Pediatric Dose Verification by Weight

Scenario

A provider orders Amoxicillin 400 mg PO q8h for a 20 kg child.
Pharmacy dispenses 50 mg/mL suspension.

Question: Verify the dose is within a safe weight-based range, determine the volume to administer, and outline nursing safety checks before the first dose.

Best Practice Answer

1) Verify a safe, weight-based range (say your math out loud)

• Common amoxicillin ranges (non-severe infections): 40–90 mg/kg/day, divided doses.
• Calculate daily range for 20 kg:
  • Low end: 20 kg × 40 = 800 mg/day
  • High end: 20 kg × 90 = 1800 mg/day
• Ordered regimen is 400 mg q8h → 3 doses/day → 1200 mg/day total.
  Conclusion: 1200 mg/day is within 800–1800 mg/day → dose is acceptable.

If the clinical picture suggests severe infection (e.g., AOM with risk factors), many institutions target the higher end of the range (80–90 mg/kg/day). Use your clinical context to decide whether escalation is warranted, but as written this order is safe and reasonable.

2) Convert milligrams to milliliters (right device matters)

• Concentration: 50 mg/mL
• Per dose volume = 400 mg ÷ 50 mg/mL = 8 mL
• Administer 8 mL every 8 hours using an oral syringe (not a kitchen spoon).

3) Pre-administration nursing safety checks

• Allergy screen: Confirm no penicillin/β-lactam allergy; if history unclear, clarify before giving.
• Indication & severity: Ensure the diagnosis matches spectrum; if severe disease suspected and this is a low-range plan, clarify with provider.
• Renal considerations: If known renal impairment, verify dose interval/amount with provider/pharmacy.
• Drug form & measuring tool: Verify 50 mg/mL suspension is what’s dispensed; provide a marked oral syringe and teach-back.
• Shake & storage: Instruct caregivers to shake well before each dose; confirm storage instructions (many suspensions require refrigeration after reconstitution—follow local policy/label).
• Scheduling & adherence: q8h means consistent spacing (e.g., 06:00 / 14:00 / 22:00). Align with family routine when possible.
• GI tolerance: Give with food if stomach upset occurs (unless otherwise directed); monitor for diarrhea, rash, or yeast overgrowth.
• When to call back: Worsening fever, breathing difficulty, hives/facial swelling, severe diarrhea, or poor intake → stop and seek care; educate caregivers explicitly.

4) Documentation & communication

• Record dose, time, volume (mL), lot if required, patient response, and teaching provided (including syringe use and spacing of doses).
• If dosing differs from typical high-dose guideline for the condition at hand, note provider rationale or your clarification.

Quick Math Recap (state this concisely in interviews)

• Range: 40–90 mg/kg/day × 20 kg = 800–1800 mg/day
• Order: 400 mg q8h → 1200 mg/day ✅ within range
• Volume: 400 mg ÷ 50 mg/mL = 8 mL per dose

Tip: In interviews, narrate your math and the five medication rights + allergy check + device teaching. That combination is what hiring panels want to hear in pediatrics.