Abstract
ObjectivesTo examine the prescribing habits of NSAIDs among pediatric medical and surgical practitioners, and to examine concerns and barriers to their use.MethodsA sample of 1289 pediatricians, pediatric rheumatologists, sports medicine physicians, pediatric surgeons and pediatric orthopedic surgeons in the United States and Canada were sent an email link to a 22-question web-based survey.Results338 surveys (28%) were completed, 84 were undeliverable. Of all respondents, 164 (50%) had never prescribed a selective cyclooxygenase-2 (COX-2) NSAID. The most common reasons for ever prescribing an NSAID were musculoskeletal pain, soft-tissue injury, fever, arthritis, fracture, and headache. Compared to traditional NSAIDs, selective COX-2 NSAIDs were believed to be as safe (42%) or safer (24%); have equal (52%) to greater efficacy (20%) for pain; have equal (59%) to greater efficacy (15%) for inflammation; and have equal (39%) to improved (44%) tolerability. Pediatric rheumatologists reported significantly more frequent abdominal pain (81% vs. 23%), epistaxis (13% vs. 2%), easy bruising (64% vs. 8%), headaches (21% vs. 1%) and fatigue (12% vs. 1%) for traditional NSAIDs than for selective COX-2 NSAIDs. Prescribing habits of NSAIDs have changed since the voluntary withdrawal of rofecoxib and valdecoxib; 3% of pediatric rheumatologists reported giving fewer traditional NSAID prescriptions, and while 57% reported giving fewer selective COX-2 NSAIDs, 26% reported that they no longer prescribed these medications.ConclusionsTraditional and selective COX-2 NSAIDs were perceived as safe by pediatric specialists. The data were compared to the published pediatric safety literature.
Highlights
Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed for the symptomatic relief of pain and fever in children, and their anti-inflammatory effects are useful for juvenile arthritis and musculoskeletal (MSK) disorders
Individuals who appeared on more than one list were sent only one email. This method of compilation of names resulted in an intentional overrepresentation of pediatric rheumatologists and pediatric sports medicine physicians, two groups of physicians the investigators believed were frequent prescribers of NSAIDs
Response rates varied by specialty; 168/635 (27%) Academy of Pediatrics (AAP) members ("pediatricians”), 100/247 (40%) pediatric rheumatologists, 12/106 (11%) sports medicine specialists, 24/145 (17%) pediatric surgeons, and 43/156 (28%) pediatric orthopedic surgeons responded
Summary
Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed for the symptomatic relief of pain and fever in children, and their anti-inflammatory effects are useful for juvenile arthritis and musculoskeletal (MSK) disorders. Many children taking NSAIDs do report abdominal pain, nausea and anorexia[11,12] In this population, a gastroprotective agent such as misoprostol, or a histamine (H2) blocker or proton-pump inhibitor along with the NSAID may be helpful[12,13,14], or for others a selective COX-2 NSAID may be an option. NSAIDs are often prescribed “off-label” in pediatrics, eight NSAIDs (including aspirin) are approved by the Food and Drug Administration (FDA) with indications for fever, pain or juvenile arthritis[15]. There are few studies of selective COX-2 NSAIDs in children, but include the treatment of acute post-surgical pain[16,17], juvenile arthritis[18,19], the arthropathy of hemophilia[20,21,22], and in the therapeutic regimen for fibrodysplasia ossificans progressiva[23]. Overexpression of the COX-2 enzyme has been recognized in childhood brain tumors, and may be a future target for treatment[24]
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