Background The use of off-label drug and manipulation are very common in paediatrics, since there is a lack of drugs in suitable strengths and child-friendly dosage forms. A manipulation is the physical alteration of a drug dosage form with the purpose to extract and administer the prescribed proportion of a drug dose.

In an earlier study, we concluded that tablets should not be split to receive a smaller dose due to the irregularity of the resulting halves, but we still lack information on how common this procedure is.

Purpose To study the frequency of manipulated medicines administered to paediatric inpatients at a large children’s hospital during 1 year.

Material and methods To answer this question, we collected data for all administered doses during 12 months at the paediatric wards at our children’s hospital, from a hospital-based register. All administered doses where the number of tablets or suppositories were decimal were added and calculated as a percentage of all administered doses. Data were anonymous but information regarding sex, age, hospital ward and number of drugs per patient were available and were analysed.

Results During 1 year, approximately 4 50 000 doses of medicine are administered to paediatric patients in our children’s hospital.

Preliminary results show that 7% of all administered doses are for a decimal number of tablets or suppositories in all age groups.

The medicines that most frequently were prescribed and administered as decimal numbers were clobazam tablets and ibuprofen suppositories.

Conclusion Our results clearly illustrate the need for more child-appropriate medicines/strengths. Most often there is a lack of knowledge of how manipulation of medicines influences the dosing accuracy and often we do this to our most vulnerable patients. Further studies are needed to investigate the relation between manipulation of medicines and dosing accuracy, and to establish best practice when manipulation is necessary.

No conflict of interest