Question

NEW YORK (CBSNewYork) — A Brooklyn family is dealing with absolute devastation after their only child died following a fatal mistake. Their baby boy was taken to the hospital with just a fever and was given what turned out to be a deadly dose of medication.

Earlier Wednesday afternoon, the New York City Medical Examiner ruled the death of 6-month-old Amaan Ahmmad an accident. The ME said the death was the result of complications following administration of an adult dose of the antibiotic azithromycin, which is commercially known as Zithromax.

Instead of looking forward to a lifetime of birthdays, the family is now making funeral arrangements for their child. Ummay Sultana and Amain Ahmmad said their son became ill last Friday, so they took him to Brookdale, where he was born.

“He catch cold and we took him to the emergency,” Sultana said.

Hospital records showed baby Amaan was brought to the ER “alert and responsive” and with the exception of a fever, which was reportedly around 100, the nursing staff did not list any other visible symptoms.

But an examination led to a diagnosis of clinical pneumonia. Amaan was transferred to the pediatric unit and given a dose of the azithromycin through an IV drip in his right arm.

According to the nursing notes, at least 36 minutes passed before the hospital staff realized something was wrong.

CBS 2’s Jay Dow spoke with the parents Wednesday and asked the boy’s father who he blames for his son’s death.

“Hospital management, doctor, nurse—of emergency,” he replied.

“I’m like ‘look, look my baby’s dying! My baby’s dying!’ and then nurse came over and said ‘no, you’re baby’s pretty good. He’s sleeping,’” Sultana told CBS 2’s Sean Hennessey.

A copy of the hospital’s discharge summary states the child was given “Azithromycin (500mg), in error” — which led to “cardiac shock.”

Family pediatrician Dr. Suzanne Loiselle said that dosage is more typical for an adult and not a 17-pound baby like Amaan.

“Nobody can feel worse for the family than the doctors and nurses that were involved in this child’s care,” Loiselle said. “About 80 milligrams would be appropriate for a child roughly in his weight class.”

Less than 24 hours after the overdose, Ummay and Amain were told their son was brain dead. Amaan was taken off a respirator on Monday.

“They told us there is no hope because his head is totally collapsed,” his father told Hennessey.

Brookdale Hospital would not answer questions from 1010 WINS or CBS 2, saying only: “We are investigating the circum- stances of this tragic incident and express our condolences to the Ahmmad family.”

“I never think like that he pass away forever,” Sultana said. “I thought he’s gonna come back.”

The two first-time parents said they are both devastated and outraged over a fatal medical mistake that cut short their baby’s

life just as it was getting started.

1) Some medications are formulated such that there is a slow release of the active ingredients. Such formulations are known as “extended release.” Azithromycin ER is a single-dose, extended release formulation. The recommended dosage for a child 6 months and older who is brought to the Emergency Room with community acquired pneumonia is 60 mg/kg administered orally. Azithromycin (immediate release) has much faster onset of action and acts almost immediately when administered intravenously (by IV). Clinicians exercise clinical judgment when deciding whether or not to treat a pediatric patient with azithromycin intravenously. If therapy is deemed necessary, a dose of 10 mg/kg for those age 6 months to 16 years is considered reasonable.

(a) Based on the information above, what would be an appropriate dose of azithromycin ER for a baby weighing 17 lbs such as Amaan? (3 points) Note: The dosage used in this problem was obtained from the reference:

http://www.drugs.com/dosage/azithromycin.html#Usual_Pediatric_Dose_for_Pneumonia

(b) How does the appropriate dose of azithromycin ER for a baby weighing 17 lbs such as Amaan compare with the dose of azithromycin that was given intravenously to Amaan. (3 points)

(c) What would be an appropriate dose of azithromycin (immediate release) administered by IV for a baby weighing 17 lbs such as Amaan? How does your calculated dose compare with that indicated by Dr. Loiselle? (3 points)

Answer 1

Question No 1:

(a)Here the baby weighing 17 lbs means the baby'sweight is 7.711kg

* As recommended azithromycin ER dose for the patient less than 34 kg is less than 60mg/kg orally as a single dose of maximum

The extended release azithromycin appropriate dose for the baby weighing 7.7kg is

* for 1kg=60mg then for 7.7kg is 60x7.7=462mg maximum as a single dose orally

(b)

*The appropriate dose of azithromycin ER for a baby weighing 17lbs such as Amaan is 462mg as a maximum of single dose orally.Instead of this Amaan is treated with Azithromycin IR ans also infused with the adult dose of azithromycin IR

*Here the weight of Amaan is 17 lbs that means in kilogram baby is weighing 7.7kg

*Amaan was given Azithromycin 500mg IV means as drip

*The recommended dose for the Azithromycin IV is 10mg/kg on days 1 and 2 of treatment,then transitioning to oral treatment when possible

That means for Amaan the recommended dose for Azithromycin is 7.7x10=77mg

*The Amaan is treated with the adult dose of azithromycin 500mg the appropriate dose of azithromycin for Amaan is 77mg,that means the over dose of azithromycin leads to the fatal death of the child.

(c)

* 1 lbs =0.454kg

*Here Amaan is weighing of 17lbs that means 7.7kg

*The recommended dose of Azithromycin immediate release is 10mg/kg to the age groupof 3months to less than 5 years

*The appropriate dose of Azithromycin IR is 10x7.7=77mg

*Here the Amaan's family pediatrician DR.Loiselle indicated that the dosage of about 80mg would be appropriate for a child roughly in his weight class

*That is correct why because the recommended dose for Azithromycin IR in his weight class is 77mg