Prescrição e preparo de medicamentos sem formulação adequada para crianças: um estudo de base hospitalar

Abstract

Este trabalho teve como objetivo identificar medicamentos cuja forma ou formulação farmacêutica representa um problema em pediatria (Medicamento Problema -MP), bem como analisar as estratégias empregadas pelos médicos, para sua utilização nas crianças e os riscos envolvidos. Trata-se de um estudo descritivo, que tem como base um inquérito com pediatras de um hospital de referência do SUS em Fortaleza-Ceará, conduzido para identificação dos MPs em julho-agosto de 2004; uma análise das prescrições contendo adaptação de formas sólidas e uma observação direta do preparo dos medicamentos, que foram conduzidas em dezembro de 2004 e janeiro de 2005, respectivamente. Os medicamentos foram agrupados pela classificação ATC e pelo cálculo de frequências das variáveis. Os pediatras (N=48, 98%) identificaram: 16 produtos sem forma injetável, 32 injetáveis necessários em concentrações menores e 30 MP sem formulação líquida para uso oral. Foram analisadas 89 prescrições contendo adaptação de formas sólidas, envolvendo 119 itens de medicamentos; todas continham inadequações, sendo a principal a partição de comprimidos. As doses prescritas corresponderam ao preconizado em 33,6% dos casos. Adaptações foram realizadas em local inadequado, por profissional não qualificado e sem as boas práticas. Concluindo, a carência de formulações apropriadas ao uso pediátrico repercute na prática médica e é agravada pela inexistência de condições adequadas para a manipulação de medicamentos por farmacêuticos, nos hospitais brasileiros.Unitermos: Prescrição pediátrica. Formulações farmacêuticas/adaptações para uso pediátrico. Medicamentos/uso pediátrico. Farmácia hospitalar.This work aimed to identify medicines whose form or pharmaceutical formula presents a problem to pediatrics (Problem Medication -PM), the strategies employed by doctors to use them in children, and the potential risks involved. Descriptive study: based on a survey with pediatricians from a SUS (Public Health System) reference hospital in Fortaleza-CE (Northeastern Brazil), in order to identify PMs, from July to August 2004; an analysis of prescriptions containing modification of medicines in the solid forms; and a follow-up of medicinal preparations, developed in December 2004 and January 2005, respectively. The medications were grouped by an anatomic, therapeutic and chemical classification and by means of a calculation of variables frequency. The pediatricians (N=48, 98% of the total) identified as PMs: 16 products without an injectable form; 32 in an injectable form that should be presented in lesser concentrations; and 30 without a liquid formula for oral use. Eighty two (82) prescriptions containing modifications of solid forms, involving 111 medicinal items were analyzed, all of which contained inadequacies; the main one being the partition of pills. In 33.6% of the cases, the prescribed doses were in accordance with that generally recommended. The modifications were carried out in inadequate places, by nonqualified professionals and without the use of best practices. Th...

Magistral drugs in hospitalized newborns and children

“…Observing the profile of oral solutions and suspensions compounded for newborns and children of the studied hospital, it was verified that solutions/suspensions of these active principles were identified in other studies: folic acid,9 , 19 folinic acid,9 , 20 ursodeoxycholic acid,11 , 14 captopril,8 , 9 , 14 , 15 , 18 , 21 caffeine,12 , 16 , 19 , 22 , 23 spironolactone,9 , 24 - 28 fluconazole,17 furosemide,8 , 9 , 26 hydrochlorothiazide,8 , 9 , 18 , 26 , 27 propranolol,10 ranitidine,9 pyrimethamine17 and sulfadiazine 17. Therefore, it is observed that the demand for oral solutions and suspensions administered to newborns and children in this study has also been observed in other studies and that the compounding of drugs is a national and international necessity due to the lack of oral liquid drugs from the pharmaceutical industry.…”

“…Modifications of pharmaceutical drug forms have been reported by Oguz et al and Khdour et al, who identified, respectively, 20.5% and 5.8% modifications in requests 78 Costa et al found 119 drug adaptations from solid to liquid form and Gavrilov et al identified two dose modifications in pharmaceutical forms 910 Dos Santos and Heineck found that 79 prescription items involved extemporaneous preparations 11.…”

“…In Brazil, there are few studies on the use of magistral drugs in infants and children, which are concentrated in hospitals from only three Brazilian cities: Fortaleza,9 , 14 , 15 Porto Alegre11 , 16 and Belo Horizonte 1718 …”

“…, 17 Of the pharmaceutical form adaptations, 75.63% had an inappropriate vehicle and there were also cases of incorrect packaging and conservation 9…”

Carência de preparações medicamentosas para uso em crianças no Brasil

“…2,4,15 From this preliminary list, we excluded those drugs commercially unavailable in Brazil, which returned from our search of the following sources: the Brazilian Dictionary of Pharmaceutical Specialties (Dicionário de Especialidades [16][17][18][19][20] To compose our final list, we added those PDP identified through a survey with pediatricians from a public reference hospital in the city of Fortaleza, State of Ceará, Brazil. 21 The identified drugs were coded at the Anatomic Therapeutic Chemical (ATC) classification system and their frequency analyzed regarding therapeutic group and subgroup and type of problem identified. 22 Drug labels of all pharmaceutical specialties were analyzed regarding pediatric indication, pharmaceutical formulation and exclusion of use in subgroups defined by age or weight, based on the following reference sources: DEF, ANVISA list of licensed drugs, and the website www.bulas.med.br.…”