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Pérez-Ingidua C, Rivas-Paterna AB, González-Perrino C, Aleo-Luján E, Ascaso-Del-Rio A, Laredo-Velasco L, Portolés-Pérez A, Vargas-Castrillón E. Adverse drug reactions in paediatric surgery: prospective study on frequency and risk related factors. BMC Pediatr 2024; 24:344. [PMID: 38760745 PMCID: PMC11102197 DOI: 10.1186/s12887-024-04803-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 05/02/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Paediatric patients are especially prone to experiencing adverse drug reactions (ADRs), and the surgical environment gathers many conditions for such reactions to occur. Additionally, little information exists in the literature on ADRs in the paediatric surgical population. We aimed to quantify the ADR frequency in this population, and to investigate the characteristics and risk factors associated with ADR development. METHODS A prospective observational study was conducted in a cohort of 311 paediatric patients, aged 1-16 years, admitted for surgery at a tertiary referral hospital in Spain (2019-2021). Incidence rates were used to assess ADR frequency. Odds ratios (ORs) were calculated to evaluate the influence of potential risk factors on ADR development. RESULTS Distinct ADRs (103) were detected in 80 patients (25.7%). The most frequent being hypotension (N = 32; 35%), nausea (N = 16; 15.5%), and emergence delirium (N = 16; 15.5%). Most ADRs occurred because of drug-drug interactions. The combination of sevoflurane and fentanyl was responsible for most of these events (N = 32; 31.1%). The variable most robustly associated to ADR development, was the number of off-label drugs prescribed per patient (OR = 2.99; 95% CI 1.73 to 5.16), followed by the number of drugs prescribed per patient (OR = 1.26, 95% CI 1.13 to 1.41), and older age (OR = 1.26, 95% CI 1.07 to 1.49). The severity of ADRs was assessed according to the criteria of Venulet and the Spanish Pharmacovigilance System. According to both methods, only four ADRs (3.9%) were considered serious. CONCLUSIONS ADRs have a high incidence rate in the paediatric surgical population. The off-label use of drugs is a key risk factor for ADRs development.
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Affiliation(s)
- C Pérez-Ingidua
- Clinical Pharmacology Department, Hospital Clínico San Carlos, Madrid, Spain
- Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, Madrid, Spain
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - A B Rivas-Paterna
- Clinical Pharmacology Department, Hospital Clínico San Carlos, Madrid, Spain
- Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, Madrid, Spain
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - C González-Perrino
- Anaesthesiology and Resuscitation Department, Hospital Clínico San Carlos, Madrid, Spain
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - E Aleo-Luján
- Paediatric Intensive Care Unit and Postanaesthesia Recovery Unit, Hospital Clínico San Carlos, Madrid, Spain
- Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - A Ascaso-Del-Rio
- Clinical Pharmacology Department, Hospital Clínico San Carlos, Madrid, Spain
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - L Laredo-Velasco
- Clinical Pharmacology Department, Hospital Clínico San Carlos, Madrid, Spain
- Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - A Portolés-Pérez
- Clinical Pharmacology Department, Hospital Clínico San Carlos, Madrid, Spain.
- Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain.
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.
| | - E Vargas-Castrillón
- Clinical Pharmacology Department, Hospital Clínico San Carlos, Madrid, Spain
- Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
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Couselo-Rodríguez C, Batalla A, Martínez-Fernández S, Dávila-Pousa C, Soto-García D, Vilanova-Trillo L, Flórez Á. Off-label Prescription in Paediatric Dermatology: A Retrospective Observational Study in a Tertiary Hospital. Acta Derm Venereol 2023; 103:adv11937. [PMID: 38078687 PMCID: PMC10726374 DOI: 10.2340/actadv.v102.11937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 10/10/2023] [Indexed: 12/18/2023] Open
Abstract
Off-label prescription in paediatric patients is common, where some studies indicate that dermatological conditions are more prone to off-label treatment. This is the first study to analyse the prevalence of off-label prescription in paediatric dermatology consultation. This retrospective observational study was performed using the medical records of paediatric patients who were evaluated in a paediatric dermatological consultation in Pontevedra University Hospital, Pontevedra, Spain. Of the 468 patients reviewed, 186 prescriptions were issued and 51.10% were off-label prescription drugs. The dermatological conditions for which off-label prescription was most common were atopic dermatitis (29.0%), followed by warts (12.9%) and infantile haemangiomas (11.8%). With respect to drugs, topical tacrolimus (23.7%) was the most frequently prescribed off-label drug. The main reason for prescribing an off-label drug was for a disease not included on the label (62.4%), followed by issuing it at a lower age than authorized (55.9%). There was a significant association between a higher percentage of off-label prescription and younger age (p < 0.001), and the treatment of vitiligo, infantile haemangiomas and warts (p < 0.001). Likewise, the off-label prescription was significantly more common in the case of topical terbinafine, timolol, desloratadine and topical salicylic acid (p < 0.001). To conclude, off-label prescription is predominant in paediatric dermatology, as observed in 51.1% of our patients.
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Affiliation(s)
- Carmen Couselo-Rodríguez
- Department of Dermatology, University Hospital of Pontevedra, Pontevedra, Spain; DIPO Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), Sergas-Uvigo, Spain.
| | - Ana Batalla
- Department of Dermatology, University Hospital of Pontevedra, Pontevedra, Spain; DIPO Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), Sergas-Uvigo, Spain
| | - Sandra Martínez-Fernández
- Department of Dermatology, University Hospital of Pontevedra, Pontevedra, Spain; DIPO Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), Sergas-Uvigo, Spain
| | | | - Diego Soto-García
- Department of Dermatology, University Hospital of Pontevedra, Pontevedra, Spain; DIPO Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), Sergas-Uvigo, Spain
| | - Lucía Vilanova-Trillo
- Department of Dermatology, University Hospital of Pontevedra, Pontevedra, Spain; DIPO Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), Sergas-Uvigo, Spain
| | - Ángeles Flórez
- Department of Dermatology, University Hospital of Pontevedra, Pontevedra, Spain; DIPO Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), Sergas-Uvigo, Spain
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Factors and Practices Associated with Self-Medicating Children among Mexican Parents. Pharmaceuticals (Basel) 2022; 15:ph15091078. [PMID: 36145300 PMCID: PMC9502490 DOI: 10.3390/ph15091078] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/12/2022] [Accepted: 08/26/2022] [Indexed: 11/26/2022] Open
Abstract
Background: Pediatric self-medication is based on the subjective interpretation of symptoms in children by the mother or an adult, the decision to self-medicate is made by a third party. The objective of this work is to provide information on the factors and practices associated with the self-medication of children among parents in Mexico. Methods: A cross-sectional and descriptive study was conducted between June 2020 and December 2021 on Mexican parents with children under 12 years of age. Online questionnaires were completed with sections on sociodemographic characteristics, use of medicines or medicinal plants and their treated symptoms, sources of collection, and their recommendation. Results: A total of 9905 online surveys were completed with representation from the 32 states of Mexico, and the prevalence of self-medication was 49.6% (n = 4908). Associated factors were age, having two or more children, children with chronic illnesses, medium educational level, unemployment or employment unrelated to health, medium and high socioeconomic level, and lack of medical security. Respondents self-medicated their children on the recommendation of a family member or friend (55.8%), and own initiative (28%). The most used medication was VapoRub (61.3%), followed by paracetamol (56.9%) and chamomile (33.1%), and the most prevalent symptoms were flu/flow (47.7%) followed by cough (34.2%). The main reasons were perceiving symptoms as not serious (69.9%) and reusing medications (51.9%). Conclusions: There is a high prevalence of self-medication in children in Mexico, mainly associated with children with chronic diseases and families with three or more children.
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Piñeiro Pérez R, Núñez Cuadros E, Rodríguez Marrodán B, Escrig Fernández R, Gil Lemus MÁ, Manzano Blanco S, Calvo C. Off-label pediatric medicines in Spain. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2021. [DOI: 10.1016/j.anpede.2020.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Piñeiro Pérez R, Núñez Cuadros E, Rodríguez Marrodán B, Escrig Fernández R, Gil Lemus MÁ, Manzano Blanco S, Calvo C. [Off-label pediatric medicines in Spain]. An Pediatr (Barc) 2021; 94:188.e1-188.e9. [PMID: 33509731 DOI: 10.1016/j.anpedi.2020.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/11/2020] [Accepted: 12/11/2020] [Indexed: 01/25/2023] Open
Abstract
Since 2009, the use of off-label and unlicensed drugs has been regulated in Spain. In pediatrics, this exceptional use is more common than in other medical specialties. It varies from 10% to 90% of all prescriptions in children. This variability is due to differences in methodology, classification and sources of information used, and also to the different pediatrics subspecialties. In addition, the knowledge of several pediatricians on this issue is limited and more than half do not comply with the law, in many cases due to ignorance. However, the use of off-label and unlicensed drugs is legal and necessary. The Medicines Committee of the Spanish Association of Pediatrics (CM-AEP) considers that it is necessary to improve the existing information on medicines in the pediatric population. Therefore, the CM-AEP works out a document where suggestions and actions are proposed to achieve it, because children's health deserves it.
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Affiliation(s)
- Roi Piñeiro Pérez
- Comité de Medicamentos de la Asociación Española de Pediatría (CM-AEP), Madrid España.
| | | | | | | | | | | | - Cristina Calvo
- Comité de Medicamentos de la Asociación Española de Pediatría (CM-AEP), Madrid España
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Self-medication, self-prescription and medicating “by proxy” in paediatrics. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.anpede.2016.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Valenzuela Ortiz M, Sánchez Ruiz-Cabello FJ, Uberos J, Checa Ros AF, Valenzuela Ortiz C, Augustín Morales MC, Muñoz Hoyos A. [Self-medication, self-prescription and medicating «by proxy» in paediatrics]. An Pediatr (Barc) 2016; 86:264-269. [PMID: 27422815 DOI: 10.1016/j.anpedi.2016.06.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 05/27/2016] [Accepted: 06/01/2016] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Self-prescribing or medicating 'by proxy' is not an autonomous, free and voluntary decision in the case of children. On the contrary, in this case it is based on the subjective interpretation of symptoms made by the mother or by a third person who is legally responsible for the minor. In our opinion, to analyse this situation is of great importance in order to know the determining factors, perceptions, and realities related to this problem. METHODS Our proposal is to perform a prospective observational study for analysing maternal and familiar determinant factors related to self-prescribing and self-medicating 'by proxy' in paediatrics. A validated survey was developed to be applied to mothers of children aged 0 to 14 who are users of the Paediatric Emergency Department in a hospital. RESULTS A total of 1,714 mothers were recruited in a random period of time. This sample included 345 mothers who exclusively self-medicated their children (case group), and 1,369 mothers (control group) who did not meet this requirement. The overall percentage of medicating 'by proxy' was 32.8%. There is a significant association between self-medicating and educational level of the mother, the number of children, and the birth order among siblings. Neither maternal age nor social-occupational level are related to this problem. Most frequently used drugs include antipyretics and 'anticatharrals', usually administered as a monotherapy. CONCLUSIONS Our results seem to indicate that the educational level and the parental experience acquired with previous children could generate the required confidence in parents to choose the medication by themselves. Almost 85% of these drugs come from the 'home first-aid kit.'
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Affiliation(s)
| | | | - José Uberos
- Servicio de Pediatría, Hospital Universitario San Cecilio, Granada, España.
| | | | - Cristina Valenzuela Ortiz
- Servicio de Anestesia, Complejo Hospitalario Ciudad de Jaén, Grupo de Investigación (PAI) CTS 190, Granada, España
| | | | - Antonio Muñoz Hoyos
- UGC de Pediatría, Hospital Universitario San Cecilio, Facultad de Medicina, Grupo de Investigación (PAI) CTS 190, Granada, España
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