Polypharmacy in Pediatrics: Modern Conditions

The number of criminal cases against doctors has increased in recent years. The major reason for them was failure in delivery of any medical services that resulted in harm to health or death of the patient. The legislation of the Russian Federation for the medical industry is imperfect, however, the health care delivery failure can be associated with doctors’ non-compliance to the action algorithms specified by regulatory acts. The review has collected up-to-date legislative information regarding polypharmacy, off-label drug administration, irrational antibiotic therapy, that are neglected by doctors. Although, these problems become more and more crucial and they arouse interest of investigation bodies.

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Irrational Drug Therapy as One of the Reasons of Medical Errors

Намазова-Баранова

Zelenkova

Губанова

et al. 2021

Pediatr. farmakol.

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Pharmacotherapy in a Multidisciplinary Paediatric Hospital: Polypharmacy and Drug–Drug Interaction Risk Illustrated with a Clinical Case

Костылева

Strok

Постников

et al. 2022

Bezopasnost' i risk farmakoterapii

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Nowadays, the problems caused by polypharmacy are recognised and widely discussed in the medical community. Multimorbidity, which is not uncommon in paediatric practice, comes with an increase in the number of prescriptions and necessitates an active search for tools to reduce the potential risk and frequency of adverse drug–drug interactions in paediatric patients.The aim of the study was to use a clinical case to illustrate the need for monitoring, including laboratory monitoring of pharmacokinetic parameters, during concomitant therapy in paediatric practice.Materials and methods: the study consisted in a retrospective analysis of the archived medical records of an 11-year-old child with nephrotic syndrome associated with a concomitant tuberculous process who had been receiving inpatient treatment with immunosuppressants at the Russian Children’s Clinical Hospital from May to July 2018.Results: the prescription of cyclosporine for nephrotic syndrome entailed monitoring of plasma drug levels for potential pharmacokinetic interactions with the medicinal products used to treat the concomitant disease. The monitoring revealed an interaction between cyclosporine and rifampicin at the level of biotransformation. An adjustment of the concomitant therapy (discontinuation of rifampicin) allowed for achieving the target blood cyclosporine concentration, decreasing proteinuria and hypercholesterolemia, and increasing the blood total protein level in the child, which indicated the effectiveness of the ongoing treatment for the chief complaint.Conclusions: the data obtained suggest that laboratory monitoring of pharmacokinetic parameters in paediatric polypharmacy can increase the effectiveness of therapy and prevent adverse reactions and irrational combination of medicinal products.

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On the issue of efficacy and safety of prescription of pharmacological agents in pediatric practice

Харитонова

2022

jour

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Errors in prescribing pharmacological drugs remain common in pediatric practice. A certain role belongs to the inadequate quality of medical care and medical errors. Typical errors that are considered in judicial practice: polypharmacy, errors in dosage, use of medicines outside the instructions (off-label), etc. Cases of irrational use of medicines are considered. Until now, in outpatient settings, up to 50% of cases, prescribing antibiotics to children is recognized as unjustified. Aggressive promotion of medicines in the pharmaceutical market exacerbates the problems of irrational use of medicines. When changing doctors, there is often no continuity in the treatment of a sick child, as a result, errors in the technique of prescribing medicines may occur. For the treatment of many diseases of childhood, especially in neonatology, there are no special pediatric drugs and specific pediatric forms, which forces medical professionals to take risks by prescribing drugs with unknown safety and questionable efficacy. The problems of drug supply in pediatrics and the use of off-label drugs have not been completely resolved. Fueling the problem is the lack of drugs that have official approval for use in pediatric including gastroenterological, practice.

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Polypharmacy in Pediatrics: Modern Conditions

Cited by 4 publications

References 28 publications

Irrational Drug Therapy as One of the Reasons of Medical Errors

Irrational Drug Therapy as One of the Reasons of Medical Errors

Pharmacotherapy in a Multidisciplinary Paediatric Hospital: Polypharmacy and Drug–Drug Interaction Risk Illustrated with a Clinical Case

On the issue of efficacy and safety of prescription of pharmacological agents in pediatric practice

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