Pediatric drugs commonly involved in drug errors

According to The Joint Commission, the rate of medication errors for pediatric and adult inpatients is similar, but potentially harmful errors occur almost three times as frequently in children. One of the most common errors that occur in hospitalized children is administering the incorrect pediatric dosage. Here are some of the medications most commonly involved in medication errors as reported to the national voluntary medication error reporting system, MEDMARX, with their FDA-approved dosages.
 

Medication	Indication	Route	Usual dosage
albuterol sulfate	Bronchospasm in children with reversible obstructive airway disease	PO (immediate-release tablets and extended-release tablets)	Children older than age 12: Initially, 2 or 4 mg (immediate-release tablets) PO t.i.d. or q.i.d. If patient fails to respond, may increase dosage to maximum of 8 mg PO q.i.d. Or, 8 mg (extended-release tablets) PO every 12 hours. If patient fails to respond, increase dosage cautiously to maximum of 16 mg PO every 12 hours. Children ages 6 to 12: Initially, 2 mg (immediate-release tablets) PO t.i.d. or q.i.d. May increase dosage cautiously, but total daily dosage shouldn’t exceed 24 mg/day (given in divided doses). Or, 4 mg (extended- release tablets) PO every 12 hours. If control of reversible airway spasm isn’t achieved with optimized asthma therapy, may cautiously increase dosage to maximum of 12 mg PO every 12 hours.
	Bronchospasm in children with reversible obstructive airway disease	PO (syrup)	Children older than age 14: Initially, 2 mg (1 tsp) or 4 mg (2 tsp) PO t.i.d. or q.i.d. If patient fails to respond, may cautiously increase to maximum of 8 mg PO q.i.d. Children ages 6 to 14: Initially, 2 mg (1 tsp) PO t.i.d. or q.i.d. If patient fails to respond, dosage may be increased to maximum of 24 mg/day given in divided doses. Children ages 2 to younger than 6: Initially, 0.1 mg/kg PO t.i.d. Initial dose shouldn’t exceed 2 mg (1 tsp) PO t.i.d. If patient fails to respond, may increase dosage to 0.2 mg/kg PO t.i.d. Maximum dosage is 4 mg (2 tsp) PO t.i.d.
cefTRIAXone sodium	Acute bacterial otitis media in children younger than age 12	IM	Children: Give single dose of 50 mg/kg IM. Maximum dosage is 1 g.
	Serious infections (including skin and skin-structure infections) other than meningitis	IV infusion over at least 30 minutes or IM	Children: 50 to 75 mg/kg IM or IV once daily or in divided doses every 12 hours. Continue for at least 2 days after signs and symptoms of infection have disappeared. Usual duration of therapy is 4 to 14 days. Maximum dosage is 2 g/day.
	Meningitis	IV infusion over at least 30 minutes or IM	Children: Initially, 100 mg/kg (not to exceed 4 g) IM or IV. Thereafter, give total daily dose of 100 mg/kg/day IM or IV for 7 to 14 days. Maximum dosage is 4 g daily. Daily dose may be administered once a day or in equally divided doses every 12 hours.
fentaNYL	To manage persistent, chronic pain only in opioid-tolerant patients (children receiving, for 1 week or longer, at least 60 mg/day of morphine PO or an equianalgesic dose of another opioid)	Transdermal	Children ages 2 and older: When converting to transdermal system, base first dose on the daily dose, potency, and characteristics of the current opioid therapy; reliability of the relative potency estimates used to calculate the needed dose; degree of opioid tolerance; and patient’s condition. It’s preferable to underestimate patient’s 24-hour fentanyl requirements and provide rescue medication than to overestimate the 24-hour fentanyl requirements, which could result in adverse reactions. Each patch is worn for 72 hours; dosage may be increased 3 days after first dose and then no sooner than every 6 days thereafter.
gentamicin sulfate	Serious infections caused by sensitive strains of Pseudomonas aeruginosa, Escherichia coli, Proteus, Klebsiella, Serratia, or Staphylococcus	IV infusion over 30 minutes to 2 hours or IM	Children: 2 to 2.5 mg/kg IV or IM every 8 hours, usually for 7 to 10 days. Infants and neonates: 2.5 mg/kg IV or IM every 8 hours, usually for 7 to 10 days. Premature or full-term neonates age 1 week or younger: 2.5 mg/kg IV or IM every 12 hours, usually for 7 to 10 days.
heparin sodium (unfractionated)	Thrombosis	IV	According to prescribing information, there are no adequate and well-controlled studies on heparin use in children. In general, the following dosage schedule may be used as a guideline: Children: Initially, 75 to 100 units/kg IV bolus over 10 minutes, followed by continuous IV infusion of 25 to 30 units/kg/hour (infants) or 18 to 20 units/kg/hour (children older than age 1). Adjust dosage to maintain PTT of 60 to 85 seconds, assuming this reflects an anti-factor Xa level of 0.35 to 0.70. Refer to current clinical practice guidelines for additional information.
vancomycin	Treatment of serious or severe infections caused by susceptible strains of methicillin-resistant (betalactam-resistant) staphylococci	IV	Children age 1 month and older: 10 mg/kg/dose IV every 6 hours. Administer over at least 60 minutes. Individualize dosage and frequency based on serum concentrations. Neonates: Initially, 15 mg/kg IV, followed by 10 mg/kg IV every 12 hours for neonates in the first week of life and every 8 hours thereafter up to the age of 1 month. Administer over 60 minutes. In premature infants, longer dosing intervals may be necessary.
	CDAD or  staphylococcal enterocolitis	PO	Children: 40 mg/kg/day PO in three or four divided doses for 7 to 10 days. Maximum dosage is 2 g/day.

 

Comerford, K.C. & Durkin, M.T.  (2023). Nursing2023 drug handbook. (43rd edition.) Philadelphia: Wolters Kluwer.