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Pediatric prescribing in tertiary care teaching hospital of Delhi (India): fragmenting medicines for use

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Abstract

Lack of availability of age-appropriate dosage forms for children often results in use of adult dosage forms, which are administered to children after crushing or breaking. This can result in inappropriate doses being given to the children. This study was done to assess the prescribing pattern of use of medicines that had to be fragmented or crushed for use in relation to the age of the child. A prescription audit of 1200 outpatients and 400 inpatient records was done in the pediatric department of Lok Nayak tertiary care teaching hospital in the National Capital New Delhi, India. A structured pro forma was used for collecting the data. The total medicines prescribed, use of adult formulations, and number of adult medicines that had to be fragmented or broken for administration to pediatric patients were assessed. A total of 880 medicines were prescribed among inpatients and 2701 in outpatients. In inpatients, 230 (26.1%) medicines and in outpatients, 1013 (37.5%) medicines were fragmented before use. Some of these medicines were available in liquid oral dosage forms in Delhi Essential Medicine List (DEML) and should be available in the hospital. Medicines for use for common conditions were fragmented. Maximum use of fragmented medicines was in the age group of 6–9 years, both among inpatients and outpatients. Association of fragmentation with age was significant (p value < 0.05).

Conclusion: Children are being prescribed dosage forms, requiring manual fragmentation or crushing. Policy changes and measures to make available age-appropriate pediatric dosage formulations need to be taken to improve pediatric pharmacotherapy in the hospital and health system.

What is Known:

• The dosage formulation prescribed to a patient can impact the patient’s compliance with the therapy, accuracy of dosing, and patient and care providers’ safety.

• Lack of availability of age-appropriate dosage forms is common for children and often results in administration of adult dosage forms after crushing or breaking.

What is New:

• Some regularly prescribed medicines (14) including amoxicillin, albendazole, chloroquine, carbamazepine, valproate, and phenytoin that had to be fragmented were available in liquid oral dosage forms in the Delhi Essential Medicine List (DEML).

• Despite being included in the EML, the patient has been denied access to appropriate medicines. It indicates a lack of concern and sensitivity about what is required for rational prescribing to children.

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Abbreviations

DEML:

Delhi State Essential Medicine List

EML:

Essential Medicine Lists

FDA:

Food and Drug Administration

IAP EMLc:

Indian Academy of Pediatrics Essential Medicine List

WHO EMLc:

World Health Organization Essential Medicine List for Children

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Authors and Affiliations

  1. Maulana Azad Medical College, New Delhi, India

    Himanshu Tayal

  2. Department of Pharmacology, Maulana Azad Medical College, New Delhi, India

    Himanshu Tayal, Vandana Roy & Shubha Singhal

  3. Department of Paediatrics, Maulana Azad Medical College, New Delhi, India

    A. P. Dubey

Authors
  1. Himanshu Tayal
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  2. Vandana Roy
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  3. Shubha Singhal
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  4. A. P. Dubey
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Contributions

Himanshu Tayal: Writing the protocol, data collection and analysis. Vandana Roy: Conceptualised and supervised the conduct of the study. She helped in analysis and interpretation of the observations. As well as editing the manuscript. Shubha Singhal: Analysis of observations and writing the manuscript. A.P Dubey: Clinical supervision of the work.

Corresponding author

Correspondence to Vandana Roy.

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Conflict of interest

The authors declare that they have no conflicts of interest.

Ethics approval

The study was conducted after approval by the Institutional Ethics Committee (F.No./11/IEC/MAMC/2011/47) of Maulana Azad Medical College, New Delhi, India.

Additional information

Communicated by Peter de Winter

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Tayal, H., Roy, V., Singhal, S. et al. Pediatric prescribing in tertiary care teaching hospital of Delhi (India): fragmenting medicines for use. Eur J Pediatr 179, 1435–1443 (2020). https://doi.org/10.1007/s00431-020-03633-4

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  • DOI: https://doi.org/10.1007/s00431-020-03633-4

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