Evaluation of rational prescribing in paediatrics

Choonara, Imti

doi:10.1136/bmjpo-2021-001045

Cited by 3 publications

(1 citation statement)

References 24 publications

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“…Polypharmacy and failure to adhere to evidence-based practice and clinical guidelines in starting and stopping medicines are indicators of irrational practices and it is common to administer medicines outside their authorisation [ 14 ]. Generation of high-quality evidence of drug efficacy and safety need to be combined with rational prescribing tools [ 15 ] and continuous monitoring of drug use with data that explore implementation of recommended practices [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

Drug utilisation in neonatal units in England and Wales: a national cohort study

Al-Turkait

Szatkowski

Choonara

et al. 2022

Eur J Clin Pharmacol

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Purpose To describe drug utilisation patterns in neonatal units. Methods Retrospective observational cohort study using data held in the National Neonatal Research Database (NNRD) for neonatal units in England and Wales including infants born at 23 to 44 weeks’ gestational age (GA) from 01 January 2010 to 31 December 2017. Results The cohort included 17,501 (3%) extremely preterm infants; 40,607 (7%) very preterm infants; 193,536 (31%) moderate-to-late preterm infants; and 371,606 (59%) term infants. The number of unique drugs received by an infant (median (IQR)) increased with decreasing GA: 17 (11–24) in extremely preterm, 7 (5–11) in very preterm, 3 (0–4) in moderate-to-late preterm, and 3 (0–3) in term infants. The two most frequently prescribed drugs were benzylpenicillin and gentamicin in all GA groups, and caffeine in extremely preterm. Other frequently used drugs among preterm infants were electrolytes, diuretics and anti-reflux medications. Among infants <32 weeks’ GA, the largest increase in use was for surfactant (given on the neonatal unit), caffeine and probiotics, while domperidone and ranitidine had the largest decline. Conclusion Antibiotics, for all GAs and caffeine, among preterm infants, are the most frequently used drugs in neonatal medicine. Preterm infants are exposed to a high burden of drugs, particularly antibiotics. Changing patterns in use reflect the emergence of evidence in some areas but several non-evidence-based drugs continue to be used widely. Improvements are needed to ensure rational drug use on neonatal units. Registration ClinicalTrials.gov (NCT03773289). Date of registration 21 Dec 2018.

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Section: Discussionmentioning

confidence: 99%