Topical corticosteroids in infants: prescribing pattern and prescribing errors in Bahrain
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A nationwide, primary care-based prescription audit in infants to determine the prescribing pattern and prescribing errors of topical corticosteroid preparations in Bahrain.
Prescriptions dispensed for infants were collected for two successive weeks from 20 primary-care health centres.
Among 2282 out of 102,084 prescriptions (2.2%) dispensed for infants, 296 (13.0%) had corticosteroids for topical application to the skin, eye and ear. Plain corticosteroids comprised 6.7%, whereas corticosteroids with antiinfectives accounted for 6.3% of topical corticosteroid preparations. Based on potency the proportions of corticosteroids prescribed were: mild (6.7%), moderately potent (2.6%) and potent (3.7%). The frequency of dosing and length of therapy were not stated in 21.6% and 43.6% of prescriptions, respectively. Base cream as a dilutional vehicle was prescribed in 11.2% (11/98) and 32.4% (12/37) prescriptions containing hydrocortisone acetate 1% cream and betamethasone valerate 0.1%, respectively. In few instances two corticosteroids were concomitantly prescribed.
Prescribing moderate-to-potent topical preparations in approximately half of the infants, co-prescription of multiple corticosteroid preparations, omission of important components of prescription, and resorting to the controversial vehicle diluting technique suggest that topical corticosteroid therapy is sub-optimal. In infants, topical corticosteroids should be rationally prescribed. Establishing the treatment guidelines, pharmacovigilance programme and revision of the primary care essential drug list are needed in Bahrain.
KeywordsTopical corticosteroids Infants Prescribing pattern Prescribing errors Primary care Middle East Bahrain
We acknowledge the help and assistance given to us by the Ministry of Health, Directorate of Health Centres/Primary Health Care: Dr. Awatif S. Sharaf (Chief of Medical Services for Primary-Care Health Centres); Dr. Bahyia Al Assoomi (Deputy Chief of Medical Services); the pharmacists and the pharmacy technicians of all health centres; Moh’d Ghali Rashid from Medical Library for information retrieval; and Radha Raghavan for her help in manuscript preparation.
Conflicts of interest
- 1.Knowles SR, Wong G, Shear NH. Dermatological drugs, topical agents and cosmetics. In: Aronson JK, editor. Side Effects of Drugs Annual-28. Amsterdam: Elsevier; 2005. ISBN 0-444-51571-2Google Scholar
- 2.British National Formulary (BNF) (# 50) 2005, Pharmaceutical Press, LondonGoogle Scholar
- 3.Wyatt EL, Sutter SH, Drake LA. Dermatological Pharmacology. In: Hardman JG, Limbird LE, editors. Goodman & Gilmans’ The Pharmacological Basis of Therapeutics. 10th ed. New York: McGraw Hill; 2001. ISBN 0-07-135469-7. Google Scholar
- 4.Martindale. The Complete Drug Reference. 33rd ed. Great Britain: Pharmaceutical Press; 2002. ISBN 0 85369 499 0Google Scholar
- 5.Al Khaja KAJ, Al-Ansari TM, Sequeira RP. An evaluation of prescribing errors in primary care in Bahrain. Intl J Clin Pharmacol Therap 2005; 43(6):294–301Google Scholar
- 12.Lexchin J. Improving the appropriateness of physician prescribing. Intl J Health Serv 1998; 28(2):253–67Google Scholar
- 13.Thomson O’Brien MA, Freemantle N, Oxman AD, et al. Continuing education meetings and workshops: effects on professional practice and health care outcomes. Cochrane Database Syst Rev 2001; 2:CD 003030Google Scholar
- 14.Worall G, Chaulk P, Freake D. The effects of clinical practice guidelines on patient outcome in primary care: a systematic review. J Canad Med Assoc 1997; 156(12):1705–12. Google Scholar