Frequency of paediatric patients administered extemporaneous preparations at a Swedish university hospital: a
Åsa C Andersson1,2, Staffan Eksborg2, Ulrika Förberg3
1Karolinska University Hospital, Astrid Lindgren Children's Hospital, Stockholm, Sweden asa.andersson.1@ki.se.
Insights
The use of extemporaneous preparations in pediatric patients increased significantly from 22% in 2009 to 40% in 2019, highlighting a persistent need for child-friendly medicine formulations. This trend indicates ongoing challenges in providing safe and appropriate medication for children.
Area of Science:
- Pediatric Pharmacy
- Pharmaceutical Compounding
- Drug Formulation
Background:
- Lack of child-friendly dosage forms necessitates medication manipulation.
- Extemporaneous preparations offer an alternative to manipulation.
- Swedish pharmacies produce these preparations under good manufacturing practice.
Purpose of the Study:
- To compare the frequency of extemporaneous preparation administration to pediatric patients.
- To analyze trends in extemporaneous preparation use over a decade.
Main Methods:
- Registry-based study at a Swedish university hospital.
- Compared pediatric oral administrations in 2009 and 2019.
- Included over 117,000 administrations in 2009 and over 128,000 in 2019.
Main Results:
- Frequency of inpatients receiving extemporaneous preparations rose from 22% (2009) to 40% (2019).
- This increase was consistent across all pediatric age groups.
- Use of certain active pharmaceutical ingredients like captopril and melatonin increased, while others like midazolam decreased.
Conclusions:
- Despite new product introductions, a significant need for extemporaneous preparations persists.
- This indicates a continued lack of commercially available, child-friendly medication options.
- Safe administration of medicines to children remains a challenge, necessitating these specialized preparations.
Background:
Lack of child-friendly dosage forms and strengths often leads to manipulation of medicines at hospital units or by caregivers in the home setting. One alternative to manipulating dosage forms is the use of extemporaneous preparations. In Sweden, these are produced according to good manufacturing practice by a few extemporaneous pharmacies.
Objectives:
To compare frequencies of patients administered extemporaneous preparations in two separate years, 10 years apart.
Methods:
This registry-based study describes and compares the frequency of extemporaneous oral preparations administered to paediatric patients in 2009 and 2019 at a Swedish university hospital.The study included 117 023 oral administrations (to 4905 patients) and 128 638 oral administrations (to 4718 patients) from 2009 and 2019, respectively.
Results:
The frequency of inpatients administered one or more extemporaneous preparations increased from 22% in 2009 to 40% in 2019 (p<0.0001). The increase was observed in all age groups. The use of some active pharmaceutical ingredients increased (eg, captopril, clonidine, hydrocortisone, melatonin and propranolol), and some active pharmaceutical ingredients decreased between the study years (eg, midazolam and sildenafil).
Conclusions:
The introduction of new authorised products has decreased the need for manipulation or extemporaneous preparations in some therapeutic groups. There remains, however, a pronounced lack of commercially available child-friendly dosage forms and suitable strengths enabling safe administration of medicines to children, indicated by the large percentage of patients receiving at least one extemporaneous preparation.
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