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Drug utilization in paediatrics: non-medical factors affecting decision making by prescribers
Insights
Pediatric pharmacotherapy reveals discrepancies between guidelines and practice. Factors like adverse events, patient setting, and education influence prescribing, impacting drug safety and cost-effectiveness.
Area of Science:
- Pharmacology
- Pediatrics
- Drug Utilization Studies
Background:
- Accepted pediatric pharmacotherapy principles may not align with actual prescribing behaviors.
- Adverse events, patient care settings (outpatient vs. inpatient), and educational backgrounds can influence drug choices.
Purpose of the Study:
- To highlight discrepancies in pediatric pharmacotherapy.
- To analyze factors influencing prescribing patterns in pediatric patients.
- To evaluate the feasibility of drug utilization studies in children.
Main Methods:
- Case examples illustrating prescribing variations after adverse events (e.g., rhabdomyolysis from penicillin).
- Analysis of antitussive prescribing in outpatient versus inpatient settings.
- Comparison of antimicrobial prescribing rates between university and regional hospitals.
- Development and evaluation of age-appropriate 'paediatric defined daily doses' (PDDD) for drug utilization studies.
Main Results:
- Penicillin use decreased significantly after fatal rhabdomyolysis cases, with inferior alternatives used.
- Antitussive prescribing was higher in outpatients due to perceived therapeutic optimism.
- Regional hospital doctors prescribed chloramphenicol ten times more than university hospital doctors.
- High cephalosporin use was not cost-effective in the university teaching hospital.
- Paediatric defined daily doses (PDDD) proved feasible for drug utilization studies in children.
Conclusions:
- Prescribing practices in pediatric pharmacotherapy can deviate from established guidelines.
- Understanding prescribing influences is crucial for optimizing pediatric drug use.
- Age-appropriate metrics like PDDD are essential for accurate pediatric drug utilization research.
Abstract:
The study was done to show that in certain areas of paediatric pharmacotherapy unexpected discrepancies may arise between accepted therapeutic principles and the actual behaviour of a prescribing doctor. The first example was of a great reduction in penicillin use in a university teaching hospital after certain therapeutic accidents: in one year, there were 2 fatal cases of rhabdomyolysis due to use of procaine benzyl-penicillin. Other antimicrobial drugs inferior to penicillin, such as lincomycin and sulphonamides, replaced penicillins. The second example showed the inverse relationship between the use of antitussives and other drugs in symptomatic treatment of respiratory diseases in outpatients and inpatients; the pressure of unduly optimistic expectations of therapy imposes a high prescribing rate of these drugs in the outpatient population, in contrast to hospitalized patients, whose doctors, being spared such pressure, prescribe antitussives far less often. The third example demonstrates the possibility of inadequate education in the use of antimicrobial drugs. Although doctors from regional hospitals receive their training at an university hospital, they tend to prescribe chloramphenicol ten times more per bed-day than their colleagues in an university hospital. In terms of the cost/effectiveness ratio, a high prescribing rate of cephalosporins is not economically favourable in a university teaching hospital. It is also shown that studies of drug utilization in children are feasible if age--appropriate adaptation of the statistical value expressed as the defined daily dose is performed. The adaptation was evaluated by comparing pharmacy-based drug consumption data expressed in "paediatric defined daily doses", with actual days of treatment with particular drugs, i.e. data from patient records for 244 beds in the University Teaching Hospital.