Dosing OTC Pediatric Meds

It’s been about a month or so that various OTC infant cold-allergy manufacturers [semi-]voluntarily recalled their products in light of dosing mismanagment. Our little one has never had any OTC medication from these recalled “infant” products, so I don’t have any experience with them. In addition, I can’t get my hands on any of the products now that they’ve been recalled to see what could have caused such problems. I mean, how hard can it be?

Obviously, as a med student with a research science background, I am not the “typical” parent one would use as a case study for following directions, but having used various brands of Tylenol (acetaminophen or paracetamol, if you prefer) for our daughter, significant directions and delivery variations DO exist. In the US, every brand of infant Tyelenol was in a concentration of 80 mg/0.8 ml. Look at that fraction. Some leftover from 5th grade fractions should be ringing about now regarding “same numbers on top and bottom.” (We’ll come back to this in a minute) The same 5th grade education should be telling you that mixing decimals and fractions, while not incorrect, is a no-no–much like leaving a fraction unreduced. Points off, no gold star. Mistake #1: When you’re dealing with…oh, I don’t know…the “lowest common denominator (LCD)” (har har) of society that’s going to read your directions, you might want to clean things up a bit.

“But Rico, nobody but math and science geeks are going to read the concentration.” Well, you got me there, but it’s still odd. Upon opening the box, you’ll find, depending on the brand, either a bottle with a dropper already built into the cap, or a separate lidded bottle (why?) and a separate dropper that you then put together, throwing the perfectly good original lid in the trash. Mistake #2: There are plenty of people who might just keep the two separate, and if they’re do that, they probably aren’t keeping the dropper sealed, away from dust, etc.

If you look at the dropper, you’ll find two markings: 0.4 and 0.8, or just one: 0.8. The dose for 24lbs or 2 years is given on the directions as 1.6 ml. Mistake #3: You’ve assumed that the LCD of the general public can add fractions, much less without a calculator while a feverish, screaming infant is in the background. In my opinion, worse still are the “Only use this dropper with [product]” so that the directions are foolproof, like “Fill dropper to the white line.” Yeah, but what if I have a Robitussin product, a Benadryl product, and a Dimetapp product that all use “special” droppers and all have no other concentration/volume information for dosing purposes on the bottle, not the long-thrown-away box? True, few people outside those in the “import/export” business have graduated cylinders or pipettes at home, but SOME information should be given plainly should that “special” dropper be lost.

We usually have things decently stocked from the US side for basic things since we travel back and forth often (especially my wife). However, we ran out of infant acetaminophen a while ago, and since Claudia was doing the shopping, she didn’t want to have to decide among all the various brands here in Mexico and bought name-brand Tylenol. At first I was shaking my head because she didn’t get a super-easy-to-find generic product, but then I saw the exquisite delivery mechanism.

Behold, friends: pediatric liquid oral dosing perfection:

The plunger is marked on both sides, one being volume and the other weight, for which the volume on the other side corresponds. Also notice the ultra-precise measurement graduations. It certainly doesn’t mean the plastic plunger is that accurate, but it’s nice to look at. Looking at the info, one finds the following concentration: 100 mg/1 ml. Look at the fraction on the US bottle: they’re the same! Except now that we’ve reduced the fraction like good 5th graders, we can make sense of this from any angle without having to multiply and divide decimal fractions. And as a bonus, since this long quasi-syringe and the bottle clearly don’t physically go together, there is a plastic housing for the setup to keep it clean in between uses. Even if I had several products from different brands, if they all had this, it would be trivial to know which ml/kg measured syringe belonged to which because there’s a clearly visible “Tylenol” on the plunger! Score 1 for Mexico. (God knows the way things have been here lately, Mexico could use some bonus points…)

Seriously people, this foolproof delivery system is where it’s at. In the US, pounds would be the unit for the general public, obviously, since asking people to do MORE math–and to use the eeevil metric system–would surely not be good for little livers everywhere. If all the pediatric OTC medicines in the US were to have had something as universal and consistent as this, one wonders if there would have ever been a recall.