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Epinephrine Dosing for Small Children

Epinephrine autoinjectors are available in 0.15 mg and 0.3 mg doses. Which dose should be administered when anaphylaxis is recognized in a child who weighs less than 7.5 kg?

a. 0.15 mg

b. 0.3 mg

c. neither

d. either

Answer: a

Epinephrine is the medication of choice for the initial treatment of anaphylaxis and should be administered immediately in stricken patients, according to an updated clinical repot recently issued by the American Academy of Pediatrics (doi:10.1542/peds.2016-4006).

All other medications, including H1-antihistamines and bronchodilators, provide adjunctive treatment but do not replace epinephrine as the first-line treatment option, said the report. Epinephrine autoinjectors (EAs) are available in 2 doses: 0.15 mg and 0.3 mg. EA manufacturers advise prescribing the 0.15 mg dose to patients weighing 15 to 30 kg and the 0.3 mg dose for kids weighing 30 kg and over.

These dosing recommendations aren’t optimal for all children, however. For example, should infants and young children weighing less than 7.5 kg receive the 0.15 mg dose, which is twice the recommended amount for their size? The report noted that international guidelines recommend use of the 0.15 mg dose for patients weighing 7.5 to 25 kg and, according to expert consensus, it’s appropriate to switch children to the 0.3 mg dose when they weigh 25 kg to 30 kg.

Dr. Scott Sicherer, a professor of pediatrics and immunology at Mount Sinai Hospital in New York City and co-author of the report, said epinephrine is the primary treatment of anaphylaxis because it supports breathing and blood circulation to provide relief of allergic reactions before the patient can get to an emergency department (ED) for more care.

Other allergy medications do not treat breathing and blood circulation, noted Dr. Sicherer. He said ED physicians and pharmacists are positioned to educate patients and their families about anaphylaxis care, prescribe autoinjectors, and refer patients to an allergist.

The report noted that when anaphylaxis occurs in health care settings, providers should administer intramuscular injections in the mid-outer thigh of epinephrine 0.01 mg/kg with a maximum dose of 0.3 mg in a prepubertal child and up to 0.5 mg in teenagers.

—Dan Cook

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