The original article can be found on: BMJ Umar Ahmed, pharmacist1 2, Nikos Spyridis, consultant in paediatric infectious diseases3 4, Ian C K Wong, professor of paediatric medicines research1 5, Mike Sharland, professor of paediatric infectious diseases3, Paul F Long, senior lecturer in pharmacognosy1 6 on behalf of the improving Children’s Antibiotic Prescribing UK Research Network (iCAP)
- Correspondence to: P F Long paul.long@kcl.ac.uk
The improving Children’s Antibiotic Prescribing UK Research Network thinks it’s time to abandon this historical rule of thumb
The penicillins have been the most important antibiotics used in children for over 50 years. As well as combating the rapid emergence of penicillinase producing bacteria, the development of penicillin derivatives in the 1950s and 1960s allowed oral dosing, removing the need for painful intramuscular injections. Penicillin V, flucloxacillin, and amoxicillin account for nearly 4.5 million of the 6 million prescriptions for oral antibiotics given to children in England each year.1
Despite their wide use over many decades, guidance on the correct dose of oral penicillins for children remains confusing. For example, the 2011 summary of product characteristics for Amoxil paediatric suspension in children weighing <40 kg is 40-90 mg/kg/day for all indications,2 whereas recommendations for amoxicillin, penicillin V, and flucloxacillin in the British National Formulary for Children are mostly based on age bands, although weight bands or weight based calculations (mg/kg) are given for some indications. The widely used doses of 62.5 mg or 125 mg are fractions of the adult dose recommended in the British National Formulary (BNF) and are still based on the original dosing principle of a big child=half an adult, small child=half a big child, baby=half a small child⇓ ⇓ ⇓.
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