Rational Use of Medicines in Neonates: Current Observations, Areas for Research and Perspectives

Abstract

A focused reflection on rational medicines use in neonates is valuable and relevant, because indicators to assess rational medicines use are difficult to apply to neonates. Polypharmacy and exposure to antibiotics are common, while dosing regimens or clinical guidelines are only rarely supported by robust evidence in neonates. This is at least in part due to the extensive variability in pharmacokinetics and subsequent effects of medicines in neonates. Medicines utilization research informs us on trends, on between unit variability and on the impact of guideline implementation. We illustrate these aspects using data on drugs for gastroesophageal reflux, analgesics or anti-epileptic drugs. Areas for additional research are drug-related exposure during breastfeeding (exposure prediction) and how to assess safety (tools to assess seriousness, causality, and severity tailored to neonates) since both efficacy and safety determine rational drug use. To further improve rational medicines use, we need more data and tools to assess efficacy and safety in neonates. Moreover, we should facilitate access to such data, and explore strategies for effective implementation. This is because prescription practices are not only rational decisions, but also have psychosocial aspects that may guide clinicians to irrational practices, in part influenced by the psychosocial characteristics of this population.

Rational Use of Antibiotics in Neonates: Still in Search of Tailored Tools

“…Rational antibiotic use implies the prescription and administration of a safe formulation using the optimal dose, based on accurate information on the medicine and based on a valid indication in neonates [11,12]. Based on the issues discussed on when, what and how, it is obvious that this is not yet the case for antibiotic use in neonates.…”

“…As already mentioned in the Special Issue, we like to believe that decisions on medicine use in neonates are driven by rational processes, but we should also explore the psychosocial aspects that guide our decisions [11,61]. Progress on the rational use of antibiotics does not only depend on the availability of high quality data on efficacy and safety (‘knowledge’) and the related new tools (‘methods’), but also on the subsequent approaches taken to streamline access to such data and the development of implementation strategies.…”

“…Progress on the rational use of antibiotics does not only depend on the availability of high quality data on efficacy and safety (‘knowledge’) and the related new tools (‘methods’), but also on the subsequent approaches taken to streamline access to such data and the development of implementation strategies. Data access and implementation strategies should not only facilitate technical access to data or guidelines, but should also consider the most effective strategies (‘skills’) to approach caregivers not only as rational decision makers, but also cover the psychosocial aspects involved in the decision process of the prescription of medicines [11,61]. The recent German survey hereby illustrated again the significant gap between the available guidelines and the daily practices in the different units [18].…”

“…Obviously, frequent prescription does not in itself reflect rational medicine use. This is because rational medicine use implies the prescription and administration of a safe formulation using the optimal dose, both based on accurate information on the medicine and its indications in neonates [11,12]. In this review, we will illustrate that important uncertainties still exist on the different aspects (when, what, and how, most prominent on the ‘when’ aspect) of antibiotic use in neonates, all related to rational drug use.…”

Consumer Awareness, Attitude, and Behavior Related to the Rational Use of Medicines in a Developing Country Context: The Case of Turkey

“…It is also stated that more comprehensive policies are needed for RUM [21]. In recent years, studies on rational drug use have been carried out in specific groups such as hypertensive, diabetic, and neonates [22], [23], [24]. The adoption and recognition of policies for practitioners and consumers are highly effective on success.…”