PEDIATRICS Vol. 120 No. 6 December 2007, pp. 1403 (doi:10.1542/peds.2007-2543)
LETTER TO THE EDITOR |
Effectiveness of Trimethoprim/Sulfamethoxazole for Children With Chronic Active Otitis Media
Jamie L. Miller, PharmDBrooke L. Honey, PharmD
Peter N. Johnson, PharmD
Tracy M. Hagemann, PharmD
Department of Pharmacy
Clinical and Administrative Sciences
University of Oklahoma College of Pharmacy
Children's Hospital of Oklahoma
Oklahoma City, OK 73117
To the Editor.—
We have concerns regarding the article by van der Veen et al1 published in the May 2007 issue of Pediatrics. According to the article, the patients in the study received trimethoprim/sulfamethoxazole at a dose of "18 mg/kg, administered orally, 2 times per day." To a reader, this statement is somewhat ambiguous. First, it is difficult to identify if the patients were to receive 18 mg/kg per day in 2 divided doses or 18 mg/kg twice daily, for a total of 36 mg/kg per day. Second, the authors did not indicate if this dose is based on the trimethoprim component, which is commonly accepted in the United States, or the sulfamethoxazole component of the formulation. A typical dose of trimethoprim/sulfamethoxazole for a mild-to-moderate infection is 8 to 12 mg/kg per day in divided doses every 12 hours, based on the trimethoprim component.2 If one were to interpret the dosing used in this study to be based on the trimethoprim component, the patient would receive doses comparable or greater to those for treatment of Pneumocystis jiroveci pneumonia (15–20 mg of trimethoprim per kg per day)3 depending on how the regimen is interpreted by the reader.
We believe this dose should be clarified, for concerns that some patients may receive an inappropriately high dose for 6 to 12 weeks of treatment, which would expose them to numerous adverse effects such as hyperkalemia, anemia, thrombocytopenia, and leukopenia.4
FOOTNOTES
Statements appearing here are those of the writers and do not represent the offcial position of the American Academy of Pediatrics or its Committees. Comments on any topic, including the contents of PEDIATRICS, are invited from all members of the profession; those accepted for publication will not be subject to major editorial revision but generally must be no more than 400 words in length. The editors reserve the right to publish replies and may solicit responses from authors and others.
Please see www.pediatrics.org for instructions on submitting letters.
REFERENCES
- van der Veen EL, Rovers MM, Albers FW, Sanders EA, Schilder AG. Effectiveness of trimethoprim/sulfamethoxazole for children with chronic active otitis media: a randomized, placebo-controlled trial.
Pediatrics. 2007;119
:897
–904
[Abstract/Free Full Text] - American Academy of Pediatrics. Antibacterial drugs for pediatric patients beyond the newborn period. In: Pickering LK, Baker CJ, Long SS, McMillan JA, eds. Red Book: 2006 Report of the Committee on Infectious Diseases. 27th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2006:762
- American Academy of Pediatrics. Drugs for parasitic infections. In: Pickering LK, Baker CJ, Long SS, McMillan JA, eds. Red Book: 2006 Report of the Committee on Infectious Diseases. 27th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2006:810
- Sulfamethoxazole/trimethoprim [package insert]. Baltimore, MD: Actavis MidAtlantic; 2006
PEDIATRICS (ISSN 1098-4275). ©2007 by the American Academy of Pediatrics
CiteULike 
Connotea 
Del.icio.us 
Digg 
Facebook 
Reddit 
Technorati 
Twitter What's this?
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
