Abstract
Despite limited evidence on safety and efficacy of drug use in neonates, drugs are extensively used in this age group. However, the availability of information on drug consumption in neonates, especially inpatient neonates, is limited. This paper systematically reviews published studies on drug utilization in hospitalized neonates. A systematic literature review was carried out to identify observational studies published from inception of databases used till August 2016. Four search engines, namely Medline, CINAHL, Embase, and PubMed, were used. Publications written in English that described drug utilization in neonatal wards were selected. Assessment of the data was based on the category of the study design, the objective of study and the method used in reporting drug consumption. A total of 20 drug utilization studies were identified, 12 of which focused on all drug classes, while the other eight evaluated antimicrobials. Studies were reported in Europe (n = 7), the United States (n = 6), India (n = 5), Brazil (n = 1), and Iran (n = 1). Substantial variance with regard to study types (study design and methods), data source, and sample size were found among the selected studies. Of the studies included, 45% were cross-sectional or retrospective, 40% were prospective studies, and the remaining 15% were point prevalence surveys. More than 70% of the studies were descriptive studies, describing drug consumption patterns. Fifteen per cent of the descriptive studies evaluated changes in drug utilization patterns in neonates. Volume of units was the most prevalent method used for reporting all drug categories. The ATC/DDD system for reporting drug use was only seen in studies evaluating antimicrobials. The most commonly reported drugs across all studies are anti-infectives for systemic use, followed by drugs for the cardiovascular system, the nervous system and the respiratory system. Ampicillin and gentamicin were the most prescribed antimicrobials in hospitalized neonates. The present review reveals that neonates are exposed to a high number of drugs and various methods are used to report drug consumption in this age group. The best measure of drug consumption to quantify prevalence of drug use in neonates remains to be identified and additional research in this area is warranted.
Highlights
The World Health Organization (WHO) defined Drug Utilization Research (DUR) as research into the marketing, distribution, prescription, and use of drugs in society, with special emphasis on the resulting medical, social, and economic consequences (World Health Organization, 2003)
Most of the drugs in the market were not tested for use in this age group as neonates were often excluded during clinical trials
Out of the 52, the following were not considered for in-depth analysis of drug utilization: studies that involved neonates or infants with particular conditions (n = 1); studies evaluating off-label/unlicensed drug use (n = 3); studies analyzing drug use of a specific drug(s) (n = 8) or a category of drug (n = 13); studies analyzing drug use in comparison with the drug
Summary
The World Health Organization (WHO) defined Drug Utilization Research (DUR) as research into the marketing, distribution, prescription, and use of drugs in society, with special emphasis on the resulting medical, social, and economic consequences (World Health Organization, 2003). Besides describing patterns of drug consumption, DUR can be used to identify problems related to drugs that deserve more research in various health care settings. Drug utilization monitoring can be used to assess the rational use of drug therapy when data on drug use is correlated with figures on morbidity, outcome of treatment (effectiveness in clinical and economic terms) and quality of care (Zuppa et al, 2007; Wettermark et al, 2016). As monitoring of drug consumption can identify problems related to drug therapy, evidence from DUR is essential to create awareness about irrational drug use by giving feedback to physicians and recommending measures to improve prescribing behavior (Chatterjee et al, 2007; Sequi et al, 2013). There is limited information on the safety and efficacy of drugs used to treat this population (Smyth and Weindling, 1999; Chatterjee et al, 2007; Sammons, 2011; Nor Aripin et al, 2012; Sequi et al, 2013)
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