Pediatrics and Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania.
Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, Colorado.
Am J Prev Med. 2019 Jun;56(6):e205-e213. doi: 10.1016/j.amepre.2018.12.015. Epub 2019 Apr 17.
INTRODUCTION: Flow restrictors are child-resistant packaging innovations designed to limit the amount of liquid dispensed from a medication bottle. In 2011, flow restrictors were added to pediatric liquid single-ingredient acetaminophen formulations. The hypothesis of this study is that implementation would be associated with reduced volume and severity of pediatric acetaminophen exposures reported to the U.S. National Poison Data System. METHODS: This study describes accidental unsupervised ingestions of acetaminophen in children aged <6 years. Exposures were grouped into pre-implementation (pre-period; January 4, 2010-July 17, 2011); transition (July 18, 2011-July 15, 2012); and post-implementation (post-period; July 16, 2012-December 25, 2016) periods. Cumulative and annual rates of change per million units (i.e., bottles) sold were calculated for the pre- and post-periods for acetaminophen and pediatric liquid ibuprofen (comparator without flow restrictors). Pre- to post-period rate ratios were used to compare products and to estimate the potential effect on other over-the-counter medications. Analysis was conducted in 2017 and 2018. RESULTS: The pre- and post-period cumulative acetaminophen exposure rate was 507.2 (95% CI=481.1, 534.6) and 325.6 (95% CI=305.8, 346.7) per 1 million units sold, respectively. Declines in the pre- versus post-period rate ratios were seen for exposures with any effect (0.642, 95% CI=0.591, 0.696) and with clinically significant outcomes (0.728, 95% CI=0.581, 0.913). In the post-period, acetaminophen exposures decreased faster than ibuprofen with a rate of change ratio of 0.936 (95% CI=0.912, 0.960) for all exposures and 0.939 (95% CI=0.909, 0.970) for exposures with any effect. CONCLUSIONS: The addition of flow restrictors to pediatric liquid acetaminophen was associated with a reduction in the number and severity of exposures. Application of flow restrictors to other liquid medications should be considered.
简介:流量限制器是一种儿童防误开包装创新设计,旨在限制从药物瓶中分配出的液体量。2011 年,流量限制器被添加到儿科液体单剂量对乙酰氨基酚配方中。本研究的假设是,实施后将与向美国国家毒物数据系统报告的儿科对乙酰氨基酚暴露量的减少有关。
方法:本研究描述了年龄<6 岁的儿童意外无人监督摄入对乙酰氨基酚的情况。将暴露分为实施前(预阶段;2010 年 1 月 4 日至 2011 年 7 月 17 日)、过渡期(2011 年 7 月 18 日至 2012 年 7 月 15 日)和实施后(后阶段;2012 年 7 月 16 日至 2016 年 12 月 25 日)。计算了实施前后(预阶段和后阶段)每百万单位(即瓶)销售的对乙酰氨基酚和儿科液体布洛芬(无流量限制器的对照药物)的累积和年度变化率。使用从预阶段到后阶段的产品率比来比较产品,并估计对其他非处方药的潜在影响。分析于 2017 年和 2018 年进行。
结果:预阶段和后阶段的累积对乙酰氨基酚暴露率分别为 507.2(95%CI=481.1,534.6)和 325.6(95%CI=305.8,346.7)/每 100 万单位销售。在有任何影响(0.642,95%CI=0.591,0.696)和有临床显著结果(0.728,95%CI=0.581,0.913)的暴露中,预阶段与后阶段的率比值下降。在后阶段,所有暴露情况下,对乙酰氨基酚暴露的变化速度比布洛芬快 0.936(95%CI=0.912,0.960),有任何影响的暴露情况下为 0.939(95%CI=0.909,0.970)。
结论:在儿科液体对乙酰氨基酚中添加流量限制器与暴露数量和严重程度的减少有关。应考虑将流量限制器应用于其他液体药物。
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