Cross-sectional study on the drug utilization and evaluation indicator of antibiotics used in pediatric population

Abstract

Background The lack of medication standards is a serious problem in paediatrics mainly because of age-related differences in organ development and physiological functions in children. Consequently, dosage measurement becomes inaccurate. For this reason, methods for evaluating and monitoring rational paediatric medications should be developed. Drug use indicators, such as those similar to the drug utilisation index (DUI) based on the Anatomical Therapeutic Chemical/Defined Daily Dose (DDD) and widely used for the assessment of appropriate dosage in adults, should be explored in terms of their applicability to children. Methods A total of 5,538 prescriptions of antibiotics selected from a general teaching hospital were included. Drug, dose, frequency and treatment duration were obtained from each prescription. The prescription daily dose (PDD) of each antibiotic drug was calculated as the average of the daily doses. Underdose and overdose were determined in terms of the PDD/DDD ratio for each prescription. Children’s DUI (cDUI) was explored in terms of the appropriate dosage for children as follows: the meaning of children’s DDD (cDDD) and the evaluation of paediatric drug dosage. Results The top five antibiotics and their utilisation rates were as follows: cefmetazole sodium injection (18.47 %), erythromycin lactobionate injection (15.07 %), amoxicillin/clavulanate potassium injection (10.72 %), ceftriaxone sodium injection (9.50 %) and azithromycin dry suspension (8.02 %). The ratio of cDUI and PDD/cDDD was mostly not close to 1. Conclusions The establishment of a cDUI system is an effective means of paediatric dosage evaluation. In addition to DDDs, cDUI and PDD/cDDD should be used to analyse the utilisation of antibiotics in children.

Appropriateness of antimicrobial selection for treatment of pneumonia in selected public hospitals of Eastern Ethiopia: A cross-sectional study

“…83 The lack of medication standards in pediatrics is a critical concern, owing to age-related changes in organ growth and physiological functions, resulting in significant pharmacodynamic and pharmacokinetic diversity. [84][85][86] As a result, the measurement of dosage becomes imprecise, necessitating the development of educational programs aimed at raising rational use. 87 The prevalence of medical comorbidity 88,89 in the elderly can also be ascribed to pharmacokinetic and pharmacodynamic alterations, which can directly interfere with the side effects and raise the risk of intoxication.…”

“…83 The lack of medication standards in pediatrics is a critical concern, owing to age-related changes in organ growth and physiological functions, resulting in significant pharmacodynamic and pharmacokinetic diversity. 84–86 As a result, the measurement of dosage becomes imprecise, necessitating the development of educational programs aimed at raising rational use. 87…”

Defined daily doses in pediatric dosing‐ a theoretical example

“… 3 The use of antibiotics in the pediatric population was stratified into five age groups according to the child growth standards of WHO as suggested by the Chinese new edition of pharmacology. 3 However, there is still no global definition of defined daily doses for children, and it is unclear which standard doses should be used for children when conducting drug utilization studies. Our aim was to theoretically calculate cDDD for three common medicines in children and discuss the usefulness in a Swedish setting.…”

“…The cDDD has been subsequently used in studies of drug utilization in children, but despite this, most studies are still using other measures (DDD for adults, number of prescriptions for example). A recently suggested approach was to calculate cDDD from adult DDDs based on the child's age 3 . The use of antibiotics in the pediatric population was stratified into five age groups according to the child growth standards of WHO as suggested by the Chinese new edition of pharmacology 3 .…”

“…A recently suggested approach was to calculate cDDD from adult DDDs based on the child's age 3 . The use of antibiotics in the pediatric population was stratified into five age groups according to the child growth standards of WHO as suggested by the Chinese new edition of pharmacology 3 . However, there is still no global definition of defined daily doses for children, and it is unclear which standard doses should be used for children when conducting drug utilization studies.…”