Prescribed medicine use and extent of off‐label use according to age in a nationwide sample of Australian children

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 us...

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Autores principales: Schaffer, Andrea L., Bruno, Claudia, Buckley, Nicholas A., Cairns, Rose, Litchfield, Melisa, Paget, Simon, Zoega, Helga, Nassar, Natasha, Pearson, Sallie‐Anne
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9540111/
https://www.ncbi.nlm.nih.gov/pubmed/35172017
http://dx.doi.org/10.1111/ppe.12870
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author Schaffer, Andrea L.
Bruno, Claudia
Buckley, Nicholas A.
Cairns, Rose
Litchfield, Melisa
Paget, Simon
Zoega, Helga
Nassar, Natasha
Pearson, Sallie‐Anne
author_facet Schaffer, Andrea L.
Bruno, Claudia
Buckley, Nicholas A.
Cairns, Rose
Litchfield, Melisa
Paget, Simon
Zoega, Helga
Nassar, Natasha
Pearson, Sallie‐Anne
author_sort Schaffer, Andrea L.
collection PubMed
description 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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spelling pubmed-95401112022-10-14 Prescribed medicine use and extent of off‐label use according to age in a nationwide sample of Australian children Schaffer, Andrea L. Bruno, Claudia Buckley, Nicholas A. Cairns, Rose Litchfield, Melisa Paget, Simon Zoega, Helga Nassar, Natasha Pearson, Sallie‐Anne Paediatr Perinat Epidemiol SPECIAL ISSUE ARTICLES 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. John Wiley and Sons Inc. 2022-02-16 2022-09 /pmc/articles/PMC9540111/ /pubmed/35172017 http://dx.doi.org/10.1111/ppe.12870 Text en © 2022 The Authors. Paediatric and Perinatal Epidemiology published by John Wiley & Sons Ltd. https://creativecommons.org/licenses/by/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle SPECIAL ISSUE ARTICLES
Schaffer, Andrea L.
Bruno, Claudia
Buckley, Nicholas A.
Cairns, Rose
Litchfield, Melisa
Paget, Simon
Zoega, Helga
Nassar, Natasha
Pearson, Sallie‐Anne
Prescribed medicine use and extent of off‐label use according to age in a nationwide sample of Australian children
title Prescribed medicine use and extent of off‐label use according to age in a nationwide sample of Australian children
title_full Prescribed medicine use and extent of off‐label use according to age in a nationwide sample of Australian children
title_fullStr Prescribed medicine use and extent of off‐label use according to age in a nationwide sample of Australian children
title_full_unstemmed Prescribed medicine use and extent of off‐label use according to age in a nationwide sample of Australian children
title_short Prescribed medicine use and extent of off‐label use according to age in a nationwide sample of Australian children
title_sort prescribed medicine use and extent of off‐label use according to age in a nationwide sample of australian children
topic SPECIAL ISSUE ARTICLES
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9540111/
https://www.ncbi.nlm.nih.gov/pubmed/35172017
http://dx.doi.org/10.1111/ppe.12870
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