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Increased Dosage Requirements in Children

Darwin E. Zaske, PharmD; Kenneth W. Miller, PhD; Edward L. Strem, MD; Sol Austrian, MD; Paul B. Johnson, MD

JAMA. 1977;237(14):1453-1455.

Abstract
While monitoring oral aminophylline (theophylline ethylenediamine) therapy, larger doses (milligrams per kilogram) were necessary for children than for adults to achieve similar therapeutic serum levels. The mean apparent theophylline clearance (ATC) determined in 59 children was significantly higher (P <.001) than determined in 114 adults (84.8 versus 51.4 ml/hr/kg). Additionally, the younger children (1 to 9 years) eliminated theophylline more rapidly than the older children (10 to 18 years) (93.8 versus 77.3 ml/hr/kg). When initiating continuous oral aminophylline therapy, dosage guidelines, based on the mean ATC calculated for each group, were predicted, and trough theophylline serum levels of 10µg/ml were obtained. The guidelines for aminophylline were 28.0, 23.2, and 15.6 mg/kg/day administered in four divided doses for the younger children, older children, and adults, respectively. Monitoring of serum levels is suggested to further individualize the patient's aminophylline therapy.

(JAMA 237:1453-1455, 1977)

Author Affiliations
From the Clinical Pharmacokinetics Lab, College of Pharmacy, University of Minnesota (Drs Miller and Zaske), and the University of Minnesota School of Medicine (Drs Strem, Austrian, and Johnson), Minneapolis; and the Pediatric Allergy Clinic, Department of Pediatrics (Drs Strem and Austrian) and the Pulmonary Division, Department of Internal Medicine (Dr Johnson), St Paul Ramsey Hospital, St Paul.

Footnotes
Read in part before the American Academy of Pediatrics, Section on Allergy, Washington, DC, Oct 20, 1975.

Reprint requests to St Paul Ramsey Hospital, 640 Jackson St, St Paul, MN 55101 (Dr Zaske).

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