Safe Caregiver Rounding Protocol

One of our primary goals is to provide safe dosing for patients and to make the decisions leading up to that safe dose — by the prescriber — as painless and fast as possible.

We believe rounded dosing for pediatric liquid medications is safer for the patient because it is easier for the caregiver to administer, and it is backed by expert medical opinion.

Clear dosing decreases the chance of the caregiver making an error, and may also protect the prescriber from potential medicolegal trouble.

Our two rounding protocols are for “Static” dosed medications and “Ranged” dosed medications.

Static dosing

Rounding for static-dosed medications is based on the Medication Dosing Tolerance (MDT). As outlined in research, a drug’s MDT is:

• The distance away from the exact dose that is still safe for the patient, AND
• is still therapeutic, AND
• does NOT go over the max dose (there are some exceptions where going over the max dose may be appropriate).

e.g. Cefdinir₃ (MDT = 10%) — every medication has its own MDT documented in research

MDTExact DoseMDT

10%14 mg/kg/day10%

Safe rounded dosing to the nearest 1 mL, 0.5 mL, 0.2 mL WITHIN that drug's Medication Dosing Tolerance (MDT) — and never above the max dose.

Ranged dosing

Some drugs are dosed across a range. Here we simply round to a syringe-friendly volume that stays inside the range and never exceeds the max dose.

e.g. Amoxicillin

Low DoseMid DoseHigh Dose

80 mg/kg/day85 mg/kg/day90 mg/kg/day

Safe rounded dosing to the nearest 1 mL, 0.5 mL, 0.2 mL WITHIN that drug's dosing RANGE — and never above the max dose.

Why these volumes?

2.5 mL

2 mL

2.2 mL

2.4 mL

2.6 mL

2.8 mL

3 mL

(syringe lines)

We round to the nearest 1 mL and 0.2 mL because these match the syringe markings handed out at pharmacies.

There is no marking on the syringe for 0.5 mL, but we round to it too because it is a logical, easy-to-understand halfway point between two whole numbers.

How the calculators use this

For static dosing, 0.2 mL rounding tends to land closest to the exact dose compared to 0.5 mL and 1 mL (but not always).

For static dosing, 1 mL rounding tends to land farthest from the exact dose compared to 0.2 mL and 0.5 mL (but not always).

For static dosing, our calculators tell you — in % — how far a given dose is from the exact dose, so you can make the best decision for your patient.

For ranged dosing, our calculators simply provide rounded doses that stay within the drug’s range (e.g. 80–90 mg/kg/day).

The provider’s goal is to quickly determine a SAFE rounded dose that is as close to the exact dose as possible.

Our calculators also compute the exact dose, for those who prefer not to round.

Our website is designed to help you decide as fast as possible, in as few taps as possible. Pair that with calculators that instantly compute exact and rounded doses — and update the moment you change the dose, frequency, or formulation — and you have a powerful combination.

This is a win-win-win between the provider, the caregiver, and the patient:

• Dosing is easier for the provider.
• Administering is easier for the caregiver.
• …and the patient benefits from a clear, safe dose.