Respiratory Drugs Research Articles

Brain activity measured by functional brain imaging predicts breathlessness improvement during pulmonary rehabilitation

BackgroundChronic breathlessness in chronic obstructive pulmonary disease (COPD) is effectively treated with pulmonary rehabilitation. However, baseline patient characteristics predicting improvements in breathlessness are unknown. This knowledge may provide better understanding...

In vitro interactions of aerosol formulations with human nasal epithelium using real-time monitoring of drug transport in a nasal mucosa-on-a-chip

The current organ-on-chip platforms used for studying respiratory drug delivery are limited to the administration of drug solutions and suspensions, lacking the in vivo aerosol drug administration and aerosol interaction with the respiratory tract barrier. Moreover, they mostly rely on conventional assays that require sample collection and ‘off the chip’ analyses, which can be labor-intensive and costly. In this study, a human nasal epithelial mucosa (NEM)-on-a-chip is developed that enables the deposition of aerosolized nasal formulations while emulating realistic shear stresses (0.23 and 0.78 Pa), exerted to the inferior and middle turbinate of the human nasal cavity. Under these different dynamic conditions in the donor channel of the NEM-on-a-chip, the deposited dose of aerosols and particle size distributions varied. In addition, the increase in the shear stress to 0.78 Pa adversely affected the cells' viability, reflected by a 36.9 ± 5.4% reduction in the transepithelial electrical resistance. The epithelial transport profiles of aerosolized ibuprofen formulations under 0.23 Pa shear stress were successfully monitored in real-time by an electrochemical sensor embedded in the acceptor channel, where the NEM-on-a-chip was able to monitor the effect of permeation enhancer in the test formulation on the rate of drug transport. The novel NEM-on-a-chip can potentially be a promising physiologically relevant tool for reliable nasal aerosol testing in vitro.

Antibiotic Prescription in the Community-Dwelling Elderly Population in Lombardy, Italy: A Sub-Analysis of the EDU.RE.DRUG Study.

Inappropriate consumption and over-prescription of antibiotics have been extensively reported. Our aim was to specifically evaluate the antibiotic prescribing patterns and appropriateness among the elderly (≥65 years) from the Lombardy region (Italy) in primary care. Antibiotic consumption (as DID: DDD/1000 inhabitants × day) and prevalence rates in 2018 were assessed, and the prescribing quality was evaluated using ESAC-based indicators and WHO-AWaRe criteria. A multivariate logistic regression analysis was performed to evaluate the association between the probability of receiving an antibiotic prescription and patients’ and physicians’ characteristics. A total of 237,004 antibiotic users were included (mean age ± SD 75.98 ± 7.63; males 42.7%). Antibacterial consumption was equal to 17.2 DID, with values increasing with age in both males and females. The study found that the proportion of patients with at least one antibiotic prescription in 2018 was around 39.1%, with different age-related trends between males and females. Consumption (as DID) of cephalosporines (65–74 years: 1.65; 75–84 years: 2.06; ≥85 years: 2.86) and quinolones (3.88, 4.61, 4.96, respectively) increased with growing age, while consumption of penicillins (6.21, 6.08, 6.04, respectively) and macrolides, lincosamides, and streptogramins (3.25, 2.91, 2.64, respectively) decreased. In 2018, antibiotics considered to have higher toxicity concerns or resistance potential, as reported by WHO-AWaRe tool, were consumed more intensively than those to be used as first choices, independent of age and sex. The probability of receiving an antibiotic prescription was greater in females, in subjects with polypharmacy, in treatment with respiratory drugs, anti-inflammatory agents or glucocorticoids, and with previous hospitalization; but increasing age was less associated with exposition to antibiotics.

SUDDEN CARDIOVASCULAR COLLAPSE DUE TO CALCIUM CHANNEL BLOCKER OVERDOSE: SUCCESSFUL MANAGEMENT WITH HIGH-DOSE INSULIN EUGLYCEMIC THERAPY

SUDDEN CARDIOVASCULAR COLLAPSE DUE TO CALCIUM CHANNEL BLOCKER OVERDOSE: SUCCESSFUL MANAGEMENT WITH HIGH-DOSE INSULIN EUGLYCEMIC THERAPY

Adding Low-Dose Propofol to Limit Anxiety during Target-Controlled Infusion of Remifentanil for Gastrointestinal Endoscopy: Respiratory Issues and Safety Recommendations.

Backgroundand Objectives: Remifentanil-based sedation is one of many protocols proposed for endoscopy procedures in spontaneous ventilation, alone or in combination with propofol. However, the effect of these small doses of propofol on the efficacy and safety of remifentanil target-controlled infusion (TCI) deserves to be examined in this context. The objective of this study was to assess the adverse respiratory and cardiovascular effects of small boluses of propofol combined with remifentanil, in comparison with remifentanil alone, and balanced with the quality of sedation and recovery. Materials andMethods: This was an observational bicenter study, representing a subgroup of a larger study describing remifentanil-based procedural sedation. In center 1, patients scheduled for gastrointestinal (GI) endoscopy had remifentanil TCI alone. In center 2, patients had a 10 mg propofol bolus before TCI and other boluses were allowed during the procedure. Remifentanil TCI was started at a target of 2 ng/mL then adapted by 0.5 ng/mL steps according to patient response to endoscopy stimulations. Results: Center 1 included 29 patients, while center 2 included 60 patients. No difference was found in the patients’ characteristics, incidence of success, average remifentanil consumption, or cardiovascular variables. Light sedation was achieved when propofol was added. The incidence of respiratory events, such as bradypnea, desaturation < 90%, and apnea requiring rescue maneuvers, were significantly higher with propofol. Conclusions: Adding propofol boluses to a remifentanil TCI for GI endoscopy ensures light sedation that may be necessary for anxiolysis but increases respiratory events, even after administration of small-dose boluses. Its safety is acceptable if the procedure is performed in an equipped environment with sedation providers trained to manage respiratory events and drugs titrated to minimal doses.

Pictorial guide for variants of Covid-19: CT imaging and interpretation.

Typical radiologic images of Covid-19 pneumonia consists in a wide spectrum of chest manifestations, which range from peripheral predominant ground-glass opacities to an organizing pneumonia pattern, with additional features including crazy-paving, consolidations, fibrotic streaks and linear opacities. With variants imaging profile of Covid-19 evolves, producing relatively atypical/indeterminate CT pattern of pulmonary involvement, which overlap with imaging features of a variety of other respiratory diseases, including infections, drug reaction and hypersensitivity pneumonia. Our knowledge of these radiological findings is incomplete and there is a need to strengthen the recognition of the many faces of Covid-19 pneumonia.

Assessment of vaping devices as an alternative respiratory drug delivery system

The respiratory system has generated significant interest as an alternative drug delivery route. However, because of the limitations encountered with the present inhalation devices, alternative options could present an ideal opportunity to enhance therapeutic effectiveness and patient compliance. Vaping devices have been extensively used to deliver nicotine. This manuscript aimed to conduct an in vitro evaluation of the performance of commonly used vaping devices to assess their effectiveness in delivering fluticasone propionate (FP) to the lungs. Vaping devices were assessed for aerodynamic performance using the NGI. The e-liquid containing FP was made using glycerin and propylene glycol. The results showed the superiority of the vape-tank and vape-coil over the vape-pod. The vape-tank delivered the highest amount of nicotine. The e-liquid containing the FP was assessed and the results were compared with a marketed FP pressurized metered-dose inhaler (pMDI). The results of the respirable dose (RD) ranged from 22.10 µg for the vape pod, to 50.38 µg for the vape-tank; whereas the marketed pMDI value was 44.54 µg despite the lower content of FP per actuation in the vaping devices (100 µg versus 125 µg). Interestingly, the vaping devices showed a significantly lower level of oropharyngeal deposition than the pMDI (10% versus 50%), and hence, the potential for fewer side effects than those encountered with the chronic use of inhalers. Despite the effectiveness of the vape tank and coil in delivering a high percentage of FP, which makes them a promising alternative for delivering an effective yet user-friendly dosage of respiratory drugs, their safety and toxicity need to be established.

Anticholinergic burden in middle and older age is associated with reduced cognitive function, but not with brain volume.

BackgroundAnticholinergic drugs block muscarinic receptors in the body. They are commonly prescribed for a variety of indications and their use has previously been associated with dementia and cognitive decline. MethodsIn UK Biobank participants with linked health-care records (n=171,266, aged 40-71 at baseline), we calculated total anticholinergic drug burden according to 15 different anticholinergic scales and due to different classes of drugs. We then used linear regression to explore the associations between anticholinergic burden and various measures of cognition and structural MRI, including general intelligence, 9 separate cognitive domains, total brain volume, volumes of 68 cortical and 16 subcortical areas, and fractional anisotropy and median diffusivity of 25 white-matter tracts. ResultsAnticholinergic burden was modestly associated with poorer cognition across most anticholinergic scales and cognitive tests (6/9 FDR-adjusted significant associations, std. betas range: -0.033, -0.006). The association was mostly driven by antibiotics (std. beta=-0.029, 95% p&lt;0.001) and drugs to treat disorders of the nervous system (std. beta=-0.017, p&lt;0.001). Anticholinergic burden due to the pharmacological subclass of glucose-lowering drugs (beta=-0.038, p&lt;0.001) and the anatomical class of respiratory drugs (beta=0.016, p=0.03) was associated with total brain volume. However, anticholinergic burden was not associated with any other measure of brain macro- or microstructure (p&gt;0.07). DiscussionAnticholinergic burden is mildly associated with poorer cognition, but there is little evidence for an effect for measures of brain structure. Future studies might focus more broadly on polypharmacy or more narrowly on distinct drug classes, instead of using purported anticholinergic action to study the effects of drugs on cognitive ability.

Impact of the COVID-19 pandemic on antiviral drug development for other community-acquired respiratory viruses’ infections

The coronavirus disease 2019 (COVID-19) pandemic indirectly resulted in missed therapeutic opportunities for many diseases. Here we focus on community-acquired respiratory viruses other than severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) [respiratory syncytial virus, parainfluenza and influenza A], and highlight the pandemics impact on clinical trials to develop novel therapies for other severe respiratory viral infections. We retrospectively reviewed inclusion rates within respiratory antiviral clinical trials in comparison with all other clinical trials in our clinical investigations center, before and during the COVID-19 pandemic. As opposed to the remaining clinical trials developed within our unit, respiratory antiviral trials inclusion rates did not recover after the initial recruitment decrease observed across all trials during the first pandemic wave. These results were discussed in the context of non-COVID-19 respiratory viral infection rates within our center, showing a general decline in seasonal respiratory viruses spread since the COVID-19 pandemic onset. Virus epidemiology changes upon the wide SARS-CoV-2 expansion as well as the lifestyle changes globally adopted to prevent SARS-CoV-2 transmission could have therefore contributed to the negative impact of the COVID-19 pandemic on antiviral drug development. Our study highlights the peculiarity of respiratory antiviral drug development during the COVID-19 pandemic era and describes potential explanations for such drug development halting.

Comparison of prices of commonly used drugs in AMRIT pharmacy, Jan Aushadhi Centre and Private chemist shop: An analytical study from a tertiary care centre in Haryana

Background: The price of medicine in India has always been a point of discussion in public domain. The price range of the same drug is very large with more than 100% difference between various brands available in different settings. Aims and Objectives: To assess the price of different drugs at Jan Aushasdhi (JA), AMRIT and Private Chemist and to compare the prices of these three outlets so that the issues. Material and Methods: This institution-based cross-sectional study was carried out from May 2019 to June 2019. A pretested proforma was prepared to compare the prices of 284 different medicines in Jan Aushadhi, AMRIT and private chemist shops. The collected data were entered in an Excel spreadsheet and presented in Proportions, percentages, and mean. Results: The price of 284 medicines were compared from JA (Median(IQR)- 15.18(18.75) INR) and Private chemist shop (Median(IQR)-88(111.5) INR) while 249 medicine from AMRIT (Median(IQR)-61.05(78.33) INR). Although the majority of the AMRIT drugs are cheaper than the chemist shop except for 31% of Antipsychotic drugs, 26.6% of antihypertensives, 25% of respiratory drugs, 25% of steroids, 21.9% of antibiotics. Conclusion: We concluded that JA is providing drugs cheaper than AMRIT and Private chemist . The prices of medicines offered at AMRIT are lower than market pricing but they are costlier when compared to JA prices.

Substance Abuse and Rural Appalachian Pediatric Trauma in West Virginia.

Introduction Rural Appalachia is endemic to issues such as substance abuse, poverty, and lack of community support, all of which negatively influence health outcomes. The incidence of pediatric trauma as it relates to substance abuse is of concern in the region, where the rate of positive drug screens in pediatric trauma cases is higher than national average. Methods The West Virginia statewide pediatric trauma database was analyzed in a retrospective cohort study for the years 2009-2019. Variables of interest included injury severity (assessed using Abbreviated Injury Scale (AIS)), drug screening results, and various measures of patient outcome. Results The sample was divided into 2009-2016 presentations (n = 3,356) and 2017-2019 presentations (n = 1,182). Incidence of critical (AIS 5) head injuries (p = 0.007) and serious (AIS 3) neck injuries (p = 0.001) increased as time progressed. Days requiring ventilation increased from 3.1 in 2009–2016 to 6.3 in 2017–2019 (p < 0.001). Drug screens were obtained at a rate of 6.9% in 2009–2016 versus 23.3% in 2017–2019 (p < 0.001). Benzodiazepine use increased from 0.8% to 1.8% (p < 0.001), and opioid use increased from 1% to 4.9% (p < 0.001). Conclusion The increasing severity of pediatric trauma and substance abuse in Appalachia is of significant concern. The use of respiratory drive-depressing drugs has risen, just as the severity of head and neck traumas has increased. These results emphasize the importance of targeted interventions in the rural pediatric population.

Profile of Prescribing COVID -19 Drug Therapy in Inpatients At Jakarta Haji Hospital

Severe acute respiratory syndrome coronavirus-2 (SARS-nCoV-2) the cause of Coronavirus Disease 2019 (COVID-19) was first discovered in Wuhan on December 2019, has spread throughout the world. Each country tries to develop treatment protocol guidelines following the latest research developments to increase the cure rate due to the absence of standard guidelines.The purpose of this research is to knowing the profile of prescribing COVID-19 drug therapy in inpatients at jakarta haji hospital the period September 2020-February 2021. This research is non-experimental with quantitative descriptive study design was taken retrospectively using secondary data in the form of prescription data history of COVID-19 patient visits recorded on the system with sampling techniques that is total sampling. The results showed that in total 387 COVID-19 patients the most were 46-65 years oldwith 198 patients and the mostly malewith 212 patients. The longest duration of treatment was 3-10 days as many as 246 patients and the highest degree of disease was mild to moderate as many as 363 patients The most widely prescribed drugs were Paracetamol (84.37%), Dexamethasone (78.4%), Osetalmivir (74.1%), Heparin (67.81%), Alprazolam (60.27%), Acetylsitein (58 ,12%), Insulin (54.93%), CTM (53.13%), Amlodipine 50.43%, Vitamin C (48.04%), Levofloxacin (35.48%), and Omeprazole (31.98 %). COVID-19 patients at the Jakarta Haji Hospital receive the main therapies, namely vitamins, antibiotics, antivirals, respiratory drugs, gastrointestinal drugs. The suitability of prescribing drug therapy classes based on the guidelines for the management of COVID-19 is 83% and those that are not in accordance with the guidelines are 27%.

Synthesis of a Respiratory Syncytial Virus Drug Candidate

Synthesis of a Respiratory Syncytial Virus Drug Candidate

A Survey of Prescription Errors in Paediatric Outpatients in Multi-Primary Care Settings: The Implementation of an Electronic Pre-Prescription System.

BackgroundPrescription errors impact the safety and efficacy of therapy and are considered to have a higher impact on paediatric populations. Nevertheless, information in paediatrics is still lacking, particularly in primary care settings. There exists a need to investigate the prevalence and characteristics of prescription errors in paediatric outpatients to prevent such errors during the prescription stage.MethodsA cross-sectional study to evaluate paediatric prescription errors in multi-primary care settings was conducted between August 2019 and July 2021. Prescriptions documented within the electronic pre-prescription system were automatically reviewed by the system and then, potentially inappropriate prescriptions would be reconciled by remote pharmacists via a regional pharmacy information exchange network. The demographics of paediatric patients, prescription details, and types/rates of errors were assessed and used to identify associated factors for prescription using logistic regression.ResultsA total of 39,754 outpatient paediatric prescriptions in 13 community health care centres were reviewed, among which 1,724 prescriptions (4.3%) were enrolled in the study as they met the inclusion criteria. Dose errors were the most prevalent (27%), with the predominance of underdosing (69%). They were followed by errors in selection without specified indications (24.5%), incompatibility (12.4%), and frequency errors (9.9%). Among critical errors were drug duplication (8.7%), contraindication (.9%), and drug interaction (.8%) that directly affect the drug's safety and efficacy. Notably, error rates were highest in medications for respiratory system drugs (50.5%), antibiotics (27.3%), and Chinese traditional medicine (12.3%). Results of logistic regression revealed that specific drug classification (antitussives, expectorants and mucolytic agents, anti-infective agents), patient age (<6 years), and prescriber specialty (paediatrics) related positively to errors.ConclusionOur study provides the prevalence and characteristics of prescription errors of paediatric outpatients in community settings based on an electronic pre-prescription system. Errors in dose calculations and medications commonly prescribed in primary care settings, such as respiratory system drugs, antibiotics, and Chinese traditional medicine, are certainly to be aware of. These results highlight an essential requirement to update the rules of prescriptions in the pre-prescription system to facilitate the delivery of excellent therapeutic outcomes.

CARDIAC ARRHYTHMIA AND HEMODYNAMIC EFFECTS DURING FIBEROPTIC BRONCHOSCOPY

Background: Arterial hypoxaemia is the commonest complication, since respiratory depressant drugs are used for premedication, and the airway is also partially occluded by the bronchoscope. The study is therefore designed to nd out the changes in arterial oxygen tension during FOB along with effect on central hemodynamics, electrocardiographically. Objectives: · To nd out the changes in arterial oxygen tension during FOB. · To study the effects of beroptic bronchoscopy on central hemodynamics, electrocardiographically. Methods: 100 patients aged 20 years and above undergoing FOB were evaluated for the arterial oxygen tension and cardiac rhythm changes at KNCH, Jodhpur. Results: All patients developed a fall in PaO2 following FOB which was highly signicant but hypoxaemia was noted only in 18 cases. There was a uniform rise in heart rate in all the patients after FOB which was statistically signicant. There was slight sinus tachycardia in most of the cases although E.C.G. indicated no major arrhythmias. There was no signicant change in pH level. Mean of SBP and mean of DBP was statistically signicant. Conclusion: All patients showed a decline in arterial PaO2 after FOB which was highly signicant. There was slight sinus tachycardia in most of cases. FOB itself does not endanger the patients with any signicant or serious complications.

PEAK EXPIRATORY FLOW RATE CHANGES AND HYPOXEMIA DURING FIBEROPTIC BRONCHOSCOPY

Background: Arterial hypoxaemia is the common complication, since respiratory depressant drugs are used for premedication, and the airway is also partially occluded by the bronchoscope. The study is therefore designed to nd out the changes in arterial oxygen tension and PEFR during FOB. Objectives: Ÿ To nd out the changes in arterial oxygen tension and in peak expiratory ow rate during FOB. Methods: 100 patients aged 20 years above undergoing FOB were evaluated for the arterial oxygen tension and peak expiratory ow rate changes at KNCH, Jodhpur. Results: All patients developed a fall in PaO2 following FOB but hypoxemia was noted only in 18 cases. The change in PEFR after FOB, no signicant statistical difference could be observed on statistically comparison. Conclusion: All patients showed a decline in arterial PaO2 after FOB which was highly signicant. FOB itself does not causes any signicant or serious complications.

Immunoallergic disorders in the elderly.

Although allergic diseases have become increasingly prevalent in the elderly, there are few data on this population. Through a retrospective analysis of the electronic medical records of patients aged 65 years and above followed in our Immunoallergology Unit, we aimed to characterize the immunoallergic diseases of the elderly. The most common disorders were respiratory diseases (n = 185; 50%), mucocutaneous diseases (n = 113; 31%), drug allergy (n = 31; 8%), food allergy (n = 9; 2%), and anaphylaxis (n = 9; 2%). Use of specific immunotherapy was residual (n = 2; 1%). There was an association between anaphylaxis and both, drug (p = 0.004) and food (p = 0.013) allergies. Non-allergic rhinitis and bronchial asthma were more frequent in females, and ACE inhibitors/ARB induced-angioedema in males. Recognizing the characteristics of immunoallergic diseases in the elderly and the specificities of this age group is paramount in providing these patients with the best possible care.

HYPOXEMIA AND LUNG MECHANICS DURING FIBEROPTIC BRONCHOSCOPY

Background: Arterial hypoxaemia is the common complication, since respiratory depressant drugs are used for premedication, and the airway is also partially occluded by the bronchoscope. The study is therefore designed to nd out the changes in arterial oxygen tension and PFTduring FOB. Objectives: To nd out the changes in arterial oxygen tension and pulmonary function tests during FOB. Methods: One hundred patients aged 20 years above undergoing FOB were evaluated for the arterial oxygen tension and pulmonary function tests changes at KNCH, Jodhpur. Results: All patients developed a fall in PaO2 following FOB but hypoxemia was noted only in 18 cases. Bronchial washing, punch biopsy and brush biopsy did contribute to hypoxemia signicantly. The pulmonary functions which include change in V.C, FVC, FEV1 and PEFR after FOB, no statistical difference could be observed on statistically comparison. Conclusion: All patients showed a decline in arterial PaO2 after FOB which was highly signicant. FOB itself does not cause any signicant or serious complications.

Sex-Related Differences in Pharmacological Response to CNS Drugs: A Narrative Review

In the last decades, both animal and human studies have neglected female subjects with the aim of evading a theorized intricacy of feminine hormonal status. However, clinical experience proves that pharmacological response may vary between the two sexes since pathophysiological dissimilarities between men and women significantly influence the pharmacokinetics and pharmacodynamics of drugs. Sex-related differences in central nervous system (CNS) medication are particularly challenging to assess due to the complexity of disease manifestation, drugs’ intricate mechanisms of action, and lack of trustworthy means of evaluating the clinical response to medication. Although many studies showed contrary results, it appears to be a general tendency towards a certain sex-related difference in each pharmacological class. Broadly, opioids seem to produce better analgesia in women especially when they are administered for a prolonged period of time. On the other hand, respiratory and gastrointestinal adverse drug reactions (ADRs) following morphine therapy are more prevalent among female patients. Regarding antidepressants, studies suggest that males might respond better to tricyclic antidepressants (TCAs), whereas females prefer selective serotonin reuptake inhibitors (SSRI), probably due to their tolerance to particular ADRs. In general, studies missed spotting any significant sex-related differences in the therapeutic effect of antiepileptic drugs (AED), but ADRs have sex variations in conjunction with sex hormones’ metabolism. On the subject of antipsychotic therapy, women appear to have a superior response to this pharmacological class, although there are also studies claiming the opposite. However, it seems that reported sex-related differences regarding ADRs are steadier: women are more at risk of developing various side effects, such as metabolic dysfunctions, cardiovascular disorders, and hyperprolactinemia. Taking all of the above into account, it seems that response to CNS drugs might be occasionally influenced by sex as a biological variable. Nonetheless, although for each pharmacological class, studies generally converge to a certain pattern, opposite outcomes are standing in the way of a clear consensus. Hence, the fact that so many studies are yielding conflicting results emphasizes once again the need to address sex-related differences in pharmacological response to drugs.

Tools for Identifying Potentially Inappropriate Prescriptions for Children and Their Applicability in Clinical Practices: A Systematic Review

Background: Drug use safety in children is a global public health problem. The potentially inappropriate prescription screening tools are expected to reduce adverse drug reactions and promote rational drug use. Objectives: To systematically evaluate children’s potentially inappropriate prescription screening tools and validation studies on these tools. Methods: We systematically searched six databases PubMed, Embase, Cochrane Library, CNKI, VIP and Wanfang Data. Two reviewers independently selected articles by the eligible criteria and extracted data. Then we evaluated the coverage of diseases or drugs in these tools and the consistency of items between tools. Results: Five children’s potentially inappropriate prescription screening tools were identified, most tools were formed by Delphi expert consensus and focused on respiratory system drugs, anti-infective drugs, and gastrointestinal drugs. The coincidence rates of items between the POPI and the POPI Int, the POPI and the POPI United Kingdom, the POPI United Kingdom and the POPI int, and the POPI United Kingdom and the PIPc were 82.0, 55.1, 51.0 and 2.2% respectively, and the KIDs List did not overlap other four tools. Only the POPI tool developed by French experts was comprehensively validated by studies and most tools have not been validated. Conclusion: The development of screening tools for potentially inappropriate prescribing in children is a neglected field and most tools lack studies to validate clinical applicability. More researchers need to form their national potentially inappropriate prescription screening tools for children based on the best available clinical evidence and the actual clinical situation in their countries.