Accuracy of acetaminophen dosing in children by caregivers in Saudi Arabia

BACKGROUND AND OBJECTIVES: Fever contributes to a significant number of visits by children to the emergency department (ED), where it is often treated with acetaminophen. The objective of this study was to determine if caregivers give children with fever an accurate dose of acetaminophen and determine factors associated with dosing inaccuracy. DESIGN AND SETTING: Cross-sectional study at the ED of a tertiary referral center over a 6-month period (March-August 2008) METHODS: We interviewed 200 caregivers who gave acetaminophen to children with fever in the preceding 24 hours. RESULTS: Of 200 caregivers, 178 (89%) were included in the study. Seventy-six caregivers (43%) gave an accurate dose of acetaminophen, 54 (30%) gave a subtherapeutic dose, and 48 (27%) gave supratherapeutic doses. Caregivers who gave accurate doses were more likely to give an acetaminophen dose in less than a 4-hour frequency (risk ratio [RR] 0.63. P <. 04, 95% Cl, 0.37-1.07). Patients receiving acetaminophen per rectum had a significantly greater rate of supratherapeutic doses than those receiving the drug by mouth (9/28 [32%] versus 39/149 [26%]), respectively (95% Cl= 0.14 to 0.48). Sixteen caregivers (9%) gave more than five doses per 24 hours (RR, 1.11; 95% Cl, 0.74-1.67). Physicians, pharmacists, and parents (the latter with intermediate and secondary levels education) more often gave inaccurate doses, but the differences were not statistically significant suggesting that they may be the source of inaccurate dosing. (RR, 1.29; 95% Cl, 0.95-1.75), (RR, 1.27 95% Cl, 0.75-2.18), (RR, 1.28; 95% Cl, 0.91-1.79), and (RR, 1.20, 95% Cl, 0.92-1.57), respectively. CONCLUSION: More than half of caregivers gave an inaccurate dose of acetaminophen to children suggesting that education may be valuable in ameliorating this common problem.