Analysis of the potential inappropriate use of medications in pediatric outpatients in China

Background The appropriate use of medications is essential in children. Yet, detailed information on how drugs are being prescribed and dispensed to pediatric populations is not documented in China. Aim The study objective was to analyze the details of medicine use and categorize the types of inappropriate use of medications on children. Methods A retrospective cross-sectional study was conducted on the prescriptions of pediatric outpatients aged < 18 years from 2019 to 2020 at a major Chinese tertiary academic center. Each age group’s demographic and clinical characteristics were collected, and the ratios of inappropriate prescriptions were analyzed. Results The total number of pediatric outpatients was 652,152, and 49.37% (322000) were prescribed medications, in which the most widely used medicines were respiratory, anti-infectives, and Traditional Chinese Medicines (TCMs). The prevalence rate of inappropriate prescriptions reached 20.49%, and in 2019 it was higher (21.71%) than that in 2020 (18.36%). The top three common inappropriate categories were indication-related off-label drug use, improper administration frequency, and overdosing, accounting for 67.93, 17.80 and 11.06% of all inappropriate prescriptions, respectively. The inappropriate prescriptions were more likely seen in patients aged 2–5 years and respiratory medicines. Conclusions The study findings indicate that inappropriate drug use in pediatric outpatients is still common, and great attention needs to be paid. More prospective trials are required to identify the effectiveness, safety, and necessity of off-label drug use of medicines in children.

Exclusive Breastfeeding Duration and Allergic Asthma Severity in Children

Introduction: Asthma is a disease marked by bronchial hyperresponsivity. It is commonly seen in children and often affects their quality of life. Many factors affect asthma, including breastfeeding. Bioactive and immunological components of maternal milk have a protective effect on allergic asthma. However, some studies denied this, stating that it had no significant association to asthma. This study aimed to analyze the correlation between breastfeeding duration and the severity of allergic asthma described by the frequency of asthma attacks, sleep disorder, and activity limitation.Methods: This analytic observational study used a cross sectional approach. The subjects were pediatric outpatients aged 1 – 5 years old with allergic asthma at Pediatric Clinic of Dr. Soetomo General Hospital Surabaya and Private Pediatric Clinic from September 2019 to July 2020. Subjects were assessed based on the history of exclusive breastfeeding duration, frequency of asthma attacks, sleep disorder, and activity limitation through an interview using questionnaire.Results: Through the data obtained from 62 respondents, duration of exclusive breastfeeding showed no significant relation to the frequency of asthma attack (rs = -0.227, p = 0.076), sleep disorder (rs = -0.214, p = 0.095), and activity limitation (rs = -0.055, p = 0.672).Conclusion: There was no correlation between the duration of exclusive breastfeeding and the frequency of asthma attack, sleep disorder, and activity limitation.

Marked Reductions in Pediatric Outpatient Antibiotic Prescribing in Portugal During the Pandemic

The COVID-19 pandemic brought unexpected effects on healthcare systems access and usage. Some of the measures implemented by governments to try and contain it, such as confinement periods, social distancing, widespread use of masks and other hygiene practices led to unprecedented epidemiological changes in several common infectious diseases.We describe changes in antibiotic prescribing in pediatric outpatients before and during the pandemic in a dynamic population analysis context during a study period of three years in mainland Portugal.There was a marked reduction in antimicrobial prescribing in all regions, particularly in younger children and during the lockdown periods.This reduction was much sharper for those antimicrobials most commonly used to treat respiratory-tract infections, as Amoxicillin (with and without β-lactamase inhibitor) and Macrolides, and considerable less accentuated in other commonly prescribed antibiotics as Co-Trimoxazole and Fosfomycin, usually associated with the treatment of urinary tract infections.Conclusion: Our findings indicate that the COVID-19 pandemic has had profound effects on antibiotic use in ambulatory care in children in Portugal.Further monitoring is necessary to ascertain whether this reduction in antibiotic prescription will persist and whether these changes may impact antimicrobial resistance.

Trends and Pattern of Antibiotic Use in Children in Northern Spain. Lessons From Interpreting Data About Antimicrobial Consumption in Outpatients

Monitoring of antibiotic prescription and consumption behavior is crucial. The Access, Watch and Reserve (AWaRe) classification of antibiotics has been recently introduced in order to measure and improve patterns of antibiotic use. In this study, retrospective data about systemic antibiotic consumption (expressed in defined daily dose per 1000 inhabitants per day [DID]) in pediatric outpatients in a region in Northern Spain (around 100000 children up to 14 years old) from 2005 to 2018 were analysed and compared with antibiotic consumption in general population in Spain. The pattern of use was analysed by the percentage of the current AWaRe categories, the Access-to-Watch index and the amoxicillin index. Data were calculated annually and compared into two periods. Mean antibiotic consumption in pediatric outpatients was 14.0 DID (CI 95% 13.38–14.62). It remained stable throughout the study and was lower than consumption in general population in Spain, particularly from 2016. Changes in the consumption of the main active principles have led to an improvement in the three metrics of the pattern of use. It is important to have a thorough knowledge of the methodology applied in studies about antibiotic consumption. There is a lack of an optimal standardized metric for pediatric population.

Factors Associated with Streptococcus pneumoniae Nasopharyngeal Carriage and Antimicrobial Susceptibility among Children Under the Age of 5 Years in the Southwestern Colombia

Objective This work aims to evaluate the factors associated with Streptococcus pneumoniae nasopharyngeal colonization and antimicrobial susceptibility among pediatric outpatients in southwestern Colombia, 2019. Methods A cross-sectional study was performed using survey-based interviews and the collection of nasopharyngeal-swab specimens for microbiological characterization and antimicrobial susceptibility testing. Logistic regression analyses were performed for factors associated with nasopharyngeal carriage. Results A total of 452 children under the age of 5 years were examined in which 41.8% carried S. pneumoniae. Higher pneumococcal carriage frequencies were observed among participants aged <2 years and in individuals belonging to indigenous communities, which were lacking established pneumococcal-conjugated vaccine-10 immunization schemes. Additionally, children attending childcare institutions were also highly colonized by pneumococci. S. pneumoniae showed 57.7% nonsusceptibility to benzyl-penicillin (meningitis-cut); 45.5% intermediate-sensitivity to benzyl-penicillin (oral-cut) and 21.7% to cefotaxime; and resistance to erythromycin (40.7%), tetracycline (36.0%), trimethoprim/sulfamethoxazole (24.9%), clindamycin (24.3%), and ceftriaxone (27.0%). Conclusion The 41.8% of participants carrying S. pneumoniae show a scenario with the presence of multidrug and extensively drug-resistant strains, which constitutes important reservoirs of bacterial transmission by children aged <5 years in Colombia, leading to an onset of pneumococcal diseases. Hence, there is an urgent need to expand conjugate pneumococcal immunization in the community and ensure compliance with established immunization schedules.

Drug-Related Problems in Prescribing for Pediatric Outpatients in Vietnam

Background: Our study was conducted to determine the prevalence of drug-related problems (DRPs) in outpatient prescriptions, the impact of DRPs on treatment efficacy, safety, and cost, and the determinants of DRPs in prescribing for pediatric outpatients in Vietnam. Methods: A retrospective cross-sectional study was conducted on pediatric outpatients at a pediatric hospital in Can Tho, Vietnam. DRPs were classified according to the Pharmaceutical Care Network Europe classification (PCNE) of 2020. The study determined prevalence of DRPs and their impacts on efficacy, safety, and cost. Multivariate regression was used to identify the determinants of DRPs. Results: The study included 4339 patients (mean age 4.3, 55.8% male), with a total of 3994 DRPs, averaging 0.92 DRP/prescription. The proportion of prescriptions with at least one DRP was 65.7%. DRPs included inappropriate drug selection (35.6%), wrong time of dosing relative to meals (35.6%), inappropriate dosage form (9.3%), inappropriate indication (7.1%), and drug-drug interactions (0.3%). The consensus of experts was average when evaluating each aspect of efficiency reduction, safety reduction, and treatment cost increase, with Fleiss’ coefficients of 0.558, 0.511, and 0.541, respectively (p < 0.001). Regarding prescriptions, 50.1% were assessed as reducing safety. The figures for increased costs and decreased treatment effectiveness were 29.0% and 23.9%, respectively. Patients who were ≤ 2 years old were more likely to have DRPs than patients aged 2 to 6 years old (OR = 0.696; 95% CI = 0.599–0.809) and patients aged over 6 years old (OR = 0.801; 95% CI = 0.672–0.955). Patients who had respiratory system disease were more likely to have DRPs than patients suffering from other diseases (OR = 0.715; 95% CI = 0.607–0.843). Patients with comorbidities were less likely to have DRPs than patients with no comorbidities (OR = 1.421; 95% CI = 1.219–1.655). Patients prescribed ≥ 5 drugs were more likely to have DRPs than patients who took fewer drugs (OR = 3.677; 95% CI = 2.907–4.650). Conclusion: The proportion of prescriptions in at least one DRP was quite high. Further studies should evaluate clinical significance and appropriate interventions, such as providing drug information and consulting doctors about DRPs.