Use Of Drugs In Children Research Articles

Impact of the COVID-19 health crisis on psychotropic drug use in children and adolescents in France

BackgroundIn 2019, the world faced a pandemic brought about by a severe acute respiratory infection caused by SARS-CoV-2 virus. The spread of this virus has profoundly affected societies, particularly in terms of their economic, human and social dimensions, as well as their healthcare systems. Several restrictive measures (reduced social interaction, periodic school closures,…) had to be taken to contain the spread of the virus. These measures have had an impact on the psychological well-being of both adults and children. The aim of this study was to assess the changes in psychotropic drugs prescriptions for children and adolescents living in Limousin, a French region, over the period 2018 to 2021.MethodsThe consumption of psychotropic drugs was studied using a national database of drug reimbursement. These data were extracted and supplied from the nationwide French reimbursement healthcare system database (SNDS). The following therapeutic classes were studied: N05A (antipsychotics), N05B (anxiolytics), N05C (hypnotics and sedatives), N06A (antidepressants) and N06B (psychostimulants). Data were collected for insured persons under the age of 18 who received at least one reimbursement for a psychotropic drug between 2018 and 2021.ResultsOver a 4-year period, 7949 patients under the age of 18 were included with an average age of 12.1 years and a sex ratio of 0.97 M/F. The number of patients increased from 2018 to 2021, as did the number of reimbursements. We observed a statistically significant difference of means of patients reimbursed per week for on five therapeutic classes, with the greatest difference in 2021 (p < 0.0001). An increase in the number of patients of between + 20.7% and + 689% was observed, depending on the drug classes studied. Comparisons between the COVID-19 and pre-COVID-19 periods showed a significantly higher COVID average for psychotropic drugs reimbursements in general and individually for all classes except psychostimulants.ConclusionThe results show a significant increase in the consumption of psychotropic drugs among youth. The increase in psychotropic drug use was continuous and progressive throughout the pandemic. All five classes were increased, but particularly anxiolytics and antidepressants. The COVID-19 context may have been at the origin of a deterioration in the mental health of children and adolescents, or of a heightened awareness of psychiatric care among young people.

The efficacy of low/lactose-free milk powder in the treatment of lactose intolerance in infants: A protocol for systematic review and meta analysis.

The aim of this study was to evaluate the efficacy and safety of formula milk powder in the treatment of lactose intolerance in children, and to provide an evidence-based medicine basis for the rational use of drugs in children with lactose intolerance caused by various reasons by meta-analysis. Use computers to search major databases, including Web of Science, PubMed, CNKI, Wanfang Data Knowledge Service Platform, and other databases, the retrieval time is from the establishment of the database to April 2023. The collected literatures were screened, data extracted and processed, and then meta-analysis was performed by Review-Manager 5.4 statistical software. A total of 10 randomized controlled trials were included, with 1112 patients, including 562 patients in the treatment group and 550 patients in the control group. The control group was treated with conventional therapy, and the treatment group was treated with lactose-free/low-lactose milk powder on the basis of conventional therapy. The results of the meta-analysis showed that the clinical efficacy of the treatment group was significantly better than that of the control group [odds ratio=6.01, 95% confidence interval (CI): 3.94-9.18, P<0.00001], the course of disease in the treatment group was shorter than that in the control group (mean difference=-1.45, 95% CI: -1.76 to -1.13, P<0.0001). The antidiarrhea time of the treatment group was shorter than that of the control group, and the difference between the 2 groups was statistically significant (mean difference=-1.41, 95% CI: -1.67 to -1.15, P<0.0001). Low/lactose-free milk powder can improve clinical efficacy and shorten the course of treatment in infants with lactose intolerance, which can be demonstrated by further large-scale clinical studies.

Profile of Chronic Non-Epilepsy Drug Use in Children with Epilepsy: Single Centre Experience

Profile of Chronic Non-Epilepsy Drug Use in Children with Epilepsy: Single Centre Experience

Early-life risperidone alters locomotor responses to apomorphine and quinpirole in adulthood

An escalating trend of antipsychotic drug use in children with ADHD, disruptive behavior disorder, or mood disorders has raised concerns about the impact of these drugs on brain development. Since antipsychotics chiefly target dopamine receptors, it is important to assay the function of these receptors after early-life antipsychotic administration. Using rats as a model, we examined the effects of early-life risperidone, the most prescribed antipsychotic drug in children, on locomotor responses to the dopamine D1/D2 receptor agonist, apomorphine, and the D2/D3 receptor agonist, quinpirole. Female and male Long-Evans rats received daily subcutaneous injections of risperidone (1.0 and 3.0 mg/kg) or vehicle from postnatal day 14–42. Locomotor responses to one of three doses (0.03, 0.1, and 0.3 mg/kg) of apomorphine or quinpirole were tested once a week for four weeks beginning on postnatal day 76 and 147 for each respective drug. The locomotor activity elicited by the two lower doses of apomorphine was significantly greater in adult rats, especially females, administered risperidone early in life. Adult rats administered risperidone early in life also showed more locomotor activity after the low dose of quinpirole. Overall, female rats were more sensitive to the locomotor effects of each agonist. In a separate group of rats administered risperidone early in life, autoradiography of forebrain D2 receptors at postnatal day 62 revealed a modest increase in D2 receptor density in the medial caudate. These results provide evidence that early-life risperidone administration can produce long-lasting changes in dopamine receptor function and density.

Pediatric Pharmacology for the Primary Care Provider: Advances and Limitations.

Despite >1 in 5 children taking prescription drugs in the United States, off-label drug use is common. To increase the study of drugs in children, regulatory bodies have enacted legislation to incentivize and require pediatric drug studies. As a result of this legislation, novel trial approaches, and an increase in personnel with pediatric expertise, there have been numerous advancements in pediatric drug development. With this review, we aim to highlight developments in pediatric pharmacology over the past 6 years for the most common disease processes that may be treated pharmacologically by the pediatric primary care provider. Using information extracted from label changes between 2018 and 2023, the published literature, and Clinicaltrials.gov, we discuss advances across multiple therapeutic areas relevant to the pediatric primary care provider, including asthma, obesity and related disorders, mental health disorders, infections, and dermatologic conditions. We highlight instances in which new drugs have been developed on the basis of a deeper mechanistic understanding of illness and instances in which labels have been expanded in older drugs on the basis of newly available data. We then consider additional factors that affect pediatric drug use, including cost and nonpharmacologic therapies. Although there is work to be done, efforts focused on pediatric-specific drug development will increase the availability of evidence-based, labeled guidance for commonly prescribed drugs and improve outcomes through the safe and effective use of drugs in children.

Barriers and facilitators to guideline for the management of pediatric off-label use of drugs in China: a qualitative descriptive study

BackgroundDespite being a global public health concern, there is a research gap in analyzing implementation strategies for managing off-label drug use in children. This study aims to understand professional health managers’ perspectives on implementing the Guideline in hospitals and determine the Guideline’s implementation facilitators and barriers.MethodsPediatric directors, pharmacy directors, and medical department directors from secondary and tertiary hospitals across the country were recruited for online interviews. The interviews were performed between June 27 and August 25, 2022. The Consolidated Framework for Implementation Research (CFIR) was adopted for data collection, data analysis, and findings interpretation to implement interventions across healthcare settings.ResultsIndividual interviews were conducted with 28 healthcare professionals from all over the Chinese mainland. Key stakeholders in implementing the Guideline for the Management of Pediatric Off-Label Use of Drugs in China (2021) were interviewed to identify 57 influencing factors, including 27 facilitators, 29 barriers, and one neutral factor, based on the CFIR framework. The study revealed the complexity of the factors influencing managing children’s off-label medication use. A lack of policy incentives was the key obstacle in external settings. The communication barrier between pharmacists and physicians was the most critical internal barrier.ConclusionTo our knowledge, this study significantly reduces the implementation gap in managing children’s off-label drug use. We provided a reference for the standardized management of children’s off-label use of drugs.

Effects of parental job loss on psychotropic drug use in children: Long-term effects, timing, and cumulative exposure

Intra-family crossover effects triggered by job losses have received growing attention across scientific disciplines, but existing research has reached discrepant conclusions concerning if, and if so how, parental job losses affect child mental health. Drawing on sociological models of stress and life course epidemiology, we ask if parental job losses have long-term effects on child mental health, and if these effects are conditional on the timing of, or the cumulative exposure to, job losses. We use intergenerationally linked Swedish register data combined with entropy balance and structural nested mean models for the analyses. The data allow us to track 400,000 children over 14 years and thereby test different life-course models of cross-over effects. We identify involuntary job losses using information on workplace closures, thus reducing the risk of confounding. Results show that paternal but not maternal job loss significantly increases the risk of psychotropic drug use among children, that the average effects are modest in size (less than 4% in relative terms), that they may persist for up to five years, and that they are driven by children aged 6–10 years. Moreover, cumulative exposure to multiple job losses are more harmful than zero or one job loss.

Use of Tobacco Products and Suicide Attempts Among Elementary School–Aged Children

The use of tobacco products, including e-cigarettes and vaping, has rapidly increased among children. However, despite consistent associations found between smoking cigarettes and suicidal behaviors among adolescents and adults, there are limited data on associations between emerging tobacco products and suicidal behaviors, especially among preadolescent children. To examine whether the use of tobacco products is associated with nonsuicidal self-injury (NSSI), suicidal ideation (SI), and suicide attempts (SAs) among preadolescent children. This cohort study, conducted from September 1, 2022, to September 5, 2023, included participants in the Adolescent Brain Cognitive Development study, a population-based cohort of 11 868 US children enrolled at 9 and 10 years of age. The cross-sectional investigation focused on 3-year periods starting from the baseline to year 2 of follow-up. Statistical analysis was performed from October 1, 2022, to June 30, 2023. Children's use of tobacco products was assessed based on youth reports, including lifetime experiences of various nicotine-related products, supplemented with hair toxicologic tests. Main outcomes were children's lifetime experiences of NSSI, SI, and SAs, assessed using the K-SADS-5 (Kiddie Schedule for Affective Disorders and Schizophrenia for the DSM-5). Multivariate logistic regression was conducted to examine the associations of the use of tobacco products with NSSI, SI, and SAs among the study participants. Sociodemographic, familial, and children's behavioral, temperamental, and clinical outcomes were adjusted in the analyses. Of 8988 unrelated study participants (median age, 9.8 years [range, 8.9-11.0 years]; 4301 girls [47.9%]), 101 children (1.1%) and 151 children (1.7%) acknowledged lifetime use of tobacco products at baseline and at 18-month follow-up, respectively. After accounting for various suicide risk factors and potential confounders, children reporting use of tobacco products were at a 3 to 5 times increased risk of SAs (baseline: n = 153 [adjusted odds ratio (OR), 4.67; 95% CI, 2.35-9.28; false discovery rate (FDR)-corrected P < .001]; year 1: n = 227 [adjusted OR, 4.25; 95% CI, 2.33-7.74; FDR-corrected P < .001]; and year 2: n = 321 [adjusted OR, 2.85; 95% CI, 1.58-5.13; FDR-corrected P = .001]). Of all facets of impulsivity measures that were significant correlates of use of tobacco products, negative urgency was the only independent risk factor for SAs (adjusted OR, 1.52 [95% CI, 1.31-1.78]; FDR-corrected P < .001). In contrast, children's alcohol, cannabis, and prescription drug use were not associated with SAs. This study of US children suggests that the increased risk of SAs, consistently reported for adolescents and adults who smoke cigarettes, extends to a range of emerging tobacco products and manifests among elementary school-aged children. Further investigations are imperative to clarify the underlying mechanisms and to implement effective preventive policies for children.

Comparison of antipsychotic drug use in children and adolescents in the Netherlands before and during the COVID-19 pandemic

This study aims to describe the patterns and trends in antipsychotic prescription among Dutch youth before and during the corona virus disease 2019 (COVID-19) pandemic (between 2017 and 2022). The study specifically aims to determine whether there has been an increase or decrease in antipsychotic prescription among this population, and whether there are any differences in prescription patterns among different age and sex groups. The study utilized the IADB database, which is a pharmacy prescription database containing dispensing data from approximately 120 community pharmacies in the Netherlands, to analyze the monthly prevalence and incidence rates of antipsychotic prescription among Dutch youth before and during the pandemic. The study also examined the prescribing patterns of the five most commonly used antipsychotics and conducted an autoregressive integrated moving average (ARIMA) analysis using data prior to the pandemic, to predict the expected prevalence rate during the pandemic. The prescription rate of antipsychotics for Dutch youth was slightly affected by the pandemic, with a monthly prevalence of 4.56 [4.50–4.62] per 1000 youths before COVID-19 pandemic and 4.64 [4.59–4.69] during the pandemic. A significant increase in prevalence was observed among adolescent girls aged 13–19 years. The monthly incidence rate remained stable overall, but rose for adolescent girls aged 13–19 years. Aripiprazole, and Quetiapine had higher monthly prevalence rates during the pandemic, while Risperidone and Pipamperon had lower rates. Similarly, the monthly incidence rates of Aripiprazole and Olanzapine went up, while Risperidone went down. Furthermore, the results from the ARIMA analysis revealed that despite the pandemic, the monthly prevalence rate of antipsychotic prescription was within expectation. The findings of this study suggest that there has been a moderate increase in antipsychotic prescription among Dutch youth during the COVID-19 pandemic, particularly in adolescent females aged 13–19 years. However, the study also suggests that factors beyond the pandemic may be contributing to the rise in antipsychotic prescription in Dutch youth.

Evaluation of adverse drug reactions to off-label use of drugs in children from spontaneously reported cases at a tertiary care hospital

Background: Off-label use of drugs (OLUDs) is relatively common in pediatric and this may be associated with adverse drug reactions (ADRs). The studies about the safety of drugs used in children cannot be applied to safety of drugs during OLUDs as drug is used in way that is different from that described in regulatory body. Hence, it is worthwhile to evaluate the off-label status of the suspected drugs causing ADRs. Aims and Objectives: The aim of the study was to analyze the pattern of ADRs occurring during OLUDs in pediatric patients from the spontaneously reported ADRs cases at the pharmacovigilance unit of a tertiary care hospital. Materials and Methods: Single center, retrospective, observational study was conducted in the department of pharmacology. ADRs spontaneously reported from January 2016 to December 2017, which occurred during OLUDs in children, where causality is certain, probable and possible. Results: A total of 46 ADRs occurred during OLUDs in 44 patients, these patients received 174 medicines among which 66 were off-labeled drugs. Off-label drugs mainly belonged to anti-infectives for systemic use (70.31%) and it is associated with 30 ADRs (68.18%). The most commonly affected organ system is skin and subcutaneous tissue (43.18%). Conclusion: OLUDs is associated with ADR, so caution should be taken while prescribing a drug in off-label manner in children.

High-Throughput Computing to Automate Population-Based Studies to Detect the 30-Day Risk of Adverse Outcomes After New Outpatient Medication Use in Older Adults with Chronic Kidney Disease: A Clinical Research Protocol.

Safety issues are detected in about one third of prescription drugs in the years following regulatory agency approval. Older adults, especially those with chronic kidney disease, are at particular risk of adverse reactions to prescription drugs. This protocol describes a new approach that may identify credible drug-safety signals more efficiently using administrative health care data. To use high-throughput computing and automation to conduct 700+ drug-safety cohort studies in older adults in Ontario, Canada. Each study will compare 74 acute (30-day) outcomes in patients who start a new prescription drug (new users) to a group of nonusers with similar baseline health characteristics. Risks will be assessed within strata of baseline kidney function. The studies will be population-based, new-user cohort studies conducted using linked administrative health care databases in Ontario, Canada (January 1, 2008, to March 1, 2020). The source population for these studies will be residents of Ontario aged 66 years or older who filled at least one outpatient prescription through the Ontario Drug Benefit (ODB) program during the study period (all residents have universal health care, and those aged 65+ have universal prescription drug coverage through the ODB). We identified 3.2 million older adults in the source population during the study period and built 700+ initial medication cohorts, each containing mutually exclusive groups of new users and nonusers. Nonusers were randomly assigned cohort entry dates that followed the same distribution of prescription start dates as new users. Eligibility criteria included a baseline estimated glomerular filtration rate (eGFR) measurement within 12 months before the cohort entry date (median time was 71 days before cohort entry in the new user group), no prior receipt of maintenance dialysis or a kidney transplant, and no prior prescriptions for drugs in the same subclass as the study drug. New users and nonusers will be balanced on ~400 baseline health characteristics using inverse probability of treatment weighting on propensity scores within 3 strata of baseline eGFR: ≥60, 45 to <60, <45 mL/min per 1.73 m2. We will compare new user and nonuser groups on 74 clinically relevant outcomes (17 composites and 57 individual outcomes) in the 30 days after cohort entry. We used a prespecified approach to identify these 74 outcomes. In each cohort, we will obtain eGFR-stratum-specific weighted risk ratios and risk differences using modified Poisson regression and binomial regression, respectively. Additive and multiplicative interaction by eGFR category will be examined. Drug-outcome associations that meet prespecified criteria (identified signals) will be further examined in additional analyses (including survival, negative-control exposure, and E-value analyses) and visualizations. The initial medication cohorts had a median of 6120 new users per cohort (interquartile range: 1469-38 839) and a median of 1 088 301 nonusers (interquartile range: 751 697-1 267 009). Medications with the largest number of new users were amoxicillin trihydrate (n = 1 000 032), cephalexin (n = 571 566), prescription acetaminophen (n = 571 563), and ciprofloxacin (n = 504,374); 19% to 29% of new users in these cohorts had an eGFR <60 mL/min per 1.73 m2. Despite our use of robust techniques to balance baseline indicators and to control for confounding by indication, residual confounding will remain a possibility. Only acute (30-day) outcomes will be examined. Our data sources do not include nonprescription (over-the-counter) drugs or drugs prescribed in hospitals and do not include outpatient prescription drug use in children or adults <65 years. This accelerated approach to conducting postmarket drug-safety studies has the potential to more efficiently detect drug-safety signals in a vulnerable population. The results of this protocol may ultimately help improve medication safety.

The effect of long-term drug use on rational use of medicines in children with medical illness

Introduction: This study was conducted to investigate the effect of long-term drug use due to medical diseases on rational drug use in children, using data obtained from parents. It is a cross-sectional study. Methods: Among the 288 parents who applied to the pediatric outpatient clinics of Muğla Training and Research Hospital between January 1, 2022 and March 31, 2022; 144 people with children aged 0-12 who have a chronic disease and have been using regular medication for at least three months are included in the research group, 144 people who did not have a chronic disease and did not use medication constantly were determined as the control group. In addition to the form containing sociodemographic data and questions to evaluate rational drug use awareness, knowledge, attitudes and behaviors, the "Parental Attitude Scale For Rational Drug Use (PASRDU)" was answered through a face-to-face interview. Data analysis was conducted with SPSS 26 program with a confidence level of 95%. Parental Attitude Scale For Rational Drug Use scores showed normal distribution in both groups. Independent samples t-test was used to compare Parental Attitude Scale For Rational Drug Use scores according to groups, a chi-square test was used to compare the relationship between groups and categorical (grouped) variables, and a two-way ANOVA test was used to compare demographic characteristics and group variables according to Parental Attitude Scale For Rational Drug Use scores. Results: Of the parents participating in the study, 67.71% were mothers and 32.29% were fathers. The average age was 34.88±6.44 years in the research group and 33.57±6.57 years in the control group. The rates of having chronically ill individuals at home and individuals constantly using medication at home are higher in the research group and are statistically significant. While the presence of leftover or spare medication at home was be similar in the research and control groups, the rate of using these medications when necessary was 45.8% in the research group and 56.3% in the control group. While 43.1% of those in the research group did not give over-the-counter medicine to their children, this rate was 16% in the control group. The control group uses over-the-counter vitamins twice as much as the research group. The most commonly used over-the-counter medication in the entire population is antipyretics with a rate of 44.79%. The scores of the research group in Parental Attitude Scale For Rational Drug Use and its subscales are higher than the control group and are statistically significant. The place of residence for the longest time, educational level, having too much medication at home, and using non-prescription medication statistically affect the scores. In addition, the duration of the disease of the children in the research group significantly affected the Parental Attitude Scale For Rational Drug Use total score and the Accurate and Conscious Use subscale, and the disease group significantly affected the Effective and Safe Use subscale score. Conclusion: According to our research, long-term use of medication in children due to medical illness affects rational drug use. Accurate and current information is required in the preparation and use of drugs used in children due to the change in dosage and pharmaceutical form depending on age. In addition, herbal products and food supplements are also used during childhood. Therefore, the knowledge, attitudes and behaviors of healthcare professionals and parents affect children’s health. As studies on rational drug use in different regions in our country increase, more detailed and separate planning can be made for drugs used in childhood while preparing education and policies for rational drug use.

A Beginner’s Guide to Vasoactive Drug use in Children with Septic Shock

A Beginner’s Guide to Vasoactive Drug use in Children with Septic Shock

Features of drug therapy for functional gastrointestinal disorders in children of preschool and primary school age

The article explores modern concepts about functional gastrointestinal disorders in children, considers features of the classification according to the Rome criteria and Russian clinical guidelines, and presents the evolution of views in the context of understanding the general pathophysiological mechanism as impaired “gut-brain” interactions, which leads to dysmotility in different parts of the gastrointestinal tract, visceral hypersensitivity, changes in the local immune system functions, dysbiosis of the gut microbiota and a failure of the central nervous system to process signals. Dysregulation of the central nervous system and the enteric nervous system causes functional gastrointestinal disorders with pain syndrome: irritable bowel syndrome, functional dyspepsia and centrally mediated abdominal pain syndrome. In addition, the article discusses the Russian version of the guidelines due to differences in the diagnostic instrumental and laboratory facilities, as well as national peculiarities of marketing authorization, indications and contraindications for drug use in children. Subject to understanding of the mechanisms of functional gastrointestinal disorders in children, the authors presented information on the role of trimebutine, a universal motility regulator of different parts of the gastrointestinal tract, in the development of functional gastrointestinal disorders, as well as modern approaches to their prevention and correction using a drug of proven efficacy. Numerous national and foreign studies proved the efficacy of trimebutine in hyperkinetic and hypokinetic movement disorders, decreased gastric evacuation function, and impaired gallbladder contractile function in patients with both hypomotor and hypermotor types of functional disorders. The accumulated experience determines the prospects for its use in pediatric practice.

Three oral Chinese patent medicines for children with tic disorder: a rapid health technology assessment

This study aims to comprehensively evaluate the clinical value of Shaoma Zhijing Granules(SZG), Changma Xifeng Tablets(CXT), and Jiuwei Xifeng Granules(JXG) in the treatment of children with tic disorder with the method of rapid health technology assessment(RHTA), which is expected to serve as a reference for medical and health decision-making and clinical rational use of drugs in children. To be specific, relevant articles were retrieved from eight databases and three clinical trial registry platforms. After the quality evaluation, rapid assessment was carried out from the dimensions of disease burden and unmet needs, technical characteristics, safety, efficacy and economy, and the results were analyzed and presented descriptively. A total of 22 articles(1 in English, 21 in Chinese) were screened out: 18 randomized controlled trials(RCTs) and 4 clinical controlled trials(CCTs). Among them, 5 were about the SZG(all RCTs) and 9 were on CXT(6 RCTs and 3 CCTs). The rest 8 focused on JXG(7 RCTs and 1 CCT). Moreover, the overall risk of bias for 94.40% RCTs was evaluated as &quot;some concerns&quot; and only one(5.60%) had high risk of bias. In terms of quality, the 4 CCTs scored 5-6 points(&lt;7 points), suggesting low quality. SZG alone or in combination with tiapride has obvious advantages in improving traditional Chinese medicine syndromes and tic symptoms compared with tiapride alone, with the average daily cost of CNY 79.44-119.16. Compared with conventional western medicine or placebo, CXT alone or in combination with conventional western medicine can improve the total effective rate and alleviate tic symptoms, and the average daily cost is CNY 22.50-67.50. JXG alone or in combination with conventional western medicine can effectively relieve tic symptoms compared with conventio-nal western medicine or placebo, with the average daily cost of CNY 82.42-164.85. The adverse events related to the three Chinese patent medicines mainly occurred in the digestive, respiratory, and nervous systems, all of which were mild. In general, SZG, CXT, and JXG are effective for children with tic disorder. They have been approved to be used in this field, of which SZG was approved in 2019, with the most up-to-date research evidence and high-quality RCT in Q1 journals. However, the comparative analysis of the three was affected by many factors, which should be further clarified. Based on the large sample data available in multiple dimensions, a comprehensive comparative evaluation of the three Chinese patent medicines should be carried out, thereby highlighting the advantages and disadvantages of them and serving a reference for rational clinical use and drug supervision.

1401-P: Psychotropic Drug Use in Children and Adolescents with Type 1 Diabetes

Psychiatric disorders in children and adolescents with type 1 diabetes (T1D) have caught increasing attention. While psychotropic drugs offer great value in managing psychiatric symptoms, their adverse effects engender considerable controversy regarding their use in pediatric patients, let alone in those with T1D. Despite the topic’s high visibility, little evidence exists on the patterns of psychotropic drug use in pediatric T1D patients. We thus conducted this cohort study of 3,720,381 children and adolescents (13,191 [0.36%] had T1D) using several Swedish national registers. We examined the trends and patterns (prescription source and treatment duration) of psychotropic drug use and estimated the risk of initiating psychotropic drugs after T1D onset. We found that psychotropic drug use increased significantly in children and adolescents with T1D from 2006 to 2019 (Figure 1), with ADHD medications, SSRI, hypnotics and anxiolytics among the most used ones. The primary prescription source was psychiatric care, and treatment durations were mostly &amp;lt;12 months (except for ADHD medications). Children and adolescents with newly-onset T1D had a higher risk of initiating any psychotropic drug (hazard ratio 1.29, 95%CI 1.20-1.38) than their peers without T1D. Our findings highlight the need for risk/benefit studies of psychotropic drugs among young users with T1D to inform future research and guideline development. Disclosure S.Liu: None. T.Lagerberg: None. J.F.Ludvigsson: Research Support; Janssen Pharmaceuticals, Inc., MSD Life Science Foundation. M.Taylor: None. B.Donofrio: None. P.Lichtenstein: None. S.Gudbjörnsdottir: None. A.Butwicka: None. Funding Swedish Research Council (2017-00788)

Potentially inappropriate prescribing in hospitalised children: a retrospective, cross-sectional study at a tertiary children’s hospital in China

IntroductionFor improving and optimising drug use in children, we previously developed a tool (including a series of criteria for identifying potentially inappropriate prescribing in children) by literature review and the...

SP3 Optimising prescribing of medicines to children by formulary interface pharmacists

ContextUnlicensed and off label drug use in children is common and leads to well recognised problems. It has been shown that there is an association between unlicensed drug use in children and particularly neonates, and increased risks of medication errors, due to prescribing, dispensing and administration.1Alongside this, the variation in strengths of oral liquid products, adds to the potential for harm to be caused to children due to a lack of awareness and education on these issues.Quality improvement initiativeA UK CCG funded two specialist paediatric pharmacist posts with the aim of rationalising, standardising, and optimising the prescribing of unlicensed medicines to children. The aim was that these pharmacists would create an interface link between primary and secondary care, to empower healthcare professionals to prescribe and supply medicines to children safely and effectively.Work undertaken ePACT2 prescribing data highlighting variation in strength, formulation and cost of unlicensed medicines supplied; feedback from colleagues across all sectors of healthcare; NPPG position statements and MHRA alerts were used to identify areas to focus interventions. Examples of the work undertaken includes:Led webinars on prescribing medicines to children to healthcare professionals across the CCGMet with ~70% of GP practices, either individually or as groups e.g. PCNs across the CCGInitiated standardisation of liquid strengths kept across 3 hospital trust and primary careIdentified areas for medication safety team work e.g. prescribing of multiple strengths of medicines to children, prescribing of alcohol–containing phenobarbital to childrenWorked with CCG Medication Safety Officers to provide a response, advice and information on MHRA alerts e.g. chloral hydrate prescribing to childrenWorked with medicines optimisation CCG teams on communication tools e.g. bulletinsCreated a paediatric guidelines and pathways section on the CCG webpageCreated a paediatric formulary pharmacist group with representatives across all 3 hospital trusts to meet monthly and foster collaborative working.Measure of improvementThrough regular feedback, meetings, and email communication it can be noted that the links between primary and secondary care have been strengthened. Praise has been received for the help and support provided and for the openness to amend and adjust work plans based on the priorities and needs of the CCG. Through monthly ePACT2 data in the form of excel specials dashboard the reduction in variation of strengths being supplied to children can be seen, with in most cases an accompanying reduction in spend.Lessons learnedAlthough much has been publicised on the importance of nationally standardising concentrations of liquid medicines2, this initiative has shown that there is still much work to be done. Dedicated pharmacists have been able to make progress in standardising the range of unlicensed medicines recommended in the local formulary and ensure that this is well communicated across both primary and secondary care. Interface links between care settings are vital if we are to achieve substantial harmonisation of medicines prescribed to children.ReferencesConroy S. Association between licence status and medication errors.Arch Dis Child2011;96:305-306.Rawlence E,et al. Is the provision of paediatric oral liquid unlicensed medicines safe?Arch Dis Child Educ Pract Ed.2018;103:310-3.

Ileus Presenting with Malnutrition Associated with Anti-diarrheal Drugs in Pediatric Patient: A Case Report

Ileus is described as a complication after the use of regular anti-diarrheal agents, such as loperamide. In children, loperamide is not recommended as a regular treatment for acute diarrhea. This case report aimed to elaborate on the cases of Ileus as a side effect of anti-diarrheal drug use in children and to signify parents' education role in cases of malnutrition. In this study, a-7-year old boy came with symptoms of increasingly severe abdominal pain, distended abdomen, and difficulty defecating in the last 3 days after consumption of anti-diarrheal drugs by his parents within 6 months. The patient has a poor history of food consumption. Clinical investigations revealed anemia, leukocytosis, underweight, short stature, and local ileus. He was diagnosed with Ileus and malnutrition and treated with fluid therapy, antibiotics, and blood transfusion and was consulted by a pediatric surgeon. In conclusion, the use of anti-diarrheal agents should be avoided in connection with their safety for children and the complications that can arise. Parental knowledge plays an important role in preventing malnutrition in children.

Off-Label, but on-Evidence? A Review of the Level of Evidence for Pediatric Pharmacotherapy.

Many drugs are still prescribed off-label to the pediatric population. Although off-label drug use not supported by high level of evidence is potentially harmful, a comprehensive overview of the quality of the evidence pertaining off-label drug use in children is lacking. The Dutch Pediatric Formulary (DPF) provides best evidence-based dosing guidelines for drugs used in children. For each drug-indication-age group combination-together compiling one record-we scored the highest available level of evidence: labeled use, systematic review or meta-analysis, randomized controlled trial (RCT), comparative research, noncomparative research, or consensus-based expert opinions. For records based on selected guidelines, the original sources were not reviewed. These records were scored as guideline. A total of 774 drugs were analyzed comprising a total of 6,426 records. Of all off-label records (n=2,718), 14% were supported by high quality evidence (4% meta-analysis or systematic reviews, 10% RCTs of high quality), 20% by comparative research, 14% by noncomparative research, 37% by consensus-based expert opinions, and 15% by selected guidelines. Fifty-eight percent of all records were authorized, increasing with age from 30% in preterm neonates (n=110) up to 64% in adolescents (n=1,630). Many have advocated that off-label use is only justified when supported by a high level of evidence. We show that this prerequisite would seriously limit available drug treatment for children as the underlying evidence is low across ages and drug classes. Our data identify the drugs and therapeutic areas for which evidence is clearly missing and could drive the global research agenda.