Abstract
A prospective audit of 100 consecutive outpatient prescriptions for sustained-release theophylline was performed to evaluate clinical dosing practice. Forty-one of 98 evaluable prescriptions failed dosing criteria based on accepted guidelines. Documentation of dose, dosage form, or schedule was inadequate in 53% ofthe reviewed charts. Serum theophylline level determinations, when performed, were lower in the group with dosing below guidelines compared to those with appropriate dosing (mean ± SD serum theophylline level: 4.5 ± 4.6 vs 7.4 ± 5.8 μg/ml; p < 0.05), and 76% of all levels were subtherapeutic ( < 10 μg/ml). Clinical outcome was highly variable and seemed to depend on factors other than the use or dosage of theophylline. Pediatric asthma specialists prescribed theophylline with fewer errors than other pediatric staff physicians and residents. We conclude that current dosing practice for sustained-release theophylline in pediatric teaching hospitals may be suboptimal and recommend a combination of targeted education and modification of institutional policies to improve drug use.
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