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Drug Utilisation Studies in Paediatrics

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Children's Health".

Deadline for manuscript submissions: closed (30 November 2021) | Viewed by 16645

Special Issue Editor

Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Derby DE22 3DT, UK
Interests: drug toxicity; clinical trials; rational use of medicines; epidemiology of the use of medicines; inequalities in child health; access to medicines in children
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Medicines play a crucial role in the treatment of children by reducing mortality and morbidity. The rational use of medicines is of key importance in ensuring that children receive treatment when needed and avoid unnecessary treatments, and hence minimise drug toxicity. The study of the pharmacoepidemiology of medicines is essential to assist in determining whether medicines are used rationally or not.

The evidence base for the use of many medicines in paediatrics is poor. Many medicines are used off-label in paediatric patients. Labelling is, however, less important than the evidence base. This Special Issue is focussed on the utilisation of medicines used in paediatric patients in different settings. It is not focussed on off-label and unlicensed use, which has previously been well documented.

This Special Issue welcomes papers from low- and lower-middle income countries as well as upper-middle and high-income countries where there has been more extensive research. Studies of all paediatric ages and all settings (primary and secondary) are welcomed. Similarly studies focussing on specific types of medicines (e.g., antibiotics, analgesics, and antiepileptic drugs) are welcomed.

Emeritus Prof. Imti Choonara
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Drug utilisation
  • Pharmacoepidemiology
  • Antiepileptic drug
  • Antibiotic
  • Analgesic
  • Paediatric
  • Neonatal
  • Antiasthmatic drugs
  • Rational drug use
  • Prescribing patterns

Related Special Issue

Published Papers (6 papers)

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Research

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14 pages, 2202 KiB  
Article
Analysis of the Consumption of Drugs Prescribed for the Treatment of Asthma in Belgian Children
by Natacha Biset, Wies Kestens, Dominique Detemmerman, Murielle Lona, Güngör Karakaya, Ann Ceuppens, Stéphanie Pochet and Carine De Vriese
Int. J. Environ. Res. Public Health 2022, 19(1), 548; https://doi.org/10.3390/ijerph19010548 - 04 Jan 2022
Cited by 1 | Viewed by 1780
Abstract
(1) Asthma is one of the most common chronic diseases in the world among children. The main purpose of this study was to analyze the consumption of asthma medications in order to investigate asthma in children (2–18 years) and the association with health [...] Read more.
(1) Asthma is one of the most common chronic diseases in the world among children. The main purpose of this study was to analyze the consumption of asthma medications in order to investigate asthma in children (2–18 years) and the association with health care consumption; (2) a retrospective study using anonymized administrative data for 2013–2018 from the third largest Belgian health insurer was conducted; (3) in 2018, 12.9% of children received at least one asthma medication and 4.4% received at least two packages with a minimum of 30 days between purchases. Preschool children (2–6 years) were three times more likely to take asthma medication than older children (7–18 years). ICS, in combination or not with LABA, were the most dispensed drugs among children. Children with asthma medications were almost twice as likely to receive antibiotics, more likely to end up in the emergency room, and twice as likely to be hospitalized; (4) most children took ICS, according to the GINA guidelines. High rates of nebulization in young children were observed, despite the recommendation to use an inhaler with a spacing chamber as much as possible. Finally, children who took asthma medications were more likely to end up in the ER or be hospitalized. Full article
(This article belongs to the Special Issue Drug Utilisation Studies in Paediatrics)
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10 pages, 782 KiB  
Article
Opioid Analgesic Prescription in French Children: A National Population-Based Study
by Samira Choufi, Simon Mounier, Etienne Merlin, Emmanuelle Rochette, Jessica Delorme, Nicolas Authier and Chouki Chenaf
Int. J. Environ. Res. Public Health 2021, 18(24), 13316; https://doi.org/10.3390/ijerph182413316 - 17 Dec 2021
Cited by 2 | Viewed by 1900
Abstract
Codeine use was restricted in 2013 and is currently contraindicated for children below the age of 12 years. We examined how the prescription of opioid analgesics in children in France evolved between 2012 and 2018. Our population-based study from the SNIIRAM database (National [...] Read more.
Codeine use was restricted in 2013 and is currently contraindicated for children below the age of 12 years. We examined how the prescription of opioid analgesics in children in France evolved between 2012 and 2018. Our population-based study from the SNIIRAM database (National System of Health Insurance Inter-Regime Information) was designed to determine trends in opioid prescription from 2012 to 2018 in all French children. The number of children who received at least one opioid prescription gradually declined from 452,665 in 2012 (347.5 children per 10,000) to 169,338 in 2018 (130.3 children per 10,000). This decrease was especially marked for codeine (36 children per 10,000 in 2018 vs. 308.5 children per 10,000 in 2012), whereas the number of tramadol prescriptions increased by 171% in 2018 (94.6 children per 10,000). Despite the increase, strong opioids still formed only a small proportion of prescriptions (2.6 children per 10,000 given opioids in 2018). Overall opioid prescriptions in French children dramatically decreased between 2012 and 2018, probably owing to restrictions on the use of codeine. Codeine has been partly replaced by tramadol. Morphine is still probably underused. This suggests that opioids are being used less often for pain management in children. Full article
(This article belongs to the Special Issue Drug Utilisation Studies in Paediatrics)
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11 pages, 1462 KiB  
Article
Amikacin or Vancomycin Exposure Alters the Postnatal Serum Creatinine Dynamics in Extreme Low Birth Weight Neonates
by Tamara van Donge, Anne Smits, John van den Anker and Karel Allegaert
Int. J. Environ. Res. Public Health 2021, 18(2), 662; https://doi.org/10.3390/ijerph18020662 - 14 Jan 2021
Cited by 5 | Viewed by 2246
Abstract
Background: Disentangling renal adverse drug reactions from confounders remains a major challenge to assess causality and severity in neonates, with additional limitations related to the available tools (modified Kidney Disease Improving Global Outcome, or Division of Microbiology and Infectious Diseases pediatric toxicity table). [...] Read more.
Background: Disentangling renal adverse drug reactions from confounders remains a major challenge to assess causality and severity in neonates, with additional limitations related to the available tools (modified Kidney Disease Improving Global Outcome, or Division of Microbiology and Infectious Diseases pediatric toxicity table). Vancomycin and amikacin are nephrotoxic while still often prescribed in neonates. We selected these compounds to assess their impact on creatinine dynamics as a sensitive tool to detect a renal impairment signal. Methods: A recently developed dynamical model that characterized serum creatinine concentrations of 217 extremely low birth weight (<1000 g, ELBW) neonates (4036 observations) was enhanced with data on vancomycin and/or amikacin exposure to identify a potential effect of antibiotic exposure by nonlinear mixed-effects modelling. Results: Seventy-seven percent of ELBW patients were exposed to either vancomycin or amikacin. Antibiotic exposure resulted in a modest increase in serum creatinine and a transient decrease in creatinine clearance. The serum creatinine increase was dependent on gestational age, illustrated by a decrease with 56% in difference in serum creatinine between a 24 or 32-week old neonate, when exposed in the 3rd week after birth. Conclusions: A previously described model was used to explore and quantify the impact of amikacin or vancomycin exposure on creatinine dynamics. Such tools serve to explore minor changes, or compare minor differences between treatment modalities. Full article
(This article belongs to the Special Issue Drug Utilisation Studies in Paediatrics)
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7 pages, 1239 KiB  
Article
Dispensing Practices of Fixed Dose Combination Controller Therapy for Asthma in Australian Children and Adolescents
by Nusrat Homaira, Benjamin Daniels, Sallie Pearson and Adam Jaffe
Int. J. Environ. Res. Public Health 2020, 17(16), 5645; https://doi.org/10.3390/ijerph17165645 - 05 Aug 2020
Cited by 1 | Viewed by 2781
Abstract
The Australian Asthma Handbook does not recommend use of fixed dose combination (FDC) controller medicines for asthma in children aged ≤5 years. FDCs are only recommended in children and adolescents (aged 6–18 years) not responding to initial inhaled corticosteroid (ICS) therapy. Using Pharmaceutical [...] Read more.
The Australian Asthma Handbook does not recommend use of fixed dose combination (FDC) controller medicines for asthma in children aged ≤5 years. FDCs are only recommended in children and adolescents (aged 6–18 years) not responding to initial inhaled corticosteroid (ICS) therapy. Using Pharmaceutical Benefits Scheme dispensing claims from 2013–2018, we examined the annual incident FDC dispensing and the incident FDC dispensing without prior ICS up to 365 days. We also determined cost of FDCs to government and patients. During 2013–2018, there were 35,635 FDC initiations and 31,368 (88%) did not have a preceding ICS dispensing. The annual incidence of FDC dispensing declined from 14.7 to 7.2/1000 children. Incidence of FDC dispensing/1000 children without a preceding ICS declined from 2.1 to 0.5 in children aged 1–2 years, 7.2 to 1.7 in 3–5 years, 14.8 to 5.1 in 6–11 years, and 18.6 to 11.9 in ≥12years. The cost of FDCs was 7.8 million Australian dollars (AUD); of which 4.4 million AUD was to government and 3.3 million AUD was to patient. Despite inappropriate dispensing of FDCs in children aged ≤5 years, incidence of FDC dispensing and more importantly incidence without a preceding ICS is declining in Australia. Full article
(This article belongs to the Special Issue Drug Utilisation Studies in Paediatrics)
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Review

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32 pages, 2876 KiB  
Review
Review of Drug Utilization Studies in Neonatal Units: A Global Perspective
by Asma Al-Turkait, Lisa Szatkowski, Imti Choonara and Shalini Ojha
Int. J. Environ. Res. Public Health 2020, 17(16), 5669; https://doi.org/10.3390/ijerph17165669 - 05 Aug 2020
Cited by 17 | Viewed by 3765
Abstract
Rational prescribing is challenging in neonatology. Drug utilization studies help identify and define the problem. We performed a review of the literature on drug use in neonatal units and describe global variations. We searched databases (EMBASE, CINAHL and Medline) from inception to July [...] Read more.
Rational prescribing is challenging in neonatology. Drug utilization studies help identify and define the problem. We performed a review of the literature on drug use in neonatal units and describe global variations. We searched databases (EMBASE, CINAHL and Medline) from inception to July 2020, screened studies and extracted relevant data (two reviewers). The search revealed 573 studies of which 84 were included. India (n = 14) and the USA (n = 13) reported the most. Data collection was prospective (n = 56) and retrospective (n = 26), mostly (n = 52) from one center only. Sixty studies described general drug use in 34 to 450,386 infants (median (IQR) 190 (91–767)) over a median (IQR) of 6 (3–18) months. Of the participants, 20–87% were preterm. The mean number of drugs per infant (range 11.1 to 1.7, pooled mean (SD) 4 (2.4)) was high with some reporting very high burden (≥30 drugs per infant in 8 studies). This was not associated with the proportion of preterm infants included. Antibiotics were the most frequently used drug. Drug use patterns were generally uniform with some variation in antibiotic use and more use of phenobarbitone in Asia. This study provides a global perspective on drug utilization in neonates and highlights the need for better quality information to assess rational prescribing. Full article
(This article belongs to the Special Issue Drug Utilisation Studies in Paediatrics)
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13 pages, 1030 KiB  
Review
Paediatric Rational Prescribing: A Systematic Review of Assessment Tools
by Fenella Corrick, Sharon Conroy, Helen Sammons and Imti Choonara
Int. J. Environ. Res. Public Health 2020, 17(5), 1473; https://doi.org/10.3390/ijerph17051473 - 25 Feb 2020
Cited by 10 | Viewed by 3151
Abstract
Rational prescribing criteria have been well established in adult medicine for both research and quality improvement in the appropriate use of medicines. Paediatric rational prescribing has not been as widely investigated. The aims of this review were to identify and provide an overview [...] Read more.
Rational prescribing criteria have been well established in adult medicine for both research and quality improvement in the appropriate use of medicines. Paediatric rational prescribing has not been as widely investigated. The aims of this review were to identify and provide an overview of all paediatric rational prescribing tools that have been developed for use in paediatric settings. A systematic literature search was made of MEDLINE, Embase, CINAHL and IPA from their earliest records until July 2019 for all published paediatric rational prescribing tools. The characteristics of the tools were recorded including method of development, types of criteria, aspects of rational prescribing assessed, and intended practice setting. The search identified three paediatric rational prescribing tools: the POPI (Pediatrics: Omissions of Prescriptions and Inappropriate Prescriptions) tool, the modified POPI (UK) tool, and indicators of potentially inappropriate prescribing in children (PIPc). PIPc comprises explicit criteria, whereas POPI and the modified POPI (UK) use a mixed approach. PIPc is designed for use in primary care in the UK and Ireland, POPI is designed for use in all paediatric practice settings and is based on French practice standards, and the modified POPI (UK) is based on UK practice standards and is designed for use in all paediatric practice settings. This review describes three paediatric rational prescribing tools and details their characteristics. This will provide readers with information for the use of the tools in quality improvement or research and support further work in the field of paediatric rational prescribing. Full article
(This article belongs to the Special Issue Drug Utilisation Studies in Paediatrics)
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