Parents May Be Misdosing Tamiflu In Kids

When it takes two health professionals 30 minutes and a bunch of algebra to puzzle out the proper dose of the flu drug Tamiflu to give their sick six-year-old, how's the average parent supposed to make sense of medication labels?

Kara Jacobson, a health literacy researcher at Emory University in Atlanta — and mom of the sick kid in question — would sure like to know.

A child takes liquid medicine. i

Don't use a kitchen spoon to measure medicine. hide caption

itoggle caption
A child takes liquid medicine.

Don't use a kitchen spoon to measure medicine.

Jacobson says she was "sick as a dog and flat on my back," with swine flu two weeks ago when her two daughters came down with flu symptoms. Their pediatrician prescribed liquid Tamiflu for the six-year-old.

And that's when the trouble began.

The bottle of Tamiflu was labeled as a "12 mg/ml oral suspension." The written instructions on the bottle were to give the child "three-fourths of a teaspoon by mouth twice a day for five days." Simple enough. But the dosing syringe that came with the package was labeled in milligrams — 30mg, 45 mg, and 60 mg.

Even Jacobson's husband, also a doctor, was initially stumped.

"He was taking his glasses off, and putting them on," says Jacobson. "Taking them off. Putting them on."

Only when the couple dug further into the drug packaging and waded through tables written in medical jargon and aimed at prescribers did they come up with this solution: Five ml (the volume of a teaspoon) x .75 x 12 mg per milliliter Tamiflu suspension = 45 mg on the syringe. Yikes!

It would have been so easy to make a mistake, Jacobson says, and that would have meant overdosing or underdosing her child.

"In this particular case," she says, "we would have been much better off without the syringe at all — that made it more confusing." But, for most parents, the word 'teaspoon' is ambiguous too. Kitchen spoons come in different sizes and many may not realize they're supposed to use a precise measuring spoon to dole out the drug.

This story has a happy ending, for Jacobson's family (all now fully recovered) and for the rest of us. As soon as she started feeling better, Jacobson and several colleagues fired off a letter detailing their experience to the New England Journal of Medicine (which published it Wednesday night online). The letter warns doctors and pharmacists to take extra care with Tamiflu dosing. The researchers called the CDC and FDA, too, and on Tuesday, the CDC sent a letter to pharmacists warning of the potential confusion. You'll find the CDC's FAQ on the proper use of Tamiflu in children here.

A spokesperson for Roche, the maker of Tamiflu, told us in an email that the company sent out its own round of letters to health providers Wednesday, and is "working with the U.S. CDC and FDA to provide appropriate information to address the dosing concerns."

None too soon, says Michael Wolf, a health literacy expert at Northwestern University and a co-author on the NEJM letter. As one of the few treatments known to mitigate the new H1N1 strain of flu, Tamiflu — in every version for every age — could see a lot of action — this fall.



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