiotic Dosing
- Age bands
- British National Formulary
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Footnotes
Contributors SS conceptualised and designed the study. OR carried out the initial analysis and drafted the initial manuscript. SS, AAL and AB coordinated data collection and supervised data analysis. All authors (SS, OR, MS, PL, ICKW, AAL, AB, CIB, JB) critically reviewed and revised the manuscript and approved the final manuscript as submitted.
Funding SS was funded by National Institute for Health Research (Career Development Fellowship CDF-2011-04-048). This study presents independent research funded by the National Institute for Health Research (NIHR). The views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. AB is part funded by Dr Foster, a Telstra Health company providing healthcare information. CIB was funded as a Clinical Research Fellow by the Global Research in Paediatrics Network of Excellence (GRiP), part of the European Union’s Seventh Framework Programme for research, technological development and demonstration (FP7/2007–2013, Grant Agreement Number 261060). The sponsors of the study had no role in study design, data collection, data analysis, data interpretation or writing the report. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement No additional data available.