Prescriptions For Pediatric Patients Research Articles

Treatment of systemic lupus erythematosus: Analysis of treatment patterns in adult and paediatric patients across four European countries

ObjectiveMultiple treatment options are recommended for Systemic Lupus Erythematosus (SLE) by clinical guidelines. This study aimed to explore SLE treatment patterns as there is limited real-world data of SLE medication utilisation, especially in childhood-onset SLE (cSLE). MethodsWe conducted a longitudinal cohort study using five routinely collected healthcare databases from four European countries (United Kingdom, France, Germany, and Spain). We described the characteristics of adult and paediatric patients at time of SLE diagnosis. We calculated the percentage of patients commencing SLE treatments in the first month and year after diagnosis, reported number of prescriptions, starting dose, cumulative dose, and duration of each treatment, and characterised the line of therapy. ResultsWe characterised 11,255 patients with a first diagnosis of SLE and included 5718 in our medication utilisation analyses. The majority of adult SLE patients were female (range 80–88 %), with median age of 49 to 54 years at diagnosis. In the paediatric cohort (n = 378), 66–83 % of SLE patients were female, with median age of 12 to 16 years at diagnosis. Hydroxychloroquine and glucocorticoids were common first-line treatments in both adults and children, with second-line treatments including mycophenolate mofetil and methotrexate. Few cases of monoclonal antibody use were seen in either cohort. Initial glucocorticoid dosing in paediatric patients was often higher than in adults. ConclusionTreatment choices for adult SLE patients across four European countries were in line with recent therapeutic consensus guidelines. High glucocorticoid prescriptions in paediatric patients suggests the need for steroid-sparing treatment alternatives and paediatric specific guidelines.

Perceptions and experiences of community pharmacists with off-label prescribing in the pediatric population.

This study aimed to investigate and provide insight into the prevalence and patterns of off-label drug use in the pediatric population from the perspective of community pharmacists, addressing the existing data gap in a developing setting. A questionnaire-based cross-sectional study was conducted on Albanian community pharmacists in June 2021. The online administered survey explored the participants' demographic details, perceptions, and experiences with off-label prescriptions in pediatric patients. The statistical analysis conducted on the survey data comprised the construction of frequency tables and the application of the chi-square test for independence. Three hundred and thirty-six community pharmacists nationwide completed the survey, out of which 186 (55.3%) were practiced in Tirana, the capital of Albania. Over 80% of surveyed pharmacists (n = 275) had encountered off-label drug prescriptions in pediatric patients, yet only 40% of participants reported dispensing medicines for off-label use. Community pharmacists reported that general pediatricians tended to prescribe off-label medications more frequently than pediatric subspecialists or general practitioners. It was found that off-label prescriptions were more frequently observed among children aged between 2 and 11 years. Antibiotics were the most reported medicines for off-label use in this study mentioned in almost all off-label categories. Prescribing medicines for unapproved uses for the treatment of pediatric patients is present in community settings in Albania. This indicates the need for further data collection and analysis to understand off-label practices in our country's pediatric population comprehensively.

POLA PERESEPAN ANTIBIOTIK PADA PASIEN ANAK DENGAN INFEKSI PERNAPASAN AKUT

Prescriptions for children who experience upper and lower acute respiratory infections (ARI), such as the common cold, rhinitis, sinusitis, pharyngitis and tonsillitis, are carried out according to the pattern. The study aimed to determine the pattern of antibiotic prescribing in pediatric ARI patients at the Karadiri Community Health Center, Nabire Regency. This type of descriptive research uses secondary data, namely medical records of antibiotic prescriptions in pediatric patients with ARI. The sample was all medical records of pediatric patients treated with ARI at the Karadiri Community Health Center, Nabire Regency, totaling 92 respondents. Sample selection with inclusion criteria is complete data, residents who live in the work area of the health center, and exclusion is incomplete data and non-residents who are disabled in the work area of the health center. The instrument uses an observation sheet. The results showed that the majority of ARI patients were aged 2-5 years (85%) and male (54%). The antibiotics used were amoxicillin in 58 patients (63%), followed by Co-trimoxazole in 25 (27%), Erythromycin in 9 (10%). The most commonly prescribed antibiotic dose was amoxicillin 66.7 mg (32%) with 24 prescriptions (26%). The duration of antibiotic administration was 5 days for 89 prescriptions (97%), with 67 prescriptions (75%) meeting the guidelines. In conclusion, the prescription of antibiotics for pediatric patients with ARI is not fully in accordance with the guidelines, namely the duration is 4 days and the dose follows the patient's body weight.

Society for Education and the Advancement of Research in Connected Health SEARCH 2022 – The National Telehealth Research Symposium Abstracts Virtual Meeting November 16–18, 2022

Society for Education and the Advancement of Research in Connected Health SEARCH 2022 – The National Telehealth Research Symposium Abstracts Virtual Meeting November 16–18, 2022

Prescribing Patterns in a Primary Care Service in a Rural Site in the Philippines from April 2019 to March 2020 - A Cross-sectional Study.

Appropriate use of medication is an important indicator of quality healthcare delivery among children. Previously published studies on drug utilization involved Filipino households in general and were conducted in the 1990s. No recent Philippine studies have been conducted that focus on drug utilization in children. To describe the current prescribing patterns in one primary care service in a rural site in the Philippines using the World Health Organization (WHO) prescribing indicators. A cross-sectional study was conducted by review of electronic medical records of patients seen at the primary care facility under the Philippine Primary Care Studies (PPCS) rural site from April 2019 to March 2020. Out of 9,930 total encounters, 623 patient encounters with prescriptions for pediatric patients were included in the study through systematic sampling. The average number of drugs per encounter, percentage of drugs prescribed by their generic names, percentage of encounters with prescribed antibiotics, percentage of encounters with prescribed injections, and percentage of drugs prescribed from the Philippine Drug Formulary were calculated. Values were compared to the cut-offs considered "good practice" for outpatient care in the WHO manual: (1) an average number of less than two drugs per encounter; (2) less than 30% of encounters are prescribed with antibiotics; (3) less than 20% of encounters are prescribed with injections; (4) 100% of drugs are prescribed by generic name; and (5) 100% of drugs are from the formulary. On the average, three drugs were prescribed per encounter. Most patient encounters (80.9%) involved antibiotics prescription - higher than the WHO standard value of 30%. All drugs were prescribed by generic name and were prescribed from the formulary. Only 0.5% of encounters were prescribed injections, all of which were administered through the intramuscular route. Of the 1,962 prescriptions generated, antibiotics was the most prescribed medication (25.7%). The most common diagnosis was infectious in nature (88.8%). The primary care service achieved the WHO standard values in terms of prescribing by injections and by generic names. There was a high rate of antibiotic prescriptions at 83%, and a high average number of drugs prescribed per encounter, exceeding the WHO standard value.

Antimicrobial Stewardship Strategies Including Point-of-Care Testing (POCT) for Pediatric Patients with Upper-Respiratory-Tract Infections in Primary Care: A Systematic Review of Economic Evaluations.

Upper-respiratory-tract infections (URTIs) are among the main causes of antibiotic prescriptions in pediatric patients. Over one-third of all antibiotic prescriptions for URTIs in children are estimated to be inappropriate, as the majority of URTIs are caused by viral agents. Several strategies, including clinical scoring algorithms and different point-of-care tests (POCTs) have been developed to help discriminate bacterial from viral URTIs in the outpatient clinical setting. A systematic review of the literature was conducted following PRISMA guidelines with the objective of summarizing evidence from health–economic evaluations on the use of POCT for URTIs in pediatric outpatients. A total of 3375 records identified from four databases and other sources were screened, of which 8 met the inclusion criteria. Four studies were classified as being of high reporting quality, and three were of medium quality. Five out of eight studies concluded in favor of strategies that included POCTs, with an additional study finding several POCTs to be cost-effective compared to usual care but over an acceptable WTP threshold. This review found POCT could be a valuable tool for antimicrobial stewardship strategies targeted towards childhood URTIs in primary care.

Clinical Correlates of Opioid Prescription Among Pediatric Patients With Chronic Pain

Up to 17%-20% of pediatric patients with chronic pain are prescribed opioid pharmacotherapy and face an increased risk of opioid misuse in adulthood. Little is known about the way clinical presentation may influence which children with chronic pain are prescribed opioids. This study examines the associations between child's and caregiver's report of child's pain, physical function, and socioemotional indices with opioid prescriptions in pediatric patients initiating treatment for chronic pain. Participants were 1,155 pediatric patients (71.26% female, n=823) aged 8-17 years and 1 of their caregivers (89% mothers) who presented for evaluation at a tertiary care pediatric pain clinic. Data were collected from 2015 to 2019 and analyzed in 2020. Binary logistic regression analyses investigated the relative contribution of child's demographic, pain, and Patient-Reported Outcome Measurement Information System measures to opioid prescription status; separate models were conducted for child's and caregiver's report. Across child and caregiver models, findings were that child's age (older), pain duration (longer; child's report only), and increased physical limitations (mobility challenges and pain interference; caregiver's report only) were the most salient clinical correlates of positive opioid status. Contrary to the existing literature on adults with chronic pain, socioemotional indices (anxiety, depression, peer functioning) were nonsignificant. A greater understanding of how clinical presentation may relate to prescribed opioid pharmacotherapy informs the field's conceptualization of the sequelae of opioid use and misuse in the context of pediatric chronic pain.

PHP117 - TRENDS OF PRESCRIPTION FOR OFF-LABEL DRUGS IN KOREAN PEDIATRIC PATIENTS USING CLAIMS DATA: WITH A FOCUS ON CLINICAL AREAS AND PRIMARY DISEASES

Lots of drugs are commonly prescribed in an off-label manner to pediatric patients under 19 years old in the real practices. The main purpose of this study is to investigate off-label prescription patterns for those patients, using some real-world data in Korea. Nine drugs frequently used in the pediatric clinical practices were selected: Carvedilol, Dopamine, Domperidone Maleate, Enalapril, Levetiracetam, Levodopa/Carbidopa complex, Mosapride Citrate Hydrate, Ramosetron, and Sildenafil. Using the Korean Health Insurance Review and Assessment Service database based on claims data from 2010 to 2015, we examined the main clinical areas and the primary diseases for off-label uses of those drugs in children. Approximately 96% of the total 23,387,281 prescriptions in pediatric patients for the nine study medications were off-label. Those drugs were prescribed most frequently at the departments of pediatrics or internal medicine ranged between 43.4% and 93.2%. Some drugs were also used often in surgical departments: Thoracic surgery (22.5%) for Dopamine; Neurosurgery (35.3%) for Levetiracetam; Orthopedics (27.2%) for Ramosetron. Dopamine was primarily used in conditions originating in the perinatal period (35.2%) or for congenital malformations, deformations, and chromosomal abnormalities (32.4%). Levetiracetam was prescribed to treat disease of the nervous system (22.1%) and convulsions (20.6%), and Ramosetron was confirmed 31.7% use in diseases of digestive system. The administration of off-label drugs is out-of-pocket in principle; however, over 22 million off-label prescriptions were still claimed to the health insurance in Korea. More flexible coverage policies need to be considered for some off-label drugs, especially for those without substitutes or in emergency care.

Lebanese Registry in the Management of Antibiotic Associated Diarrhea in Children: Observational Study in Daily Practice

Background: Antibiotic-associated diarrhea (AAD) is a common complication in patients prescribed antibiotics, and represents an economic and health burden. Evidence that probiotics may be beneficial for the prevention of AAD is increasing. The aims of this registry were to assess the prevalence of probiotic prescriptions in pediatric patients for whom an antibiotic treatment regimen was prescribed, and to explore the potential health benefits that such an administration may provide. Methods: This longitudinal, multicenter, observational study enrolled 249 pediatric patients prescribed an antibiotic treatment for 5 - 14 days, with or without a concomitant probiotic. The number of probiotic-administered patients, and AAD incidence rates throughout the 15-day follow-up period, were assessed. Results: Of the 246 patients who met inclusion/exclusion criteria in Lebanon, the investigators had prescribed an additional probiotic treatment to 118 (48%) of them, while, the other 128 (52%) did not receive such additional treatment. A significantly higher number of patients in the probiotic group were at high risk of developing diarrhea (probiotic: 27.1% vs. no probiotic: 6.3%; P < 0.001). Among high risk patients, the frequency of diarrhea was doubled in the group with no probiotics (probiotic: 21.9% (n = 7) vs. no probiotic: 50.0% (n = 4); P = 0.182). Despite the significantly larger number of probiotic-administered patients that were at high risk of developing diarrhea, the proportion of patients who reported developing diarrhea was not statistically different between the two groups (probiotic: n = 22 (18.6%) vs. no probiotic: n = 24 (18.8%); P = 0.983). Conclusions: In conclusion, this Lebanese disease registry demonstrated that almost half of pediatric patients with mild to moderate infections were prescribed probiotics in combination with antibiotics to decrease the risk of AAD. This observation was particularly significant in the high risk population as per the treating physicia n’ s judgment. Int J Clin Pediatr. 2017;6(1-2):8-19 doi: https://doi.org/10.14740/ijcp269w

Unlicensed and off-label drug use in a Swiss paediatric university hospital.

Many medicines used in newborns, infants, children and adolescents are not licensed ("unlicensed") or are prescribed outside the terms of the marketing authorization ("off-label"). Several studies have shown that this is a common practice in various healthcare settings in the USA, Europe and Australia, but data are scarce in Switzerland. The aim of our prospective study was to determine the proportion of unlicensed or off-label prescriptions in paediatric patients. This pilot study was conducted prospectively over a six month period in the department of paediatrics of a university hospital. Sixty patients aged from three days to 14 years were included in the study. A total of 483 prescriptions were written for the patients. More than half of all prescriptions (247; 51%) followed the terms of the marketing authorization. 114 (24%) were unlicensed and 122 (25%) off-label. All patients received at least one unlicensed or offlabel medicine. The use of unlicensed or off-label medicines to treat children was found to be common. Co-operation between the pharmaceutical industry, national regulatory authorities, clinical researchers, healthcare professionals and parents is required in order to ensure that children do not remain "therapeutic orphans".

Unlicensed and off-label drug use in a Swiss paediatric university hospital.

Many medicines used in newborns, infants, children and adolescents are not licensed ("unlicensed") or are prescribed outside the terms of the marketing authorization ("off-label"). Several studies have shown that this is a common practice in various healthcare settings in the USA, Europe and Australia, but data are scarce in Switzerland. The aim of our prospective study was to determine the proportion of unlicensed or off-label prescriptions in paediatric patients. This pilot study was conducted prospectively over a six month period in the department of paediatrics of a university hospital. Sixty patients aged from three days to 14 years were included in the study. A total of 483 prescriptions were written for the patients. More than half of all prescriptions (247; 51%) followed the terms of the marketing authorization. 114 (24%) were unlicensed and 122 (25%) off-label. All patients received at least one unlicensed or offlabel medicine. The use of unlicensed or off-label medicines to treat children was found to be common. Co-operation between the pharmaceutical industry, national regulatory authorities, clinical researchers, healthcare professionals and parents is required in order to ensure that children do not remain "therapeutic orphans".