Improve Drug Use Research Articles

A Drug Utilization Evaluation of Bronchodilators Using a Defined Daily Dose Method

Drug therapy is crucial to promoting human health by increasing quality of life and extending lifespan. A method to assess and improve drug use is by conducting Drug Utilization Study. Drug utilization, in terms of DDD, aids in converting the available volume of medications into medically relevant units, allowing estimations of the number of people exposed to a certain medicine or class of medicines. A prospective observation study was carried out to assess the consumption of bronchodilators among in-patients. Theophylline was the most utilized bronchodilator with 469.54 DDD/100bed-days. Total consumption of bronchodilators 872.91 DDD/100bed-days. Methylxanthines like Theophylline and Etofylline tablets were over-utilized with PDD:DDD ratio of 4.35 and 3.26 respectively.

1006-P: Distributional Cost-Effectiveness Analysis of Glucagon-Like Peptide-1 Receptor Agonists (GLP-1 RA) and Tirzepatide Compared with Sulfonylureas (SU) in People with Inadequately Controlled Type 2 Diabetes (T2D)

We assessed the cost-effectiveness of GLP-1 RA and tirzepatide compared with SU when added to metformin in people with inadequately controlled T2D. Using data from the National Health and Nutrition Examination Survey (2013-2018), we constructed a nationally representative T2D sample poorly controlled on metformin (A1c> 7.0%). We used the BRAVO diabetes model, a validated microsimulation model, to predict individuals’ lifetime health and economic outcomes based on their current health profile and received treatment (GLP-1 RA, tirzepatide, or SU). We identified factors driving the cost-effectiveness and developed a scoring algorithm using these variables, with higher scores indicating more cost-effective. Under a willingness to pay threshold of $100,000/QALY, GLP-1 RA ($92,590/QALY) and tirzepatide (5 mg: $70,540/QALY, 10 mg: $60,700/QALY, 15 mg: $55,600//QALY) were all cost-effective compared with SU. The cost-effectiveness drivers included age, gender, smoking, diabetes duration, A1c, SBP, and cardiovascular disease history (Figure). Our scoring algorithm can stratify patients by the cost-effectiveness of using GLP-1 RA or tirzepatide, which can be used to design precision interventions to improve drug use targeting patients for whom the drug use can be cost-effective. Disclosure P.Li: None. A.G.Winterstein: Consultant; Bayer Inc., Genentech, Inc., Ipsen Biopharmaceuticals, Inc., Research Support; Merck Sharp & Dohme Corp. J.Guo: Consultant; Pfizer Inc., Research Support; PhRMA Foundation, NIH - National Institutes of Health. H.Shao: Consultant; Lilly Diabetes. D.Guan: None. M.K.Ali: Advisory Panel; Bayer Inc., Eli Lilly and Company, Research Support; Merck & Co., Inc. K.Narayan: None. V.Fonseca: Consultant; Abbott, Corcept Therapeutics, Eli Lilly and Company, Other Relationship; BRAVO4HEALTH, LLC, Research Support; Fractyl Health, Inc., Stock/Shareholder; Amgen Inc. G.Umpierrez: Research Support; Abbott, Dexcom, Inc., Baxter. L.Shi: None. J.Bian: None. Y.Guo: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (R01DK133465)

Sex differences in neural responses to stress and drug cues predicts future drug use in individuals with substance use disorder

BackgroundSubstance use disorders (SUDs) are chronically recurring illnesses, where stress and drug cues significantly increase drug craving and risk of drug use recurrence. This study examined sex differences in functional magnetic resonance imaging (fMRI) brain responses to stress and drug cue exposure and assessed their prospective association with future drug use post-treatment. MethodsInpatient, treatment engaged men (N = 46) and women (N = 26) with SUDs, including alcohol, cocaine and/or cannabis use disorders, participated in an fMRI scan that assessed subjective (anxiety, drug craving), heart rate and neural responses to brief individualized script-driven imagery of stress, drug, and neutral-relaxing trials. Prospective follow-up interviews post-treatment assessed future drug use recurrence over 90 days. ResultsDuring fMRI, stress and drug versus neutral cue exposure led to increased anxiety, heart rate and craving responses (p’s < 0.004) in both men and women, but greater drug cue-induced anxiety (p < .017) and higher drug use days during follow-up (p < .006) in women relative to men. In whole brain analyses of stress and drug cues (p < .05 FWE corrected), and in whole brain correlation (p < .05, FWE corrected) with drug use days, significant sex differences revealed drug cue-related striatal hyperactivation (caudate, putamen) in men, but drug cue-related cortico-limbic (insula and dorsolateral prefrontal cortex) hypoactivation and stress-related hypoactivation in the ventromedial prefrontal cortex (VmPFC) in women; and these were significantly associated with higher future drug use days. ConclusionsFindings indicate sex-specific pathophysiology of SUD recurrence and support the need for differential treatment development for men and women with SUD to improve drug use outcomes.

Drug Utilization Evaluation among the Patients with Renal Disease In a Tertiary Care Hospital

Aim: The main aim of this study was to conduct drug utilization evaluation among the patients with renal disease in a tertiary care hospital.Materials and Methods: An observational study was conducted among 102 patients for a period of six months in a tertiary care teaching hospital. Both male and female genders with renal diseases undergoing pharmacological therapy who were aged between 20-70 years were included in this study. Pregnant and lactating women and patients with incomplete laboratory data were excluded from this study. Results: Out of 102 patients included in this study, 54.9% (n=56) were male and 45.1% (n=46) were female. In this study, antibiotics (17.3%) were prescribed mostly and anti-fungals (1.9%) were found to be less prescribed. Among the antibiotics used, combination of Piperacillin + ?-lactamase inhibitors were prescribed mostly followed by combination of Cephalosporins + ?-lactamase inhibitors and Aminoglycosides were prescribed leastly. Conclusion: Drug utilization evaluation plays a major role to evaluate and improve drug use especially in a country like India, where illiteracy, poverty, different medicine system practices, dispensing without prescription, predominance in medical and marketing field and lack of drug information is evident. It is critical that standard guidelines in the therapeutic management to be developed and adopted that will help to prescribe the medication based on the evidence, hence improves the overall quality of drug use and ensures betterment of patients.

The Significance of the Ocular Adverse Effect Induced by Systemic Taxane Application.

In recent years, in-depth research on anti-tumor therapy has brought the emergence of new active chemotherapeutic agents and combination regimens. However, as one of them, taxane drugs are widely used in clinical practice, but it should be noted that many side reactions caused by their application bring some difficulties to routine management. Among the side reactions related to taxane anti-tumor therapy, ocular adverse reactions are occasionally reported and are not life-threatening but may seriously affect patients' life quality. Thus, the continuation, reduction and cessation of taxane chemotherapy still need to be further evaluated by ophthalmologists and oncologists once the side effects show up. To prevent ocular side reactions, close attention should be paid to complications during medication. To facilitate the oncology department and ophthalmologists to comprehensively understand the ophthalmic adverse reactions of taxane drugs and their possible mechanisms and improve drug use efficiency, we collected relevant literature and reviewed and provided some suggestions for the monitoring and managing of ophthalmic toxicity.

Feasibility and outcomes of a general practice and specialist alcohol and other drug collaborative care program in Sydney, Australia.

Alcohol and other drug (AoD) use is an important health and community issue and may be positively affected by collaborative care programs between specialist AoD services and general practice. This paper describes the feasibility, model of care and patient outcomes of a pilot general practice and specialist AoD (GP-AoD) collaborative care program, in Sydney, Australia, based on usual care data, the minimum data set, service utilisation information and the Australian Treatment Outcome Profile (ATOP), a patient-reported outcome measure. There were 367 referrals to the collaborative care program. GPs referred 210 patients, whereas the AoD service referred 157 patients. Most GP referrals (91.9%) were for AoD problems, whereas nearly half the AoD service referrals were for other issues. The primary drugs of concern in the GP group were either opioids or non-opioids (mostly alcohol). The AoD service-referred patients were primarily using opioids. An ATOP was completed for 152 patients. At the time of referral, those in the GP-referred non-opioid group were significantly less likely to be abstinent, used their primary drug of concern more days and were more likely to be employed (all P < 0.001). A second ATOP was completed for 93 patients. These data showed a significant improvement in the number of days the primary drug of concern was used (P = 0.026) and trends towards abstinence, improved quality of life and physical and psychological well-being for patients in the program. There are few studies of GP-AoD collaborative care programs and nothing in the Australian context. This study suggests that GP-AoD collaborative care programs in Australia are feasible and improve drug use.

Clinical pharmacology-real basis of effi cient and inoff ensive pharmacotherapy

Clinical pharmacology play an important role in ensuring effective and inofensive pharmacotherapy. The administration of a adjusted treatment according to the pharmacokinetic and pharmacodynamic peculiarities of the drug, as well as the patient’s condition is indispensable. The rational use of medicines would increase the patient’s quality of life, as well as has important financial and public health benefits. Excessive, unreasonable prescription of drugs, polypharmacy, misuse of drugs, including expensive and unnecessary are the most common problems of irrational drug use. Many efforts have been made to improve drug use, but few evaluations have been carried out in this area. Identifying the problems that lead to irrational drug use and awareness of the importance of clinical pharmacology could ensure safe and effective pharmacotherapy.

The Effect of Educational Intervention on Rational Prescribing in Public Health Facilities in Selected Local Government Areas of Rivers State: An Interventional Study

Background: Despite progress made so far in identifying intervention models to improve drug use, irrational use of drugs has remained a serious global health problem. The study intends to determine the effectiveness of an educational intervention on rational prescribing among prescribers in selected local government areas of Rivers State.&#x0D; Methods: This was a quasi-experimental study that measured the effect of educational intervention on rational prescribing of drugs among prescribers in public health facilities in two selected Local Government Areas (LGA) of Rivers State: Ikwerre LGA (KELGA) which served as the control and Port Harcourt LGA (PHALGA) which served as the intervention by using cluster sampling with randomization. Paired data were analysed using McNemar’s Chi-square test and the paired t-test. The level of significance was set at P≤ 0.05. The EPI-INFO version 7.02 statistical software was used in the analysis.&#x0D; Results: Findings showed that the largest category of prescribers was nurse/midwives representing 48.61% and 44.4% in the intervention and control LGA respectively. There was an improvement in the knowledge and attitude of respondents in the facilities in the intervention LGA at one month and three months post-intervention (P&lt;0.05). The average number of drugs per encounter (ANDPE), the percentage encounters with an antibiotic (PEA), the percentage encounters with an injection (PEI) were lower for the interventions group compared to the control (P&lt;0.05). Percentage generic drug prescription (PGD) was higher in the intervention group compared to the control (P=0.001).&#x0D; Conclusion: Educational intervention was an effective and sustainable means of improving rational prescribing in the state. Update courses and continuing medical education on rational drug use should be held periodically for health care professionals by the State and National Primary Health Care Development Agency as well as other interested stakeholders.

DETERMINANTS OF SELF MEDICATION RATIONALITY IN PHARMACY VISITORS

Background: As a developing country, Indonesia has a high prevalence of self-medication, with a potential risk ofirrationally using drugs. Meanwhile, factors such as educational level, economic status, age, gender, knowledge level affects the rationality of drug use. Therefore, this study aims to analyze the factors related to the rationality of self-medication in order to improve drug use rationality in Indonesia. Method: An observational analysis study was used with a cross-sectional design involving 193 pharmacy visitors. Furthermore, this study was conducted in April-May 2018, and data were collected through guided interviews and filling out questionnaires for socio-demographic data, level of self-medicated knowledge, and drug use rationality. Also, sampling was done by consecutive non-random sampling, and data analysis used SPSS V.21, Chi-square and Fisher statistical tests with a significance level of 0.05. Results : Out of the 193 subjects, 59.6% were aged 17-25 years, 59.1% were female, 62.7% had moderate education level, 50.3% had moderate levels of self-medicated knowledge, and 70.5% were rational drug users. Based on the chi-square and fisher test, it was found that gender, educational and knowledge levels were significantly related to treatment rationality with a value of p = 0.014, p = 0.000, and p = 0.000. Conclusion:There was a significant correlation between gender, educational level and level of self-medicated knowledge of the drug use rationality. Keywords: self-medication, rationality, drugs

Prospective Study of Antibiotics Utilization in Multi-speciality hospitals in Narasaraopet at Guntur District, Andhra Pradesh

Drug use is a complex process uncertainties in diagnosis, treatment and medication adherence contribute to wide variations in the way drugs are used for any given conditions. In any country, a large number of sociocultural factors also contribute to the way drugs are used. In India, this include national drug policy, illiteracy, poverty, use of multiple health care systems, drug advertising and promotion, same of prescription drugs without prescription, competition in the medical and pharmaceutical marketplace and limited availability of and unbiased drug information. The complexity of drug use means that optimal benefits of drug therapy in patient care may not be achieved because of under use, over use or misuse of drugs. One method to evaluate and improved drug use is conducting drug use evaluation studies. Method: This study was prospective observational study in multi-specialty hospitals in Narasaraopet at Guntur district Andhra Pradesh Results: The study was conducted from August 2018 to Dec 2019 in various multi-specialty hospitals in Narasaraopet at Guntur district Andhra Pradesh. Total three departments we collected data Pediatrics, orthopedic, gynecology A total of 435 patients were participated in the current study out of 153 (35%) were males and 282 (65%) were females. In this study most common group antibiotics is cephalosporin’s 152 (34.9%) out of 435 of which mostly cefitriaxone are most commonly prescribed 70 (46%) Conclusion: Study provides the information about the prospective study of antibiotics utilization in multi-specialty hospital. It has helped to identify irrational prescribing patterns of drugs in various departments like pediatrics, gynaecology orthopedic.

Examination of the Influence of Cognitive Behavior Therapy Components, Consumer Satisfaction and Engagement in Mothers Referred for Drug Abuse and Child Neglect on Treatment Outcomes.

Psychological interventions for child maltreatment have predominately been limited to family-supported, multi-component behavioral therapies. Although these comprehensive programs have resulted in positive outcomes, they are relatively costly and there is limited information available as to how the components of these programs influence treatment outcomes. In this study, the CBT components of an evidence-based treatment for child neglect and drug abuse (Family Behavior Therapy) were examined in regards to consumer preferences, consumer engagement and treatment outcomes. Thirty-five mothers identified for child neglect and drug abuse were administered various CBT components successively and cumulatively based on their preferences. Repeated measure ANOVAs indicated that participants chose to receive components that were specific to managing antecedents to drug abuse and child neglect most frequently, followed by parenting skills training, communication skills training, and job/financial skills training. No differences were found in treatment providers' ratings of the participants' engagement across intervention components throughout treatment. Participants rated the intervention components as similarly helpful. Partial correlations revealed that participants' ratings of helpfulness and provider ratings of participants' engagement were not associated with improved drug use outcomes at 6- and 10-months post baseline. Participants' ratings of helpfulness were associated with child maltreatment outcomes at 10-month post baseline, and provider ratings of participants' engagement were associated with child maltreatment outcomes at both 6- and 10-month post baseline. Participants identified for neglect not related to drug exposure in utero improved at a higher percentage than did participants identified for in utero drug exposure, and receiving behavioral intervention components more frequently led to greater percentages of participants improving in both drug use and child maltreatment outcomes.

Implications of Drug Use Disorders on Spine Surgery

The opioid crisis has been declared a "public health emergency." Spine surgeons are treating more patients with substance use disorders (SUDs). To investigate the outcomes of patients with SUD who undergo spine surgery. A retrospective chart review was performed on patients with SUD who underwent nonelective spine surgery by orthopedic or neurosurgical staff from 2012 to 2017 at a level 1 trauma center and spine referral center. Three elective cases were excluded. A total of 49 patients undergoing 72 surgeries were reviewed. The most common substances of abuse were opioids (44/49 patients; 90%). Of 31 patients using multisubstances (63%), 29 misused opioids. The most common indications for surgery were infection (26/49, 53%), trauma (13/49, 27%), and myelopathy (7/49, 14%). Fusions (35/49, 71%) and irrigation and debridement surgeries (12/49, 24%) predominated. Twenty-nine percent (14/49) of patients had complications, the most common being hardware failure (7/49, 14%). Twenty percent (10/49) of patients left against medical advice and 22% (11/49) did not follow up after hospital discharge. The average length of hospital stay was 22 days. Forty-five percent (22/49) of patients were known to be in a drug program preoperatively versus 39% (19/49) postoperatively. Sixty-five percent (32/49) were prescribed opioids in the immediate postoperative period and 47% (23/49) continued to abuse drugs postoperatively. Patients with SUD are at increased risk of complications and inadequate follow-up. Additional studies are warranted to determine whether additional perioperative education, psychiatry consultations, or prescription of opioid addiction treatment regimens will improve drug use cessation and outcomes.

Feasibility and Preliminary Efficacy of Isradipine During Outpatient Buprenorphine Stabilization and Detoxification: A Pilot Randomized, Placebo-Controlled Trial.

Background:Given the immense burden of the widespread use of opioids around the world, exploring treatments that improve drug use outcomes, and craving and withdrawal measures in individuals with opioid use disorder is crucial. This pilot study examined the feasibility and preliminary efficacy of the L-type calcium-channel blocker isradipine (ISR) to improve drug use outcomes, and craving and withdrawal measures during buprenorphine (BUP)/ISR stabilization and subsequent taper in opioid-dependent individuals.Methods:Participants were stabilized on BUP sublingual tablets within the first 2 days of week 1, were then randomized and inducted on either ISR or placebo, gradually increasing the dose over the next 2 weeks, followed by a 10-day BUP taper during weeks 5-6, and ISR/placebo taper during weeks 7 to 8. Assessments included thrice-weekly measures of craving and withdrawal, as well as vital signs and urine drug screens. Medication compliance was assessed by monitoring number of missed clinic visit days.Results:Baseline characteristics of participants (n = 25; 60% male, 96% Caucasian, 48% employed, mean age 32.8 years) did not differ significantly between treatment groups (isradipine, n = 11; placebo, n = 14). During the stabilization phase (n = 19), ISR participants had significantly lower rates of illicit opioid-positive urines (treatment × visit: t = -2.16, P = 0.03), as well as reduction in craving intensity (t = –2.50, P = 0.01), frequency (t = –3.43, P < 0.01) and duration (t = –2.51, P = 0.01). ISR was well tolerated with mild adverse effects.Conclusions:This study was likely underpowered due to being a pilot trial. Although preliminary results suggest ISR may improve BUP-assisted treatment outcomes, concerns about high number of exclusions (n = 11 during taper phase) based on cardiovascular measures as well as ISR-induced changes in vital signs with the immediate release formulation may limit the feasibility of this approach.Trial Registration:Clinicaltrials.gov identifier NCT01895270. Registered 10 July 2013, https://clinicaltrials.gov/ct2/show/NCT01895270?id=NCT01895270&draw=2&rank=1

Profile of studies of potential drug interactions in Brazilian hospitals: an integrative review of the literature

The risk of drug interaction (DI), especially in the hospital setting, increases along with the number of drugs used by the patient. Studies that evaluate drug interactions based on patient prescriptions are therefore useful to know this risk and guide strategies to improve drug use. The present study is aimed to identify studies that evaluated DI in patients of Brazilian hospitals. As of bibliographic search in several databases, we collected articles describing prescribing evaluations which focused on the analysis and identification of drug interactions in Brazilian hospitals. The search was conducted in 2017 and there was no restriction of publication time. Of a total of 273 articles retrieved, 23 were included for analysis. Most was published after 2010, and the predominant design was cross-sectional studies. The Micromedex® database was the most used to categorize the interactions, and midazolam and fentanyl was the most commonly reported potential DI in the studies. The results may guide futures research which should assess the real harm of IMP in patients and, then, promote the rational use of drugs.

Self-assessment and subsequent external review as an effective model for improving drug use for elderly in primary care: A descriptive study of SÄKLÄK2.

Primary health care often has overall responsibility for elderly patients and their medication treatment. This is a challenging task due to the issue of multiple caregivers, different systems for documentation and multimorbidity among the elderly. The multiprofessional project SÄKLÄK2 was developed to raise drug safety in Swedish primary health care, and this study aimed to assess whether the action agreements that emerged from the model were effective enough to potentially improve drug use in elderly patients. The SÄKLÄK2 project was conducted during 2016. A total of 12 primary health care centres (PHCs) in three counties participated in the project. The intervention method concerned the management of the PHCs and comprised self-assessment, peer review, feedback, and written agreements for change, which were concluded between the reviewers and the manager of the PHC. The action agreements were analysed using summative content analysis (sorted under predesigned categories) and were also assessed as fulfilled, initiated, or not fulfilled within the follow-up time RESULTS: The importance of securing an accurate medication list was reflected in the number of action agreements in this area. Other prominent improvement areas were follow-up of prescriptions, pharmacogeriatric further education, and cooperation between caregivers. Action agreements to facilitate for the patient to be able to handle his/her drugs were also common. The great majority (88%) of the action agreements were implemented or initiated within the follow-up time. The SÄKLÄK2 intervention model is considered effective in setting up a variety of relevant measures to improve drug safety in primary health care, which are possible to implement in the near future. Hence, the model is regarded as effective and should therefore be offered in a wider context.

Employing online social networks in precision-medicine approach using information fusion predictive model to improve substance use surveillance: A lesson from Twitter and marijuana consumption

The impact that connected community have on precision health or medicine and vice versa offers opportunities for any type of research and survey information, e. g, to predict trends in health-related issues, specifically people behavior towards drug use. Here, precision medicine influences the way to treat the information and get a better outcome to support the stakeholder decision. Online social networks analysis seems to be good tools to quickly monitor the population behavior where users freely share large amounts of information related to their own lives on day- to- day basis. This novel kind of data can be used to get additional real time insights from people to understand their actual behavior related to drug use (Cortés et al., 2017). The aim of this research is to generated an information fusion model of marijuana use tendency confident enough to be employed by stakeholders. So, we will: (a) collect and process the data from Twitter; (b) design a set of algorithms to estimate the tendency of marijuana use in relation to age, localization and gender, moreover, used a set of processes and activities to verify if our model were performing as expected; and (c) fusion of the information in a model to fully characterize the marijuana use population comparable to the national marijuana consume survey for policy makers utilization to improve drug use prevention. First,we collect the data from Twitter accounts based in Chile using an algorithm for traversing graph data structures, we collected the data from Twitter accounts based in Chile. Then, we estimated marijuana user prevalence during a period from 2006 to 2018 and, within each of the years we predicted the prevalence of user population in relation with age (in range), the localization (regions) and gender. Finally, we built indicators to explore the similarity between data obtained through Twitter (our results) and the actual data collected by the National Service for the Prevention and Rehabilitation of Drug and Alcohol (SENDA) under the same variables analyze in their own survey. When we compare the results of the algorithms and methods developed by us with those provided by the SENDA, we observed that most of the indicators present similar trends, i.e., the variation of the prevalence by years in the age, location and gender, showed similar changes in both analyzes. Also, the algorithms effectiveness and capacity to predict variations of complex cases like marijuana use in Chilean population. This study is a key opportunity to obtain in a faster, low cost and continuous way information about marijuana use, also, is an excellent tool for marijuana surveillance to get information to support policy makers and stakeholder decisions.

Physician’s feedback on a clinical pharmacy program on geriatric wards

ABSTRACT Objectives As clinical pharmacy (CP) services can improve drug use and clinical outcome in older inpatients, a dedicated CP program was installed at the geriatric wards of an academic hospital. The aim of this study was to evaluate and potentially improve the CP program, by obtaining physician’s feedback. Methods An anonymous e-questionnaire was sent to all physicians who were active between October 2014 and March 2018 on the acute geriatric wards (80 beds) of the University Hospitals Leuven, Belgium. Thematic content analysis was applied. Six themes were defined: satisfaction with the service, time allocation of the clinical pharmacists, content and clinical relevance of pharmaceutical interventions, communication, time savings for the treating physician and future perspectives. Results A total of 45 physicians (59%) completed the e-questionnaire. All respondents were satisfied with the content of the provided pharmaceutical recommendations. A minority (44%) found that a 0.8 full-time equivalent clinical pharmacist presence was sufficient in terms of the expected workload. The provided CP interventions improved quality of care according to 38 (84%) physicians. Oral and written communication were considered necessary by 89% and 82% of physicians, respectively. On average, an estimated 30 minutes physician time (IQR: 15–60) per patient was saved as a result of the program. The majority (87%) preferred clinical pharmacist presence for discharge support in all geriatric patients. Conclusion Physician’s satisfaction with the CP service was very high. CP services in geriatric inpatients were perceived to be clinically relevant as well as time-saving by the involved physicians.

Pattern of Prescribing NSAIDs Utilisation at Outpatient Pediatric Poly at Universitas Sumatera Utara Hospital.

BACKGROUND:The wrong prescription pattern on NSAIDs also often results in side effects and drug interactions that cause serious and detrimental drug reactions. Drug use research is needed to describe the pattern of drug use, early signs of rational drug use, interventions to improve drug use, cycles of quality control, and continuous quality improvement.AIM:This study aimed to determine the prescribing pattern of NSAIDs at outpatient Pediatric Poly at Universitas Sumatera Utara Hospital, Medan, Indonesia in 2017.METHODS:This descriptive retrospective study was conducted from October to November 2016 with data from July and August 2017.RESULT:The study showed, outpatient of pediatric poly at Universitas Sumatera Utara Hospital in Medan there were 45,000 prescriptions, and 62 (0.15%) prescriptions contained NSAIDs. The most frequently prescribed NSAIDs 53 (85.48%) of prescriptions for outpatient pediatric poly was paracetamol. The most use of NSAIDs was consumed by a female in the age group of 3 years-12 years was 35 (58.06%). The highest frequency of NSAIDs utilisation was 7 days with 25 prescriptions (40.32%). There were 17 (27.42%) prescriptions with inappropriate dose, and the most widely prescribed dosage form was syrup for 34 (54.83%) prescriptions. The most duration of treatment with NSAIDs drugs which is paracetamol reached up to seven-days 25 (40.32%). The most frequently prescribed drugs 57 (91.93%) were generic drugs.CONCLUSION:It can be concluded that there are still inappropriate doses and frequency of NSAIDs utilisation.

Retrospective study of irrational prescribing in French paediatric hospital: prevalence of inappropriate prescription detected by Pediatrics: Omission of Prescription and Inappropriate prescription (POPI) in the emergency unit and in the ambulatory setting

Background and objectivePediatrics: Omission of Prescription and Inappropriate prescription (POPI) is the first detection tool for potentially inappropriate medicines (PIMs) and potentially prescribing omissions (PPOs) in paediatrics. The aim of...

Two decades of off-label prescribing in children: a literature review.

In the past two decades, many legislative and regulatory initiatives were taken globally to improve drug use in children. However, children are still found to be prescribed with off-label drugs. This study was conducted to provide an overview of the worldwide trend in off-label prescribing in children from the year 1996 to 2016. The articles published in PubMed, MEDLINE and Google Scholar were searched using text words: off-label, unlicensed, paediatric and children. Additional articles were identified by reviewing the bibliography of the retrieved articles. Full-text articles published in English which reported on the prevalence of off-label prescribing in children between January 1996 and December 2016 were included. A total of 101 studies met the inclusion criteria. Off-label prescribing definition included four main categories: age, indication, dose and route of administration. The three most common reference sources used in the studies were summary of product characteristics, national formularies and package inserts. Overall, the off-label prescribing rates in children ranged from 1.2 to 99.7%. The most common category of off-label prescribing in children was dose and age. This review highlighted that off-label prescribing in children was found to be highly prevalent throughout the past two decades, persistently in the neonatal intensive care units. This suggests that besides legislative and regulatory initiatives, behavioural, knowledge aspects and efforts to integrate evidence into practice related to off-label prescribing also need to be evaluated and consolidated as part of the concerted efforts to narrow the gaps in prescribing for children.