Comparison of pediatric antibiotic prescribing practice between low and high prescribers for children in primary care

Background. Antibiotic prescribing is more prevalent in children. Many factors influence this practice, including the burden of outpatient visits. We aimed to compare antibiotic prescribing for children by low prescribers (LP) and high prescribers (HP) in primary care. Methods. We analyzed pediatric prescriptions in primary care in Istanbul. Among the physicians randomly selected by systematic sampling, those generating ≥1 pediatric prescription/day (n=1218) were defined as LP or HP when they belonged to the lowest (n=305) or highest (n=304) quartile of prescribing, respectively. The antibiotic prescribing characteristics of these groups were compared. Results. We identified that 38.5% of the prescriptions written by physicians included antibiotics, significantly higher in HPs (38.8%) than in LPs (37.2%), (p=0.04). Among antibiotic-containing prescriptions, the mean number of drugs and boxes and the percentage of prescriptions containing injectable drugs/antibiotics were significantly higher in HPs compared to that in LPs. We detected that co-amoxiclav was the most frequently prescribed antibiotic in the LP and HP groups (61.1% and 48.3%, respectively). Stratification of antibiotics by their spectra showed that 11.2% were narrow, 79.8% were broad and 0.5% were ultra-broad-spectrum drugs. LPs were significantly more likely to prescribe broad-spectrum antibiotics (82.5%) than do HPs (78.9%,p<0.001). Conclusions. Antibiotic prescribing remains excessive in pediatric primary care, slightly more marked in HPs. While HPs also tend to prescribe a higher number of overall and injectable drugs/antibiotics, broad-spectrum anti-biotherapy seems to be more practiced by LPs surprisingly. Both physician groups appeared to prefer either narrow-or broad-spectrum drugs without paying enough attention to their pharmacodynamic properties

Investigation of allergy management in primary care: Child vs. adult prescriptions

Objective: Allergic diseases are conditions that are frequently encountered in primary care, and different drug groups can be used in their treatment. This study aimed to compare the use of drugs in allergy in children and adults applied to primary care. Methods: We analyzed prescriptions written by those who were selected by systematic sampling (n=1431) among family physicians serving in İstanbul between January 1 and December 31, 2016. Among these, single-diagnosis prescriptions containing “T78.4-allergy, unspecified” were included in the study, and the prescriptions were divided into those written to children (<18 years old) and adults (≥18 years old). The demographic characteristics of the patients and drug details in the prescriptions were compared according to the groups. Results: A total of 37,042 prescriptions with a single diagnosis of allergy were identified, and 55.9% of which were for adults. Allergy diagnosis was higher in men (52.4%) among children and in females (67.7%) among adults. Antihistamines (85.3% and 83.4%, p<0.001), systemic steroids (5.4% and 1.6%, p<0.001), and inhalants (1.8% and 1.3%; p<0.001) were more likely prescribed to adults, whereas topical drugs were prescribed more in children (51.7% and 42.7%, p<0.01). Monotherapy was more preferred in children (45.8%) than in adults (41.6%, p<0.0001). Although antihistamine monotherapy was similar in these groups, topical drug monotherapy was used more in children (10.3%) than in adults (5.6%). Prescriptions with first-generation antihistamines were higher in adults (6.8%) than in children (5.4%; p<0.001). Desloratadine was the most commonly encountered drug in the prescriptions of both pediatric and adult patients (21.2% and 10.3%, respectively). Conclusion: The study revealed that antihistamines, mostly second-generation agents, are frequently preferred. Apart from the higher prescription of systemic corticosteroids for adults and topical drugs for children, it is understood that the pharmacological management of allergic conditions in primary care shows overall similarities in both age groups

Evaluation of serum prolactin le-vels in children with febrile and afebrile convulsions

Bu çalışmada, konvülziyon geçiren çocuklarda serum prolaktin düzeyine bakarak epileptik durumları nonepileptik durumlardan ayırt etmede bu ölçütü kullanıp kullanamayacağımızı değerlendirmek istedik. Gereç ve yöntem: Haydarpaşa Numune Eğitim ve Araştırma Hastanesi Çocuk Sağlığı ve Hastalıkları Kliniği’ne febril ve afebril konvülziyon geçirerek getirilen 2 yıllık süreçteki toplam 51 olgu analiz edildi. Febril konvülziyon geçiren 8 erkek, 9 kız yaşları 32,8+- 22,9 ay olan toplam 17 çocuk grup 1’i oluşturdu. Grup 2 de ise ortalama yaş 76,4+- 48,4 ay olan 20 erkek, 14 kız toplam 34 çocuktan oluştu. Grup 3 ise 24 erkek, 26 kız poliklini ğimize konvülziyon dışı yakınmayla başvuran toplam 50 çocuktan oluşan kontrol grubuydu. Olgularda konvülziyon sonrası 1. saatte, 2. saatte ve 24. saatte venöz kan alınarak serum prolaktin düzeyi bakıldı. Bulgular: Serum prolaktin birinci saat değerleri afebril grupta (grup 2), febril gruba (grup 1) göre anlamlı yüksek bulundu. Serum prolaktininin postkonvulzif 24. saat değeri açısından 3 grup karşılaştırıldığında istatistiksel açıdan anlamlı farklılık tespit edilmedi. Sonuç: Çalışmamız afebril konvülziyonda birinci saatte bakılan prolaktin düzeyinin anlamlı yüksekliği bize epileptik nöbetlerin nonepileptik durumlardan ayrımında, EEG monitorizasyonu zor ula- şılabilir bir yöntem olduğu için, bu yöntemi kullanabileceğimizi göstermektedir.In this study, we wanted to evaluate if we can use the serum prolactin levels as a marker in differential diagnosis epileptic syndromes and non epileptic ones. Materials and methods We analyzed totally 51 children during two years who were admitted to our clinic by having experienced febrile or afebrile convulsions. Group 1 included 8 male and 9 female totally 17 children whose mean ages were 32.8+/- 22.9 months and had febrile convulsions. Group 2 had 20 males and 14 females 76.4 +/- 48.4 months aged totally 34 children who had experienced afebrile convulsions. Group 3 included 24 males 26 females who had no neurologic symptoms or convulsions but taken to our clinic by other symptomatologies. Blood samples of cases were evaluated in the first hour, in the second and 24.hour of post convulsive follow-up. Results: We found that serum prolactin levels were significantly higher in the afebril convulsive group (group 2) than in the febrile convulsive group (group1). Serum prolactin levels of post convulsive 24.hour determination revealed no statistically difference between the three groups. Conclusion: In this study, we concluded that, we can use serum prolactin levels in the first hour of post convulsive follow-up for differential diagnosis of epileptic syndromes and non epileptic ones, since EEG monitorization is a hardly performed evaluation

Utilization of biotechnological drugs in rare diseases requiring the use of off-label drugs in children in Turkey

Background/aim: Pediatric patients, especially those with rare diseases, represent a population that has a high tendency towards off label drug use (OLDU) and needs a more careful practice of pharmacotherapy than in adults. We aimed to investigate biotechnological drug use in children with rare diseases requiring OLDU. Materials and methods: This retrospective study examined all single-diagnosed OLDU applications (n = 5792) for 4992 children (<18 year) in Turkey. Applications of rare diseases were selected, and their descriptive characteristics were examined, including demographic features of patients, biotechnological drug utilization status, and disease categories. The off-label statuses of the drugs at the end of 2020 were also examined. Results: In total, 77.7% (n = 4501) of OLDU applications were made for rare diseases. Biotechnological drug use was higher in rare disease applications than in nonrare diseases (37.9% vs. 19.2%, respectively; p < 0.0001). Canakinumab was the top applied biotechnological drug (73.2%). Compared to that in small-molecule drugs, the mean age of patients was higher in biotechnological drug-containing applications (8.1 +/- 5.3 vs. 9.7 +/- 4.9, respectively; p < 0.0001). Biotechnological drug use was higher in nonneoplastic rare diseases (40.3%) than in neoplastic rare diseases (26.4%), (p < 0.0001). At the end of 2020, the approval status of the off-label indications covered in 2016 was significantly higher for rare (24.4%) vs. nonrare (5.2%, p < 0.0001) diseases and for biotechnological (32.3%) vs. small molecule (13.9%, p < 0.0001) drugs. In total, 87.7% of the drugs would have to be still used in the off-label setting at the end of 2020. Conclusion: It was seen that more than three-quarters of the pediatric OLDU applications are for rare diseases, and the need for biotechnological OLDU in this group is almost 2-fold of small-molecule drug use. While further projected findings imply a higher approval tendency for rare diseases and biotechnological drugs, there seems to be more room for improvement for pediatric drug use.Marmara Universit

Off-label drug use in children

Çocukluk çağı, dinamik ve evre evre fizyolojik değişikliklerin olduğu bir dönemdir. Pediatrik popülasyonda görülen farmakokinetik ve farmakodinamik farklılıklar, ilaç kullanımı esnasında etkililik ve gü- venlilik başta olmak üzere çeşitli sorunlara yol açabilmektedir. Buna göre çocuklarda kullanılacak ilaçların, yaş grubuna özgü klinik araştır- malarla incelenip, onaylarının ayrıca alınması gerekmektedir. Oysa ço- cuklara özgü klinik araştırma ve bu yaş grubunda onaylı endikasyona sahip ilaç sayısı, çeşitli idari ve prosedürel nedenlerle kısıtlıdır. He- kimlerin, çocuk hastaların ilaç ile tedavisini düzenlerken çocukta kul- lanım endikasyonu onayı olmayan müstahzarları, sıklıkla ekstrapolasyon yoluyla kullandığı bilinmektedir. İlaçların, ruhsat al- dıkları alan dışındaki farklı endikasyon, doz, uygulama şekli, yaş grubu, özel popülasyon vb. kullanımları “endikasyon dışı ilaç kullanımı (EDİK)” olarak adlandırılır. EDİK oranı çocuklarda yüksek seyret- mekte, özellikle küçük yaş gruplarında hemen hemen tüm ilaçların en- dikasyon dışı kullanılmak zorunda kalınabildiği durumlar görülmektedir. Özellikle son 20 yılda tüm dünyada, çocuklarda klinik araştırmaların artırılması için yapılan düzenlemeler ise çocuklarda ilaç kullanımı ile ilgili kanıta dayalı bilgi hacmini, dolayısıyla çocuklarda endikasyon onayı olan ilaç sayısını artırmaya başlamıştır. Bu gelişme- lerin, pediatrik popülasyonda EDİK pratiğini mümkün olduğunca sı- nırlamaya yardımcı olacağı aşikârdır. Ancak EDİK’in rutin olmaktan öte istisnai durumlarda uygulanması hedefine ulaşmak için uzun zaman gerektiği göz önünde bulundurulduğunda, çocuklarda farmakoterapi sürecinin daha başarılı yönetilmesi için ilave yönlendirmelere ihtiyaç duyulmaktadır. Bu çalışmada, çocuklarda EDİK’in nedenleri, dünyada ve Türkiye’deki güncel durumu ve azaltılması/rasyonel yönetilmesi için atılabilecek adımlar ele alınmıştır.Childhood is a period with dynamic physiological changes stage by stage. Pharmacokinetic and pharmacodynamic vari- ations in pediatric population can cause various problems, especially efficacy and safety issues during drug use. Hence, drugs to be used in children should also be investigated and approved through clinical trials specific to the age group. However, the number of clinical tri- als and drugs with approved indications in children are limited for a variety of administrative and procedural reasons. Thus physicians tend to extrapolate drug information when treating their pediatric pa- tients with unapproved indication in pediatric population. The use of drugs outside their approved purpose, including different indications, doses, administration forms, age groups, or special populations etc. is called “off-label drug use (OLDU)”. Its prevalence is high in chil- dren, especially in very young age groups where almost all drugs may have to be used off-label. In the last 20 years, the regulations to fa- cilitate clinical research in children throughout the world have helped to increase the volume of evidence-based information about drug use, thus the number of drugs approved, in children. Obviously, these ad- vances will decrease OLDU practice in children. Considering the long time required to achieve the goal of applying OLDU only in excep- tional cases, additional guidance is needed to make the pharma- cotherapy more appropriate in children. In this review, causes of pediatric OLDU practice and the current situation in Turkey and glob- ally are evaluated with further discussion of the steps that can be taken for reduction/rational management of OLDU

Examination of the adverse events in children and adults in primary care

...British Pharmacological Societ

Self-Medication in Children

Çocuklarda akılcı ilaç kullanımının gereği gibi sağlanabilmesinde, ebeveynlerin bu konudaki tutum ve davranışlarının önemli rolleri bulunmaktadır. Bu araştırmada ebeveynlerin hastaneye başvuru öncesi çocuklarının tedavisinde ilaç/destekleyici tıbbi ürün kullanım alışkanlıklarının değerlendirilmesi amaçlandı. Tanımlayıcı tipteki bu araştırmada, İstanbul’daki bir eğitim ve araştırma hastanesi pediatri kliniğinin poliklinik ve acil servisine çocuklarının tedavisi için başvurmuş olan toplam 500 ebeveyne yüz yüze görüşme yöntemiyle anket yapıldı. Hastaneye başvuru öncesi çocuklarına ilaç kullanan ve kullanmayan ebeveynlerin ankete verdikleri yanıtlar karşılaştırıldı. Çocukların %46.3’ünün mevcut şikâyetleri başladığında doktora gelmeden önce ilaç kullandığı (ortalama 1.5±0.8 adet) ve bu ilaçların büyük bölümünün analjezik (%56.7), solunum sistemi ilaçları (%20.5) ve antibiyotikler (%12.5) olduğu tespit edildi. Başvuru öncesi ilaç kullanan ve kullanmayan ebeveynlerin bazı özellikleri karşılaştırıldığında; eğitim durumları, yaşları, meslekleri, aylık gelirleri, sosyal güvencelerinin bulunması, çocukların yaş grupları bakımından gruplar arasında anlamlı farklılık bulunmadı (p>0.05). Buna karşın, başvuru öncesi ilaç kullanmış olanlarda ilaç kullanmamış olanlara göre destekleyici tıbbi ürün kullanımının da daha fazla (sırasıyla %37.7 ve %13.4) olduğu ve çocuklarına düzenli sağlık kontrolü yaptırmayanların yine bu grupta daha fazla (sırasıyla %81 ve %71.4) olduğu saptandı.Ebeveynlerin yaklaşık olarak yarısı sağlık kurumuna başvurmadan önce çocuklarına ilaç kullanmıştır. Kullanılan ilaçların çoğu analjezikler, solunum sistemi ilaçları ve antibiyotiklerdir. Ebeveynlere akılcı ilaç kullanımı konusunda eğitim verilmesi kendi kendine ilaç kullanımı sıklığını azaltabilir.Parents sometimes exhibit the habit of self-medication for the diseases of their children. The attitude of the parents in this matter greatly influences the success of providing rational drug use for children. In this study, we aimed to investigate parental self-medication. In this descriptive study, 500 parents, who had visited the outpatient and emergency services of a pediatric department in a teaching and research hospital in İstanbul for the treatment of their children, were interviewed face to face. The answers of the parents to the questionnaires, who had and had not practiced self-medication, were compared. It was found that self-medication had been practiced by 46.3% of the parents and that their children had been given an average of 1.5±0.8 drugs, the majority of which were analgesics (56.7%), respiratory system drugs (20.5%) and antibiotics (12.5%). There were no statistically significant differences between the parents who had and had not practiced self-medication related to the education, age, profession, monthly income, and the presence of social security of the parents and the age groups of the children. The parents who had practiced self-medication were found to have used supportive medical products more frequently (37.7% vs 13.4%) and to have not taken their children to regular medical checkup (81% vs 71.4% ) (p<0.05). Approximately half of the parents have practiced self-medication. Majority of the self-medicated drugs have been analgesics, respiratory system drugs and antibiotics. Rational drug use education to parents may decrease the frequency of self- medication

Comparison of pediatric antibiotherapy in primary care: Low vs. high prescribers

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The comparison of drug use in children and adults with allergy in primary care

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