Tayal Himanshu, Roy Vandana, Singhal Shubha, Dubey A P
Maulana Azad Medical College, New Delhi, India.
Department of Pharmacology, Maulana Azad Medical College, New Delhi, India.
Eur J Pediatr. 2020 Sep;179(9):1435-1443. doi: 10.1007/s00431-020-03633-4. Epub 2020 Mar 17.
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.
儿童缺乏适合其年龄的剂型常常导致使用成人剂型，这些成人剂型在碾碎或掰开后给儿童服用。这可能导致给儿童的剂量不恰当。本研究旨在评估针对儿童年龄必须碾碎或掰开使用的药物的处方模式。在印度新德里国家首都地区洛卡·纳亚克三级护理教学医院的儿科，对1200名门诊患者和400名住院患者的记录进行了处方审核。使用结构化表格收集数据。评估了所开药物的总数、成人剂型的使用情况以及必须碾碎或掰开以供儿科患者服用的成人药物数量。住院患者共开了880种药物，门诊患者开了2701种。住院患者中，230种（26.1%）药物以及门诊患者中1013种（37.5%）药物在使用前被碾碎。其中一些药物在《德里基本药物清单》（DEML）中有液体口服剂型，且医院应该备有。用于常见病症的药物被碾碎。在住院患者和门诊患者中，6 - 9岁年龄组碾碎药物的使用最多。碾碎与年龄的关联具有显著性（p值<0.05）。结论：给儿童开的是需要手动碾碎或掰开的剂型。需要采取政策变革和措施来提供适合儿童年龄的剂型，以改善医院和卫生系统中的儿科药物治疗。已知信息：• 给患者开的剂型会影响患者对治疗的依从性、给药准确性以及患者和医护人员的安全。• 儿童缺乏适合其年龄的剂型很常见，常常导致碾碎或掰开后使用成人剂型。新发现：• 《德里基本药物清单》（DEML）中有一些经常开具的必须碾碎的药物（14种），包括阿莫西林、阿苯达唑、氯喹、卡马西平、丙戊酸盐和苯妥英，有液体口服剂型。• 尽管被列入基本药物清单，但患者仍无法获得合适的药物。这表明在合理给儿童开处方所需药物方面缺乏关注和敏感度。
