Abstract
Pediatricians in Africa requested a tool to improve caregiver dosing of liquid antiretroviral medication. We developed, evaluated and disseminated a clip to control the amount of medication drawn into an oral syringe. In a laboratory, a user tested clips of different lengths, corresponding to different volumes, by drawing water into a syringe with a clip. In Texas and Malawi, 149 adults attempted to measure Pepto-Bismol™ using a syringe with a clip, a syringe without a clip, and a dosing cup, in a randomly assigned order. In the laboratory, the volume of liquid, ranging from 1 to 4.5 mL, drawn into the syringe was always within at least 5 μL of the intended dose. In Texas, 84% of doses were accurate within ±10%, vs. 63% using the syringe alone, and 21% with the dosing cup. In Malawi, 98% of doses were accurate to within ±10%, vs. 90% using the syringe alone, and 27% with the dosing cup. For target accuracy values within ±45% (±21%), a significantly higher fraction of Houston (Kamangira) participants delivered an accurate dose using the syringe with the clip than with the syringe alone (p < 0.05). The clip enables a greater proportion of users to accurately measure liquid medication.
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Antiretroviral Drugs for Treating Pregnant Women and Preventing HIV Infection in Infants: Recommendations for a Public Health Approach. World Health Organization. 2010. http://whqlibdoc.who.int/publications/2010/9789241599818_eng.pdf. Accessed November 4, 2012.
Bagenda, A., L. Barlow-Mosha, D. Bagenda, R. Sakwa, M. G. Fowler, and P. M. Musoke. Adherence to tablet and liquid formulations of antiretroviral medication for paediatric HIV treatment at an urban clinic in Uganda. Ann. Trop. Paediatr. 31:235–245, 2011.
Davies, M. A., A. Boulle, T. Fakir, J. Nuttall, and B. Eley. Adherence to antiretroviral therapy in young children in Cape Town, South Africa, measured by medication return and caregiver self-report: a prospective cohort study. BMC Pediatr. 8:34, 2008.
Frush, K. S., X. Luo, P. Hutchinson, and J. N. Higgins. Evaluation of a method to reduce over-the-counter medication dosing error. Arch. Pediatr. Adolesc. Med. 158(7):620–624, 2004.
Gribetz, B., and S. A. Cronley. Underdosing of acetaminophen by parents. Pediatrics 80(5):630–633, 1987.
Guidance for industry: dosage delivery devices for OTC liquid drug products. US Department of Health and Human Services. Food and Drug Administration. Center for Drug Evaluation and Research (CDER). http://www.fda.gov/downloads/Drugs/GuidanceComplianceRegulatoryInformation/Guidances/UCM188992.pdf. Accessed on November 15, 2010.
Haberer, J., and C. Mellins. Pediatric adherence to HIV antiretroviral therapy. Curr. HIV/AIDS Rep. 6:194–200, 2009.
Hawkins, N., and J. Golding. A survey of the administration of drugs to young infants. The Alspac Survey Team. Avon Longitudinal Study of Pregnancy and Childhood. Br. J. Clin. Pharmacol. 40:79–82, 1995.
Hope, A. C. A. A simplified Monte Carlo significance test procedure. J. R. Stat. Soc. B 30:582–598, 1968.
Li, S. F., B. Lacher, and E. F. Crain. Acetaminophen and ibuprofen dosing by parents. Pediatr. Emerg. Care 16(6):394–397, 2000.
Madlon-Kay, D. J., and F. S. Mosch. Liquid medication dosing errors. J. Fam. Pract. 49:741–744, 2000.
Malawi—Statistics. The United Nations Children’s Fund. http://www.unicef.org/infobycountry/malawi_statistics.html. Accessed on November 4, 2012.
McMahon, S. R., M. E. Rimsza, and R. C. Bay. Parents can dose liquid medication accurately. Pediatrics 100(3 pt 1):330–333, 1997.
Mills, E. J., J. B. Nachega, D. R. Bangsberg, S. Singh, B. Rachlis, et al. Adherence to HAART: a systematic review of developed and developing nation patient-reported barriers and facilitators. PLoS Med. 3(11):2039–2064, 2006.
Nahirya-Ntege, P., A. Cook, T. Vhembo, W. Opilo, R. Namuddu, et al. Young HIV-infected children and their adult caregivers prefer tablets to syrup antiretroviral medications in Africa. PLoS ONE 7(5):1–8, 2012.
Oden, M., Y. Mirabal, M. Epstein, and R. Richards-Kortum. Engaging undergraduates to solve global health challenges: a new approach based on bioengineering design. Ann. Biomed. Eng. 38(9):3031–3041, 2010.
Phelps, B. R., and N. Rakhmanina. Antiretroviral drugs in pediatric HIV-infected patients: pharmacokinetic and practical challenges. Pediatr. Drugs 13(3):175–192, 2011.
Ravikiran, S. R., and Y. M. Shivarajashankara. Dosing ability of Indian parents for liquid medication. Indian Pediatr. 48:153–154, 2011.
Richards-Kortum, R., L. V. Gray, and M. Oden. Engaging undergraduates in global health technology innovation. Science 336:430–431, 2012.
Simon, H. K., and D. A. Weinkle. Over-the-counter medications: do parents give what they intend to give? Arch. Pediatr. Adolesc. Med. 151(7):654–656, 1997.
Sobhani, P., J. Christopherson, P. J. Ambrose, and R. L. Corelli. Accuracy of oral liquid measuring devices: comparison of dosing cup and oral dosing syringe. Ann. Pharmacother. 42(1):46–52, 2008.
Vreeman, R. C., S. E. Wiehe, E. C. Pearce, and W. M. Nyandiko. A systematic review of pediatric adherence to antiretroviral therapy in low- and middle-income countries. Pediatr. Infect. Dis. J. 27(8):686–691, 2008.
World Data on Education. United Nations Educational, Scientific and Cultural Organization. International Bureau of Education. http://www.ibe.unesco.org/fileadmin/user_upload/Publications/WDE/2010/pdf-versions/Malawi.pdf. Accessed on November 4, 2012.
Yin, H. S., B. P. Dreyer, L. Van Schaick, G. L. Foltin, C. Dinglas, and A. L. Mendelsohn. Randomized controlled trial of a pictogram-based intervention to reduce liquid medication dosing errors and improve adherence among caregivers of young children. Arch. Pediatr. Adolesc. Med. 162(9):814–822, 2008.
Yin, H. S., M. Johnson, A. L. Mendelsohn, M. A. Abrams, L. M. Sanders, and B. P. Dreyer. The health literacy of parents in the United States: a nationally representative study. Pediatrics 124(suppl 3):S289–S298, 2009.
Yin, H. S., A. L. Mendelsohn, M. S. Wolf, et al. Parents’ medication administration errors: role of dosing instruments and health literacy. Arch. Pediatr. Adolesc. Med. 164(2):181–186, 2010.
Yin, H. S., M. S. Wolf, B. P. Dreyer, L. M. Sanders, and R. M. Parker. Evaluation of consistency in dosing directions and measuring devices for pediatric nonprescription liquid medications. JAMA 304(23):2595–2602, 2010.
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This work was supported in part by a grant to Rice University from the Howard Hughes Medical Institute through the Undergraduate Science Education Program.
Conflict of interest
Drs. Richards-Kortum, Oden, Ms. Dinh, Ms. Gutierrez, and Ms. Lukomnik submitted a patent application for the dosing clip described in this paper. Drs. Richards-Kortum and Oden have waived their financial interest in this patent.
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Spiegel, G.J., Dinh, C., Gutierrez, A. et al. Design, Evaluation, and Dissemination of a Plastic Syringe Clip to Improve Dosing Accuracy of Liquid Medications. Ann Biomed Eng 41, 1860–1868 (2013). https://doi.org/10.1007/s10439-013-0780-z
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DOI: https://doi.org/10.1007/s10439-013-0780-z