European Journal of Clinical Pharmacology @ by Springer-Verlag 1978
Europ. J. clin. Pharmacol. 14, 39-46 (1978)
Patterns of Drug Prescribing for Children in Hospital T. A. Moreland, G. W. Rylance, L. J. Christopher, and I. H. Stevenson Department of Child Health, MedicinesEvaluationand MonitoringGroup and Department of Pharmacologyand Therapeutics, Universityof Dundee, NinewellsHospital and MedicalSchool, Dundee, Scotland
Summary. The drugs prescribed for children in Tayside hospitals in 1974 and 1975 were surveyed using the computer files of over 4000 children in each year. The results were compared with similar data on adult patients. Although similar proportions of both age groups received drugs, less than 3 drugs were prescribed for the great majority of the children (mean 2.5) compared with twice that number for adults. Seven classes of drugs accounted for almost fourfifths of the drugs prescribed for children but the same classes formed two-fifths only of the total drug use in adults. There was significantly greater use of antihistamine/sedative, anticonvulsant and decongestant/mucolytic drugs in children than in adults while the reverse was true for diuretics, KC1, cardioactive agents, sedatives/hypnotics, and tranquillisers. Antimicrobial drugs accounted for approximately one-third of the total drugs used in children and one half of all patients received at least one drug from this class. Penicillin preparations alone accounted for 65.1 per cent of all antimicrobial drug use. The percentage of children given ampicillin fell by almost half from 1974 to 1975 with a corresponding increase in the proportion receiving amoxycillin.
Key words: Drugs, prescribed, children, adults, surveyed.
A number of systems have been introduced in recent years to document the use of drugs in hospital inpatients (Coull et al., 1970; B. C. D. S.P., 1972). Although several have included children among the patients surveyed, these surveys have primarily been adult orientated (Sice, 1975) and have been either preliminary studies on small numbers (B. C. D. S. P.,
1972) or have focussed on adverse reactions to drugs with little information on the drugs prescribed during the adverse reaction episode (McKenzie et al., 1973). The present study was undertaken to obtain data on prescribing patterns in children admitted to hospital in the Tayside area to assess the feasibility of various research projects in paediatric pharmacology. This preliminary investigation also provides a background for subsequent detailed studies on adverse drug reactions, reasons for drug use and other prescribing information relevant to drug use in children. In addition to being able to compare drug use in children with that in adults it has also been possible to compare, for each age group, prescribing habits for the years 1974 and 1975.
Methods Dam Collected
The data for this survey covered the entire calendar years 1974 and 1975 and were obtained from the prescription records of a total of 59, 820 patients in Tayside Area hospitals kept on file as part of the Aberdeen-Dundee Medicines Evaluation and Monitoring System (Coull et al., 1970). On discharge of the patient from hospital, drug information was extracted from a standard prescription form used by medical staff for prescribing all in-patient medication. The data were entered into a computer file and subsequently linked with routine patient identification and vital statistics data. Drug information collected included, for each of the two years, the number of days each prescription was operative, the number of prescriptions per patient and the number of patients receiving drugs from each class. Repeat prescriptions of the same drug were counted as two prescriptions. 0031-6970/78/0014/0039/$01.60
40
T.A. Morelandet al.: Drug Prescribingfor Children 36-
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Number of prescriptions
I~g. 1. Frequencyof use of one or more prescriptions per patient in children(shaded) and in adults (open) in 1974 and 1975
Hospitals The data were collected on all in-patients over 4 weeks of age in the six hospitals monitored by the Dundee centre. These comprise three general teaching hospitals (all medical and surgical specialities included), one infectious diseases teaching hospital and two small convalescent/geriatric hospitals.
Age Groups The data were grouped according to patient age. Two paediatric sub-groups of 4 weeks to under 3 years and 3 to under 13 years were compared with a combined adolescent and adult group of 13 years and over, referred to subsequently as the adult group.
preparations, such as ampicillin and cloxacillin, were recorded as combinations rather than as the individual constituents. Due to obvious age-related differences in the fiequency and indication for the use of major tranquillisers and antidepressant drugs, detailed comparison would be of little value in these drug classes and only those prescribed for more than 50 days per year in children were included. Thus, imipramine was the only drug within the antienuretic/antidepressant class and chlorpromazine and promazine were the only tranquitlisers considered.
Results
Drug Classes
Comparison of Prescribing Patterns in the Paediatric and Adu# Groups
Seventeen pharmacological drug classes as defined by the Aberdeen-Dundee Medicines Evaluation and Monitoring Group were examined (Table 3). Parenterally administered water, electrolyte solutions, insulin preparations and anaesthetics were not included. The antimicrobial group included antibiotic, antiprotozoal, antifungal and antitubercular drugs, Diazepam was classed as an anficonvulsant in children and as a hypnotic in adults. Drugs prescribed in combination as proprietary
Table t provides data on overall drug use in the paediatric and adult groups for the years 1974 and 1975. Of a total of 4,297 paediatric patients in 1974, over 40 per cent did not receive drugs compared with less than 35 per cent of the 24,170 adult patients (Table 1, p
Europ. J. clin. Pharmacol. 14, 39-46 (1978)
Patterns of Drug Prescribing for Children in Hospital T. A. Moreland, G. W. Rylance, L. J. Christopher, and I. H. Stevenson Department of Child Health, MedicinesEvaluationand MonitoringGroup and Department of Pharmacologyand Therapeutics, Universityof Dundee, NinewellsHospital and MedicalSchool, Dundee, Scotland
Summary. The drugs prescribed for children in Tayside hospitals in 1974 and 1975 were surveyed using the computer files of over 4000 children in each year. The results were compared with similar data on adult patients. Although similar proportions of both age groups received drugs, less than 3 drugs were prescribed for the great majority of the children (mean 2.5) compared with twice that number for adults. Seven classes of drugs accounted for almost fourfifths of the drugs prescribed for children but the same classes formed two-fifths only of the total drug use in adults. There was significantly greater use of antihistamine/sedative, anticonvulsant and decongestant/mucolytic drugs in children than in adults while the reverse was true for diuretics, KC1, cardioactive agents, sedatives/hypnotics, and tranquillisers. Antimicrobial drugs accounted for approximately one-third of the total drugs used in children and one half of all patients received at least one drug from this class. Penicillin preparations alone accounted for 65.1 per cent of all antimicrobial drug use. The percentage of children given ampicillin fell by almost half from 1974 to 1975 with a corresponding increase in the proportion receiving amoxycillin.
Key words: Drugs, prescribed, children, adults, surveyed.
A number of systems have been introduced in recent years to document the use of drugs in hospital inpatients (Coull et al., 1970; B. C. D. S.P., 1972). Although several have included children among the patients surveyed, these surveys have primarily been adult orientated (Sice, 1975) and have been either preliminary studies on small numbers (B. C. D. S. P.,
1972) or have focussed on adverse reactions to drugs with little information on the drugs prescribed during the adverse reaction episode (McKenzie et al., 1973). The present study was undertaken to obtain data on prescribing patterns in children admitted to hospital in the Tayside area to assess the feasibility of various research projects in paediatric pharmacology. This preliminary investigation also provides a background for subsequent detailed studies on adverse drug reactions, reasons for drug use and other prescribing information relevant to drug use in children. In addition to being able to compare drug use in children with that in adults it has also been possible to compare, for each age group, prescribing habits for the years 1974 and 1975.
Methods Dam Collected
The data for this survey covered the entire calendar years 1974 and 1975 and were obtained from the prescription records of a total of 59, 820 patients in Tayside Area hospitals kept on file as part of the Aberdeen-Dundee Medicines Evaluation and Monitoring System (Coull et al., 1970). On discharge of the patient from hospital, drug information was extracted from a standard prescription form used by medical staff for prescribing all in-patient medication. The data were entered into a computer file and subsequently linked with routine patient identification and vital statistics data. Drug information collected included, for each of the two years, the number of days each prescription was operative, the number of prescriptions per patient and the number of patients receiving drugs from each class. Repeat prescriptions of the same drug were counted as two prescriptions. 0031-6970/78/0014/0039/$01.60
40
T.A. Morelandet al.: Drug Prescribingfor Children 36-
7.
32
28
.°-, ..
24 ... ..,
20
°-.,
16
;'Y"7 'o', &'l ,,,-]
12
",'.1 '.'.1
8,°°
!!:1
4
,','1 .'.'1 ,'&l &'J :'.1 --j
"1
0 1
2
3
i 4
E
6
7
8
9
10
11
12
13
> 13
Number of prescriptions
I~g. 1. Frequencyof use of one or more prescriptions per patient in children(shaded) and in adults (open) in 1974 and 1975
Hospitals The data were collected on all in-patients over 4 weeks of age in the six hospitals monitored by the Dundee centre. These comprise three general teaching hospitals (all medical and surgical specialities included), one infectious diseases teaching hospital and two small convalescent/geriatric hospitals.
Age Groups The data were grouped according to patient age. Two paediatric sub-groups of 4 weeks to under 3 years and 3 to under 13 years were compared with a combined adolescent and adult group of 13 years and over, referred to subsequently as the adult group.
preparations, such as ampicillin and cloxacillin, were recorded as combinations rather than as the individual constituents. Due to obvious age-related differences in the fiequency and indication for the use of major tranquillisers and antidepressant drugs, detailed comparison would be of little value in these drug classes and only those prescribed for more than 50 days per year in children were included. Thus, imipramine was the only drug within the antienuretic/antidepressant class and chlorpromazine and promazine were the only tranquitlisers considered.
Results
Drug Classes
Comparison of Prescribing Patterns in the Paediatric and Adu# Groups
Seventeen pharmacological drug classes as defined by the Aberdeen-Dundee Medicines Evaluation and Monitoring Group were examined (Table 3). Parenterally administered water, electrolyte solutions, insulin preparations and anaesthetics were not included. The antimicrobial group included antibiotic, antiprotozoal, antifungal and antitubercular drugs, Diazepam was classed as an anficonvulsant in children and as a hypnotic in adults. Drugs prescribed in combination as proprietary
Table t provides data on overall drug use in the paediatric and adult groups for the years 1974 and 1975. Of a total of 4,297 paediatric patients in 1974, over 40 per cent did not receive drugs compared with less than 35 per cent of the 24,170 adult patients (Table 1, p
