Abstract

BackgroundAdequate asthma treatment of childhood exacerbations with IV aminophylline depends on appropriate dosage. Recommendations to aim for a target therapeutic range may be inappropriate as serum concentrations correlate poorly with clinical improvement. This review aims to evaluate the evidence for the optimum dosage strategy of intravenous aminophylline in children suffering an exacerbation of asthma.MethodsA systematic review comparing dosage regimens of intravenous aminophylline in children suffering an exacerbation of asthma. Primary outcomes were time until resolution of symptoms, mortality and need for mechanical ventilation. Secondary outcomes were date until discharge criteria are met, actual discharge and adverse effects.Data sourcesCENTRAL, CINAHL, MEDLINE and Web of Science. Search performed in March 2016Eligibility criteriaStudies using intravenous aminophylline in children with an acute exacerbation of asthma which reported the dosage and clinical outcomes.Findings14 RCTs were included. There is a poor relationship between the dosage administered to children and symptom resolution, length of stay or need for mechanical ventilation. This study is limited due to its use of indirect evidence.ConclusionThe currently recommended dosage regimens may not represent the optimum safety and efficacy of intravenous aminophylline. There is a need to develop the evidence base correlating dosage with patient centered clinical outcomes, to improve prescribing practices.

Highlights

  • Intravenous aminophylline can be used to manage exacerbations of asthma in children who do not respond to first line inhaled/nebulised therapy [1]

  • This review aims to evaluate the evidence for the optimum dosage strategy of intravenous aminophylline in children suffering an exacerbation of asthma

  • A systematic review comparing dosage regimens of intravenous aminophylline in children suffering an exacerbation of asthma

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Summary

Introduction

Intravenous aminophylline can be used to manage exacerbations of asthma in children who do not respond to first line inhaled/nebulised therapy [1]. Aiming for a target serum concentration of aminophylline is complicated by its high interindividual variation in clearance rates [11], the reasons for which are poorly understood [12,13,14]. It is not clear whether recommended adjustments of aminophylline dosage based on age, weight, and previous serum drug concentrations [5] optimise its efficacy and safety. Recommendations to aim for a target therapeutic range may be inappropriate as serum concentrations correlate poorly with clinical improvement. This review aims to evaluate the evidence for the optimum dosage strategy of intravenous aminophylline in children suffering an exacerbation of asthma

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