Accuracy of Caregiver Dosing of Acetaminophen and Ibuprofen for Febrile Children Presenting to a Saudi Arabian Tertiary Hospital Emergency Department.

Abstract

Background: Fever and its related symptoms are common reasons for pediatric emergency department (ED) visits. Parents are often concerned about fever in children, and a frequent reason for ED visits is the persistence of fever despite the administration of antipyretics at home. It is hypothesized that caregivers often administer incorrect doses of acetaminophen and ibuprofen. Objective: To assess caregivers' dosing practices in children with fever by evaluating the accuracy of acetaminophen and ibuprofen dosing and to identify factors associated with inaccurate dosing in Saudi Arabia. Methodology: A cross-sectional survey was conducted over a six-month period from 1 January 2022 to 30 June 2022 in the emergency department. We included caregivers of children under 14 who received a quantifiable dose of acetaminophen or ibuprofen for fever. Data were collected using a structured questionnaire. Multivariable regression analysis was utilized to identify factors associated with inaccurate dosing. Results: A total of 330 caregivers of children were included in the study. The caregivers' ages ranged from 18 to 60 years, with a mean age of 32.3 ± 6.4. Of these, 148 (44.8%) had university-level education or higher, while 33 (10%) had education below high school level. Only 81 caregivers (24.5%) administered the correct dose of medication. In contrast, 118 (35.8%) gave subtherapeutic doses, 40 (12.1%) administered higher-than-recommended doses, and 91 (27.6%) were unsure about the correct dose. Multivariable regression indicated that caregivers with education below high school (aOR = 2.65; 95% CI: 1.30-5.40 for low dose) and those making self-directed dosing decisions (aOR = 2.10; 95% CI: 1.15-3.85 for low dose) were significantly associated with incorrect dosing. Conclusions: The study indicates that approximately three-quarters of caregivers either administered incorrect doses of acetaminophen or ibuprofen or were unsure of the correct dose. Given that 93% of caregivers were unaware of medication concentrations, targeted educational interventions are required to improve dosing accuracy.