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Background

Pediatric patients with renal impairment have a higher risk of medication errors and adverse events associated with dosing errors in drug prescription than pediatric patients with normal renal function. In addition to age-related changes, impaired kidney functions in children affect the pharmacokinetic profile of drugs. Furthermore, many authorized drugs are neither tested nor authorized for use in children with renal impairment.

Aim

The purpose of this study was to examine how pediatric drug formularies manage pediatric renal dosing information and to examine the evidence behind dosing recommendations. The secondary purpose of this study was to compare how different pediatric drug formularies present other relevant drug information.

Methods

A descriptive study of 57 drugs containing recommendations for pediatric patients with renal impairment was reviewed and evaluated in the product monographs, national and international pediatric drug formularies.

Results

In the product monograph eight drugs (14%) had renal dosage recommendations. In the national drug formulary (ePed) had renal dosage recommendations for five drugs (8%) and in the international drug formularies had renal dosage recommendations for 11-38 drugs (19-66%). Adults renal dosing recommendations were the primary sources for pediatric renal dosing information. Literature reports regarding drug dosing in pediatric patients with renal impairment found in the references were case-control and retrospective or prospective pharmacokinetics studies. In most studies that were conducted grading the level of evidence, the rating became a very low quality of evidence. The national drug formulary contained other relevant drug information such as reconstitution and preparation for drugs.

Conclusion

There is a need for more pediatric-specific studies to improve dosage guidelines for pediatric patients with renal impairment.