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Analgesic Drug Prescription Patterns on Five International Paediatric Wards

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Abstract

Aim

Analgesic and anti-inflammatory drugs are frequently prescribed in paediatrics. Prescribing and dosing patterns in hospitalised children are not well known. This study explores analgesic drug utilisation on five paediatric wards and discusses its findings in comparison with World Health Organization (WHO) guidelines.

Method

A sub-analysis of a prospective, multicentre, observational cohort study was undertaken. Prescription data of children aged up to ≤18 years were collected between October 2008 and December 2009 on paediatric general medical wards in five hospitals in Australia, Germany, the United Kingdom (UK), Hong Kong (HK) and Malaysia. Analgesic drug prescriptions were analysed for prescribing patterns in terms of dosing, frequency and route of administration. Dosing data were compared with local recommendations and WHO guidelines for children.

Results

In the study cohort, 56.8 % (726/1278) of paediatric patients received at least one analgesic drug prescription (1227 prescriptions). The median age of patients with analgesics was 2.2 years [interquartile range (IQR) 0.8–7.3], and the median number of prescriptions per patient was one (IQR 1–2). The most commonly prescribed drugs were oral paracetamol (45.9 %, 563/1227) and oral ibuprofen (19.9 %, 244/1227). Daily doses of paracetamol ranged from 30 mg/kg/day in Germany to 67–68 mg/kg/day in the UK and HK (p < 0.05). For ibuprofen, single doses ranged from 5–6 mg/kg in HK and the UK to 10 mg/kg in Germany and Australia (p < 0.001). Opioid use prevalence was statistically different between the centres and ranged from 0 to 17.6 % (p < 0.001).

Conclusion

This study provides a comprehensive overview of analgesic drug use of hospitalised children. Similar to primary care data, paracetamol is the most commonly used analgesic. As recommended by WHO guidelines, oral medication was favoured and opioids used in addition to paracetamol and ibuprofen. Overall drug utilisation was in line with local recommendations and WHO guidelines. Differences in use of paracetamol and ibuprofen among countries were seen, indicating that safety concerns are perceived differently. More large-scale safety studies are needed.

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Acknowledgments

We would like to thank Ann-Kathrin Oehme and Wolfgang Rascher (Germany), Siew Siang Chua and Norrashidah Bt Abdul Wahab (Malaysia), Noel Cranswick and Valerie Sung (Australia), and Kenneth Lee and Tsui Ha Chan (Hong Kong) for their help with the data collection.

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Authors and Affiliations

  1. Department of Paediatrics and Adolescent Medicine, Faculty of Medicine, Paediatric Clinical Study Centre, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Loschgestrasse 15, 91054, Erlangen, Germany

    Sebastian Botzenhardt & Antje Neubert

  2. Institute of Pharmaceutical Science, King’s College London, King’s Health Partners, London, UK

    Asia N. Rashed & Stephen Tomlin

  3. Pharmacy Department, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, King’s Health Partners, London, UK

    Asia N. Rashed & Stephen Tomlin

  4. Research Department of Practice and Policy, UCL School of Pharmacy, London, UK

    Ian C. K. Wong

  5. Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China

    Ian C. K. Wong

Authors
  1. Sebastian Botzenhardt
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  2. Asia N. Rashed
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  3. Ian C. K. Wong
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  4. Stephen Tomlin
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  5. Antje Neubert
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Corresponding author

Correspondence to Antje Neubert.

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Conflict of interest

SB, AR, IW, ST and AN have declared that they have no financial interests that may be relevant to the submitted work.

Funding

AR was funded by the Yamani Cultural and Charitable Foundation, London, UK.

Ethical approval and informed consent

The study protocol was reviewed and approved by the appropriate national research ethics committee in each participating country and has been performed in accordance with the ethical standards of the Declaration of Helsinki. As this was an observational study, involving intensive chart review, no direct contact with patients or informed consent was required. Only anonymised data was recorded, which cannot be traced to individual patients.

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Botzenhardt, S., Rashed, A.N., Wong, I.C.K. et al. Analgesic Drug Prescription Patterns on Five International Paediatric Wards. Pediatr Drugs 18, 465–473 (2016). https://doi.org/10.1007/s40272-016-0198-9

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