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Noga F, Hoti E, Ibrahimi E, Toma D, Malaj L. Perceptions and experiences of community pharmacists with off-label prescribing in the pediatric population. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2024:riae031. [PMID: 38965914 DOI: 10.1093/ijpp/riae031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 06/19/2024] [Indexed: 07/06/2024]
Abstract
OBJECTIVES This study aimed to investigate and provide insight into the prevalence and patterns of off-label drug use in the pediatric population from the perspective of community pharmacists, addressing the existing data gap in a developing setting. METHODS A questionnaire-based cross-sectional study was conducted on Albanian community pharmacists in June 2021. The online administered survey explored the participants' demographic details, perceptions, and experiences with off-label prescriptions in pediatric patients. The statistical analysis conducted on the survey data comprised the construction of frequency tables and the application of the chi-square test for independence. KEY FINDINGS Three hundred and thirty-six community pharmacists nationwide completed the survey, out of which 186 (55.3%) were practiced in Tirana, the capital of Albania. Over 80% of surveyed pharmacists (n = 275) had encountered off-label drug prescriptions in pediatric patients, yet only 40% of participants reported dispensing medicines for off-label use. Community pharmacists reported that general pediatricians tended to prescribe off-label medications more frequently than pediatric subspecialists or general practitioners. It was found that off-label prescriptions were more frequently observed among children aged between 2 and 11 years. Antibiotics were the most reported medicines for off-label use in this study mentioned in almost all off-label categories. CONCLUSIONS Prescribing medicines for unapproved uses for the treatment of pediatric patients is present in community settings in Albania. This indicates the need for further data collection and analysis to understand off-label practices in our country's pediatric population comprehensively.
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Affiliation(s)
- Fabiola Noga
- Department of Pharmacy, University of Medicine Tirana, Tiranë, AL 1005, Albania
| | - Ela Hoti
- Department of Pharmacy, University of Medicine Tirana, Tiranë, AL 1005, Albania
| | - Eliana Ibrahimi
- Department of Biology, University of Tirana, Tiranë, AL 1001, Albania
| | - Diana Toma
- Order of Pharmacists of Albania, Tiranë, AL 1007, Albania
| | - Ledjan Malaj
- Department of Pharmacy, University of Medicine Tirana, Tiranë, AL 1005, Albania
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Yoneda K, Shinjo D, Takahashi N, Fushimi K. Geographical distribution of antimicrobial exposure among very preterm and very low birth weight infants: A nationwide database study in Japan. PLoS One 2024; 19:e0295528. [PMID: 38271353 PMCID: PMC10810499 DOI: 10.1371/journal.pone.0295528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 11/21/2023] [Indexed: 01/27/2024] Open
Abstract
OBJECTIVES To examine spatial effects in neonatal care, we conducted a retrospective cohort study to investigate the geographical distribution of antimicrobial exposure among very preterm and very low birth weight infants in Japan. STUDY DESIGN We utilized a nationwide claims database in Japan to extract prescriptions of injectable antimicrobials for 41,423 very preterm and very low birth weight infants admitted within the first two days of life from April 2010 to March 2021. We identified frequently prescribed antimicrobials, revealed early neonatal exposure and neonatal exposure to each antimicrobial agent by 47 prefectures in Japan, and evaluated their spatial autocorrelation using global and local Moran's I statistics. We then scrutinized regional disparities in antimicrobial drug prescriptions. RESULTS The top 10 antimicrobials prescribed to very preterm and very low birth weight infants in Japan were ampicillin, amikacin, gentamicin, cefotaxime, fluconazole, ampicillin combination, micafungin, cefmetazole, cefazolin, and vancomycin. We identified northern cold spots for fluconazole exposure and southern hot spots for ampicillin, amikacin, gentamicin, and cefmetazole exposure. Geographical heterogeneity in the selection of antibacterial and antimycotic agents was observed. CONCLUSION Our study revealed the geographical distribution of antimicrobial exposure among very preterm and very low birth weight infants in Japan, thus disclosing its spatial effects. Further research addressing the spatial effects of neonatal care is needed to understand how drug exposure affects the outcomes of preterm infants.
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Affiliation(s)
- Kota Yoneda
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
- Department of Pediatrics, The University of Tokyo Hospital, Tokyo, Japan
| | - Daisuke Shinjo
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Naoto Takahashi
- Department of Pediatrics, The University of Tokyo Hospital, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
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Mathevula H, Schellack N, Orubu S, Godman B, Matlala M. Off-Label and Unlicenced Medicine Use among Hospitalised Children in South Africa: Practice and Policy Implications. PHARMACY 2023; 11:174. [PMID: 37987384 PMCID: PMC10661306 DOI: 10.3390/pharmacy11060174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/25/2023] [Accepted: 11/05/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Information regarding off-label and unlicensed medicine use among South African children is limited. This is a concern as the prescribing of off-label and unlicensed medicines can lead to issues of effectiveness and safety as well as raise liability issues in the event of adverse events. This potentially exposes physicians to legal penalties. Consequently, we sought to determine the prevalence of off-label and unlicensed medicine use among paediatric patients in South Africa to provide future direction. METHODS This study retrospectively examined the use of medicine in a point-prevalence survey study (PPS) involving paediatric patients aged (0-2 years) admitted to selected public hospitals in Gauteng Province, South Africa. Data were collected per hospital over two days between February 2022 and July 2022. Demographics, duration of treatment, diagnosis, and medicines prescribed were collected from patient medical records using a mobile application. Prescribed medicines were reviewed against the medicine formularies and other databases to assess their appropriateness. RESULTS From three academic hospitals, 184 patient records were reviewed. A total of 592 medicines were dispensed, of which 379 (64.0%) were licensed and 213 (36.0%) were used off-label/unlicensed for paediatric patients 0-2 years of age. The most prevalent off-label and unlicensed medicines were multivitamins (n = 32, 15.0%) and ampicillin injections (n = 15, 7.0%). CONCLUSION The frequency of unlicensed and off-label medicine prescribing shown in this study is consistent with the literature and can be considered high. This practice can pose a risk because it adversely affects patients if not properly regulated. Attention is needed to ensure future high-quality, safe, and effective use of medicines.
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Affiliation(s)
- Hlayiseka Mathevula
- School of Pharmacy, Sefako Makgatho Health Sciences University, Molotlegi Street, Pretoria 0204, South Africa; (B.G.); (M.M.)
| | - Natalie Schellack
- Department of Pharmacology, University of Pretoria, Pretoria 0084, South Africa;
| | - Samuel Orubu
- Pharmacy Department, Niger Delta University, Yenagoa P.O. BOX 72, Nigeria;
- Global Strategy Lab, York University, Toronto, ON 4700, Canada
| | - Brian Godman
- School of Pharmacy, Sefako Makgatho Health Sciences University, Molotlegi Street, Pretoria 0204, South Africa; (B.G.); (M.M.)
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Science (SIPBS), University of Strathclyde, Glasgow G4 0RE, UK
| | - Moliehi Matlala
- School of Pharmacy, Sefako Makgatho Health Sciences University, Molotlegi Street, Pretoria 0204, South Africa; (B.G.); (M.M.)
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Shaniv D, Bolisetty S, Young TE, Mangum B, Ainsworth S, Elbers L, Schultz P, Cucchi M, de Wildt SN, van der Zanden TM, Caldwell N, Smits A, Allegaert K. Neonatal Drug Formularies-A Global Scope. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10050848. [PMID: 37238396 DOI: 10.3390/children10050848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 04/26/2023] [Accepted: 05/05/2023] [Indexed: 05/28/2023]
Abstract
Neonatal drug information (DI) is essential for safe and effective pharmacotherapy in (pre)term neonates. Such information is usually absent from drug labels, making formularies a crucial part of the neonatal clinician's toolbox. Several formularies exist worldwide, but they have never been fully mapped or compared for content, structure and workflow. The objective of this review was to identify neonatal formularies, explore (dis)similarities, and raise awareness of their existence. Neonatal formularies were identified through self-acquaintance, experts and structured search. A questionnaire was sent to all identified formularies to provide details on formulary function. An original extraction tool was employed to collect DI from the formularies on the 10 most commonly used drugs in pre(term) neonates. Eight different neonatal formularies were identified worldwide (Europe, USA, Australia-New Zealand, Middle East). Six responded to the questionnaire and were compared for structure and content. Each formulary has its own workflow, monograph template and style, and update routine. Focus on certain aspects of DI also varies, as well as the type of initiative and funding. Clinicians should be aware of the various formularies available and their differences in characteristics and content to use them properly for the benefit of their patients.
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Affiliation(s)
- Dotan Shaniv
- Pharmacy Services, Kaplan Medical Center (Clalit Health Services), Pasternak St., P.O. Box 1, Rehovot 76100, Israel
- Neonatal Intensive Care Unit, Kaplan Medical Center (Clalit Health Services), Pasternak St., P.O. Box 1, Rehovot 76100, Israel
| | - Srinivas Bolisetty
- Division of Newborn Services, Royal Hospital for Women, Sydney 2031, Australia
| | - Thomas E Young
- Co-Founder of Neofax and Acorn Publishing, Raleigh, NC 27610, USA
- WakeMed Health and Hospitals, Raleigh, NC 27610, USA
- School of Medicine, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Barry Mangum
- Co-Founder of Neofax and Acorn Publishing, Raleigh, NC 27610, USA
- Co-Founder and CEO of Paidion Research Inc., Durham, NC 27707, USA
- School of Medicine, Duke University, Durham, NC 27710, USA
| | - Sean Ainsworth
- Directorate of Women and Children's Health, Victoria Hospital, Kirkcaldy, Scotland KY2 5AH, UK
| | - Linda Elbers
- Micromedex/NeoFax Editorial Services, Merative, 100 Phoenix Drive, Ann Arbor, MI 48108, USA
| | - Petra Schultz
- Micromedex/NeoFax Editorial Services, Merative, 100 Phoenix Drive, Ann Arbor, MI 48108, USA
| | - Melanie Cucchi
- Wolters Kluwer-Health, Clinical Effectiveness, Waltham, MA 02453, USA
| | - Saskia N de Wildt
- Department of Pharmacology and Toxicology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
- Intensive Care and Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, 3015 CN Rotterdam, The Netherlands
- Dutch Knowledge Center Pharmacotherapy for Children, Postal Box 25270, 3001 HG Rotterdam, The Netherlands
| | - Tjitske M van der Zanden
- Department of Pharmacology and Toxicology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
- Dutch Knowledge Center Pharmacotherapy for Children, Postal Box 25270, 3001 HG Rotterdam, The Netherlands
- Department of Pediatrics, Erasmus MC Sophia Children's Hospital, 3015 CN Rotterdam, The Netherlands
| | - Neil Caldwell
- Pharmacy Department, Wirral University Teaching Hospital/Liverpool John Moores University, Arrowe Park Road, Upton, Merseyside CH49 5PE, UK
| | - Anne Smits
- Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium
- Neonatal Intensive Care Unit, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Karel Allegaert
- Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, 3000 Leuven, Belgium
- Department of Hospital Pharmacy, Erasmus MC, 3015 GD Rotterdam, The Netherlands
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Bedard P, Winsor GL, Garlock ES, Azad MB, Becker AB, Mandhane PJ, Moraes TJ, Sears MR, Turvey SE, Subbarao P, Brinkman FSL, Kozyrskyj AL. From Prescription Drugs to Natural Health Products: Medication Use in Canadian Infants. CHILDREN 2022; 9:children9101475. [PMID: 36291411 PMCID: PMC9600175 DOI: 10.3390/children9101475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/25/2022] [Accepted: 09/26/2022] [Indexed: 11/28/2022]
Abstract
Limited data exist on pharmaceutical product use by infants, although available data suggests higher prevalence of use among children under 12 months of age. We conducted a descriptive study of 3050 infants recruited in the CHILD Cohort Study, a prospective, multicenter, longitudinal cohort following children from pregnancy through childhood. Parents were surveyed for use of prescription and over-the-counter drugs, and natural health products (NHPs, including homeopathic products and vitamins) at 3, 6, and 12 months after delivery. By one year of age, 96.0% of children had taken at least one pharmaceutical product. Among 307 reported products, 32 were given to at least 1% of cohort infants. Vitamin D, acetaminophen, ibuprofen, topical hydrocortisone, amoxicillin, and nystatin were the most common medications and natural health products (NHPs) received, with 8/32 of the most frequently used products being NHPs. Overall, 14.7% of pharmaceutical products administered to children were off-label and 35.8% were NHPs or products without a Drug Identification Number (DIN). The use of over-the-counter medications and NHPs is common and off-label use of drugs is frequent, even in the first year of life. This study highlights the importance of conducting studies on medication use in infants, and of infant medication use monitoring by healthcare providers.
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Affiliation(s)
- Pascal Bedard
- Department of Pharmacy, CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada
| | - Geoffrey L. Winsor
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
| | - Emma S. Garlock
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
| | - Meghan B. Azad
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB R3A 1S1, Canada
- Children’s Hospital Research Institute of Manitoba, Winnipeg, MB R3E 3P4, Canada
| | - Allan B. Becker
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB R3A 1S1, Canada
| | - Piush J. Mandhane
- Department of Pediatrics, University of Alberta, Edmonton, AB T6G 1C9, Canada
| | - Theo J. Moraes
- Department of Pediatrics, Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Malcolm R. Sears
- Department of Medicine, McMaster University, Hamilton, ON L8P 1H6, Canada
| | - Stuart E. Turvey
- Department of Pediatrics, BC Children’s Hospital and The University of British Columbia, Vancouver, BC V6H 0B3, Canada
| | - Padmaja Subbarao
- Department of Pediatrics, Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Fiona S. L. Brinkman
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
- Correspondence: (F.S.L.B.); (A.L.K.)
| | - Anita L. Kozyrskyj
- Department of Pediatrics, University of Alberta, Edmonton, AB T6G 1C9, Canada
- Correspondence: (F.S.L.B.); (A.L.K.)
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Schaffer AL, Bruno C, Buckley NA, Cairns R, Litchfield M, Paget S, Zoega H, Nassar N, Pearson S. Prescribed medicine use and extent of off-label use according to age in a nationwide sample of Australian children. Paediatr Perinat Epidemiol 2022; 36:726-737. [PMID: 35172017 PMCID: PMC9540111 DOI: 10.1111/ppe.12870] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 01/16/2022] [Accepted: 01/25/2022] [Indexed: 12/18/2022]
Abstract
BACKGROUND Medicine prescribing for children is impacted by a lack of paediatric-specific dosing, efficacy and safety data for many medicines. OBJECTIVES To estimate the prevalence of medicine use among children and the rate of 'off-label' prescribing according to age at dispensing. METHODS We used population-wide primarily outpatient dispensing claims data for 15% of Australian children (0-17 years), 2013-2017 (n = 840,190). We estimated prescribed medicine use and 'off-label' medicine use according to the child's age (<1 year, 1-5 years, 6-11 years, 12-17 years) defined as medicines without age-appropriate dose recommendations in regulator-approved product information. Within off-label medicines, we also identified medicines with and without age-specific dose recommendations in a national prescribing guide, the Australian Medicines Handbook Children's Dosing Companion (AMH CDC). RESULTS The overall dispensing rate was 2.0 dispensings per child per year. The medicines with the highest average yearly prevalence were systemic antibiotics (435.3 per 1000 children), greatest in children 1-5 years (546.9 per 1000). Other common medicine classes were systemic corticosteroids (92.7 per 1000), respiratory medicines (91.2 per 1000), acid-suppressing medicines in children <1 year (47.2 per 1000), antidepressants in children 12-17 years (40.3 per 1000) and psychostimulants in children 6-11 years (27.0 per 1000). We identified 12.2% of dispensings as off-label based on age, but 66.3% of these had age-specific dosing recommendations in the AMH CDC. Among children <1 year, off-label dispensings were commonly acid-suppressing medicines (35.5%) and topical hydrocortisone (33.1%); in children 6-11 years, off-label prescribing of clonidine (16.0%) and risperidone (13.1%) was common. Off-label dispensings were more likely to be prescribed by a specialist (21.7%) than on-label dispensings (7.5%). CONCLUSIONS Prescribed medicine use is common in children, with off-label dispensings for medicines without paediatric-specific dosing guidelines concentrated in classes such as acid-suppressing medicines and psychotropics. Our findings highlight a need for better evidence to support best-practice prescribing.
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Affiliation(s)
- Andrea L. Schaffer
- Centre for Big Data Research in HealthUNSW SydneySydneyNew South WalesAustralia
| | - Claudia Bruno
- Centre for Big Data Research in HealthUNSW SydneySydneyNew South WalesAustralia
| | - Nicholas A. Buckley
- Biomedical Informatics and Digital HealthThe University of SydneySydneyNew South WalesAustralia,NSW Poisons Information CentreThe Children’s Hospital at WestmeadSydneyNew South WalesAustralia
| | - Rose Cairns
- NSW Poisons Information CentreThe Children’s Hospital at WestmeadSydneyNew South WalesAustralia,Faculty of PharmacyThe University of SydneySydneyNew South WalesAustralia
| | - Melisa Litchfield
- Centre for Big Data Research in HealthUNSW SydneySydneyNew South WalesAustralia
| | - Simon Paget
- The Children’s Hospital at Westmead Clinical SchoolThe University of SydneySydneyNew South WalesAustralia
| | - Helga Zoega
- Centre for Big Data Research in HealthUNSW SydneySydneyNew South WalesAustralia,Centre of Public Health SciencesFaculty of MedicineUniversity of IcelandReykjavikIceland
| | - Natasha Nassar
- The Children’s Hospital at Westmead Clinical SchoolThe University of SydneySydneyNew South WalesAustralia,Menzies Centre for Health PolicyThe University of SydneySydneyNew South WalesAustralia
| | - Sallie‐Anne Pearson
- Centre for Big Data Research in HealthUNSW SydneySydneyNew South WalesAustralia,Menzies Centre for Health PolicyThe University of SydneySydneyNew South WalesAustralia
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