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We investigated the pediatric doses of drugs for children aged 2 years to less than 15 years for the following age groups : early childhood (2-5 years),childhood (6-11 years),and puberty (12-14 years).Pediatric dosages indicated in package inserts of renally excreted drugs (vancomycin,fosfomycin,arbekacin,norfloxacin,amoxicillin,and digoxin) were adjusted using three variables : body,body surface area (BSA),and glomerular filtration rate (GFR).It was found that Dose/GFR was a better factor for adjustment than Dose/Body and Dose/BSA because Dose/GFR showed little variation with age during childhood.Based on the ratio between childhood and adult GFR (GFRC/GFRA),we established a formula for calculating the pediatric dose (DC=DA·GFRC/GFRA) and derived linear approximation and second-order approximation equations stratified by gender for clinical application.Compared with the Augsberger equation,these approximation methods produced smaller variations from the dosages indicated in the package inserts for almost all the drugs examined and enhanced predictability.While the linear and second-order approximation equations produced similar results,the former was considered to be more useful in the clinical setting due to its simplicity.The linear equations proposed for males and females in this study are DC ~= DA·(0.054 Age+0.093)and DC ~= DA·(0.062 Age+0.12),respectively.Our new method of estimating pediatric doses may be better than conventional methods (Augsberger,Young,Clark,and Crawford equations,and von Harnack conversion table) because of its compatibility with pharmacokinetic mechanism(s).Conventional methods do not consider drug metabolism/excretion pathways and their physiological variations.

Approximation Method for Estimating Pediatric Doses of Renal-Excretion Drugs Based on Physiological Development of Renal Function