Abstract
The present study was conducted to evaluate the utilization of Clark's, Salisbury and Penna's rules and the Body Surface Area (BSA) formula for calculation of pediatric drug dosage, as well as their reliability and viability in the clinical use. These rules are frequently cited in the literature, but much controversy still exists with regards to their use. The pediatric drug dosage was calculated by utilization of the aforementioned rules and using the drugs Paracetamol, Dipyrone, Diclofenac Potassium, Nimesulide, Amoxicillin and Erythromycin, widely employed in Pediatric Dentistry. Weight and body surface areas were considered of children with ages between 1 and 12 years old as well as the dosage for the adult. The pediatric dosages achieved were compared to the predetermined dosages in mg kg-1 herein-named standard dosages. The results were submitted to the parametric test ANOVA and to the Tukey test (p<0,05). The antibiotics and Diclofenac provides acceptable utilization of the rules in pediatric dentistry, however for the Dipyrone, the dosages obtained by the rules suggest their clinical ineffectiveness. For the Paracetamol, the Penna's rule and the BSA formula should not be clinically employed, especially for children between 1 and 5 years old, once such dosages were much close to the hepatotoxic dosage of the drug. It can be concluded that the use of the rules for safe calculation of the pediatric drug dosage is possible and it depends on the used drug and age group.
Highlights
The most important aspect for selection of a drug and establishment of the proper pediatric dosage is the acknowledgment that the pediatric patient is not just a small adult
The Salisbury rule provides dosages within the safe range, close to those recommended by the British National Formulary (BNF), and less prescription mistakes may be expected with its utilization
As regards to Diclofenac, the drug dosages obtained by the Body Surface Area (BSA) formula that would be employed for control of inflammation in the pediatric patient are higher than the therapeutic standard dosage recommended and did not exceed the ideal maximum dosage of 2mg kg-1,15, in groups 1 and 2
Summary
The most important aspect for selection of a drug and establishment of the proper pediatric dosage is the acknowledgment that the pediatric patient is not just a small adult. Dosages based on the body weight are believed to be insufficient for the achievement of proper serum concentration of most drugs, being the body surface the most valid basis for dosage, since it is related to some physiological functions that account for the differences in pharmacokinetics in patients of different ages[2,13,21]. The Salisbury rule provides dosages within the safe range, close to those recommended by the British National Formulary (BNF), and less prescription mistakes may be expected with its utilization This rule is closely related to the Body Surface Area, as desirable, and has the further advantage of easier and more reliable calculation[8]. Marcondes[10] suggests better results with utilization of the rule empirically established by Penna, which follows the body surface It is employed at the Children’s Institute (Sao Paulo, SP, Brazil). The present study was performed with a view to evaluate the reliability and possibility of clinical utilization of the existing rules, both by specialists and by dental professionals that occasionally assist children
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