Pediatric dosing--the pharmacist's dilemma.

Several pediatric dosing rules commonly are published in medical and pharmaceutical texts. However, most authorities do not regard these published dosing rules (e.g., Clark's weight rule) to be responsible approaches to pediatric dosing. This study compares the actual doses administered to patients in a 310-bed, university-affiliated, pediatric hospital with the dose calculated for each patient using Clark's weight rule, Clark's surface area rule, Young's age rule, and Shirkey's dosing recommendations. A t test analysis for paired comparisons revealed that the actual dose administered differed significantly from doses calculated, except for doses calculated using Clark's surface area rule. The dosage deviation range was greatest for Clark's surface area rule. This suggests that Clark's surface area rule is also unreliable. Responsible dosing must involve more than the application of commonly published, pediatric dosing calculation rules. Shirkey's recommendations provided the most reasonable approach to pediatric dosing. However, pharmacists should monitor these patients carefully and recommend dosage adjustments whenever necessary.