Medication errors in the pediatric population occur in both the inpatient and outpatient settings. Pediatric medication errors occur at an approximate rate of 16% of cases in the outpatient setting.1
Many potential medication errors may occur. In this series, I focus on 10 errors that are commonly seen in outpatient clinics. In previous articles, I focused on common errors associated with infant acetaminophen,2 insulin,3 ceftriaxone(Drug information on ceftriaxone),4 and hydralazine(Drug information on hydralazine) and hydoxzyine.5
A 5-month-old boy (weight, 7 kg) presented to the clinic with otitis media. The patient was given a prescription for amoxicillin(Drug information on amoxicillin)/clavulanic acid (Augmentin®, 250 mg/5 mL; 330 mg PO bid x 7 days). After 1 day of taking this medication, the patient started having frequent diarrhea and his parents brought him into the clinic to be seen again.
What’s the problem here?
Discussion
High-dose amoxicillin/clavulanic acid is an appropriate medication for managing otitis media in the pediatric population. The suspension formulation of this medication comes in various concentrations (125 mg/5 mL, 200 mg/5 mL, 250 mg/5 mL, 400 mg/5 mL, and 600 mg/5 mL). Each concentration includes a different amount of clavulanic acid (Table).6
The problem here is that the clinician should have prescribed an Augmentin® product with a concentration that has an amoxicillin to clavulanic acid ratio of 7:1 or higher (200 mg/5 mL, 400 mg/5 mL, or 600 mg/5 mL).6 Diarrhea is a major adverse effect of amoxicillin/clavulanic acid, and the risk is increased tremendously if the amoxicillin to clavulanic acid ratio is lower than 7:1.
This potential medication error can be easily prevented by paying close attention to the amoxicillin to clavulanic acid ratio.
Table. Clavulanic acid content in various Augmentin® concentrations | ||
Augmentin® concentration (mg/5 mL) | Clavulanic acid amount (mg/5 mL) | Amoxicillin to clavulanic acid ratio |
125 | 31.25 | 4:1 |
200 | 28.5 | 7:1 |
250 | 62.5 | 4:1 |
400 | 57 | 7:1 |
600 | 42.9 | 14:1 |
From: Taketomo CK, Hodding JH, Kraus DM. Pediatric Dosage Handbook. 2011.6 | ||
