Artikel
Drug utilisation patterns in hospitalised children and adolescents: an international perspective
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Autoren
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Asia N. Rashed
- Institute of Pharmaceutical Science, King’s College London, King’s Health Partners, London, United Kingdom
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Sebastian Botzenhardt
- Department of Paediatric and Adolescent Medicine, University Hospital Erlangen, Erlangen, Germany
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Ian C. K. Wong
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
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Stephen Tomlin
- Evelina Children’s Hospital, Guy’s & St. Thomas’ NHS Foundation Trust, King’s Health Partners, London, United Kingdom
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Antje Neubert
- Department of Paediatric and Adolescent Medicine, University Hospital Erlangen, Erlangen, Germany
| Veröffentlicht: | 18. November 2014 |
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Gliederung
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Background: Data on drug use in hospitalised children are limited and comparison of this data is difficult since the majority of published studies originate from primary care. The aim was to investigate and compare the drug prescribing patterns in paediatric inpatients in five countries using a standardised protocol and terminologies.
Materials and Methods: This prospective cohort study was conducted on paediatric medical wards in UK, Germany, Australia, Hong Kong (HK), and Malaysia. Data were collected over three months. All drugs prescribed were classified according to the WHO Anatomical Therapeutic Chemical (ATC) classification system. For each drug, frequency of prescriptions and patients’ exposures were calculated for ATC anatomic and therapeutic levels overall and by country. Dosing regimens were analysed for the most frequently used drug groups.
Results: A total of 1278 patients [55.2% male, median age 2 years (IQR 0-7)] were included (Australia n=146, Germany n=376, UK n=313, HK n=143, Malaysia n=300). 89.2% of patients (n=1140) received medications with 5367 prescriptions issued [median 3 per patient (IQR 2-5)].
The three most frequently prescribed therapeutic groups accounted for 55.9% (n=2999) of all prescriptions: systemic antibacterials (n=1355, 25.3%), analgesics/NSAIDs (n=1172, 21.8%) and drugs for obstructive airway diseases (n=472, 8.8%).
Overall, 65.1% (n=742) of patients received at least one systemic antibacterial, being highest in Malaysia (n=244, 84.7%) and lowest in HK (n=43, 37.1%). 63.7% (n=726) of patients received at least one analgesic/NSAID. The number of patients exposed to this drug groups varied significantly between countries (p<0.001).
Paracetamol was the most frequent prescribed analgesic in Australia, UK, HK and Malaysia. Ibuprofen and metamizole were most frequently used in Germany and Morphine was mainly prescribed in the UK. Australia and Germany used higher ibuprofen doses than the UK (p<0.001). In contrast, the UK used the highest paracetamol doses and HK the lowest. Combined prescribing of ibuprofen and paracetamol was more common in the UK than in any other country (42% vs. 6-22% of all patients receiving ibuprofen or paracetamol).
Conclusion: This study provides a comprehensive overview on drug utilisation patterns in five countries. Prescription patterns and dose selection varied significantly which might be related to differences in treatment strategies between the countries. Nevertheless, there is a need for more rational drug prescribing in hospitalised children particularly with respect to analgesics and antibacterials.
