Prescrição de medicamentos para crianças hospitalizadas: como avaliar a qualidade?

Abstract

Pediatric patients called "therapeutic orphans" are usually excluded from clinical trials for development of new drugs, which, sometimes, are used empirically. This study evaluates the prescriptions for pediatric inpatients, and proposes criteria for evaluation of the quality of the prescriptions.The hospital pharmacist determined the prevalence of drug prescription in five pediatric wards. One day collection of all prescriptions for pediatric inpatients was performed in March, April, May and June 1999, and the data were jointly analyzed. Six criteria were proposed for quality evaluation of the drug prescriptions. The drugs were classified according to the ATC classification index.The prescriptions of a total of 322 patients were collected in the four collection days. The three most common diagnoses were: pneumonia 40.4%, meningitis and meningococcemia 6%, diarrhea and dehydration 6%. The three most prescribed therapeutic classes were: nervous system (N ) 109%, general antiinfectives for systemic use ( J ) 81.9% and respiratory system ( R ) 69,0%. The three most prescribed drugs were: metamizole 88.3%, fenoterol 30.7% and penicillin G 25.0%. The quality evaluation showed 1. an excessive use of the intravenous route, 2. appropriate dose schedule for drugs with narrow therapeutic index, 3. no therapeutic duplication, 4. prescription of unapproved and off-label drugs, 5. frequent potential adverse drug interactions, and 6. prescription of drugs not in the therapeutic formulary of the hospital.Very simple measures can improve the quality of the health care of pediatric inpatients as inclusion of adequate drug presentations in the hospital formulary, and a careful evaluation of the need of the intravenous route. This study also shows the hospital pharmacists acting as part of the multidisciplinary health care team.