Paediatric pharmacology is a neglected area in terms of rational use of drugs. Wide differences have been observed in children’s exposure to drugs between and within countries and regions. The aim of the current thesis is to investigate the determinants of drug prescription in paediatrics. Pharmacoepidemiology and the use of administrative databases can be a useful tool for this scope.
Data collected in regional and multiregional administrative prescription databases were analysed. Prevalence data by sex and age were calculated by dividing the number of drug users by the total number of male and female residents in each age group. Univariable and multivariable analyses were performed with the aim to identify the determinants of drug prescriptions.
The studies showed quantitative and qualitative differences in drug prescription to children and adolescents among Italian regions and within regions. The prescription of a great number of different, redundant, active substances, even among experienced paediatricians, was found. A North-South trend was found in antiasthmatic and antibiotic prevalence, with an important association with average income at the area level. A confirmation of the high prevalence of these drugs and poor qualitative profile was also found.
Large heterogeneity was found in psychotropic drug prevalence among different Italian regions. Psychotropic drugs were scantly prescribed and some of the most used drugs were prescribed off-label. The analyses of the prescription of generic antibiotics showed that generic formulations are scantly prescribed by Italian paediatricians, and the lowest prescription rate of generic drugs was found in paediatricians who prescribe more antibiotics. Some quality indicators for antibiotic prescribing were developed at the paediatrician level. The youngest paediatricians and those who were not exposed to educational interventions showed a significantly worse quality of prescribing. The thesis provide some useful data for policy makers in order to improve the rational drug use in children
