Basco William T, Garner Sandra S, Ebeling Myla, Hulsey Thomas C, Simpson Kit
Department of Pediatrics, College of Medicine, The Medical University of South Carolina, Charleston, S.C.; Department of Clinical Pharmacy and Outcome Sciences, South Carolina College of Pharmacy, Charleston, S.C.; Department of Epidemiology, West Virginia University, Morgantown, W.Va.; and Department of Health Administration and Policy, College of Health Professions, The Medical University of South Carolina, Charleston, S.C.
Pediatr Qual Saf. 2016 Dec 21;1(2):e007. doi: 10.1097/pq9.0000000000000007. eCollection 2016 Nov.
Combination preparations of acetaminophen/opioid are the most common opioid form prescribed to children. We tested the hypothesis that dispensed prescriptions of acetaminophen/opioid preparations more appropriately match acetaminophen dosing parameters than opioid dosing parameters. We also hypothesized that the frequency of potential overdose was inversely related to subject age.
Using 2011 to 2012 South Carolina outpatient Medicaid data, the authors identified acetaminophen/opioid preparations dispensed to children 0 to 36 months. Utilizing Centers for Disease Control and Prevention (CDC) data to impute subject weights as the 97th percentile for age and gender, the authors used imputed weights to calculate the maximum recommended daily dose (expected dose) of each component. We calculated the dose delivered per day (observed dose) based on drug concentration, volume dispensed, and days' supply and then calculated the frequency of overdose (observed dose/expected dose, >1.10) by each component, comparing overdose frequency of acetaminophen to the overdose frequency of opioid using a risk ratio. Logistic regression evaluated differences in potential overdose by age, controlling for race/ethnicity and gender.
Among 2,653 dispensed prescriptions of study drugs to 2,308 children 0 to 36 months old, the frequency of potential overdose was 0.7% for acetaminophen and 1.6% for opioid (risk ratio, 2.28). Age less than 3 months was associated with a greater frequency of potential overdose of either acetaminophen or opioid, even after controlling for gender and race/ethnicity.
Prescriptions of acetaminophen-opioid drugs dispensed to children 0 to 36 months old contained potential overdoses of opioid at greater than twice the frequency of acetaminophen and were more likely to occur in infants less than 3 months old.
对乙酰氨基酚/阿片类药物的复方制剂是给儿童开具的最常见的阿片类药物剂型。我们检验了以下假设：对乙酰氨基酚/阿片类药物制剂的配药处方中，对乙酰氨基酚的给药参数比对阿片类药物的给药参数匹配得更恰当。我们还假设潜在过量用药的频率与受试者年龄呈负相关。
利用2011年至2012年南卡罗来纳州门诊医疗补助数据，作者确定了给0至36个月儿童配药的对乙酰氨基酚/阿片类药物制剂。作者利用疾病控制与预防中心（CDC）的数据，将受试者体重估算为年龄和性别的第97百分位数，并使用估算体重计算每种成分的最大推荐日剂量（预期剂量）。我们根据药物浓度、配药量和供应天数计算每日给药剂量（观察剂量），然后计算每种成分的过量用药频率（观察剂量/预期剂量，>1.10），使用风险比比较对乙酰氨基酚与阿片类药物的过量用药频率。逻辑回归分析评估了年龄对潜在过量用药的差异，同时控制种族/族裔和性别因素。
在给2308名0至36个月大儿童配药的2653份研究药物处方中，对乙酰氨基酚的潜在过量用药频率为0.7%，阿片类药物为1.6%（风险比为2.28）。即使在控制了性别和种族/族裔因素后，3个月以下的儿童对乙酰氨基酚或阿片类药物潜在过量用药的频率更高。
给0至36个月大儿童配药的对乙酰氨基酚-阿片类药物处方中，阿片类药物潜在过量用药的频率是对乙酰氨基酚的两倍多，且更易发生在3个月以下的婴儿中。
