Inappropriate use of anti-asthmatic drugs in the Italian paediatric population

Clavenna, Antonio; Rossi, Elisa; Berti, Alessandra Paim; Pedrazzi, Giorgio; Rosa, Marisa De; Bonati, Maurizio

doi:10.1007/s00228-003-0660-9

Cited by 33 publications

(37 citation statements)

References 16 publications

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“…However, the general prescribing profile is similar to that observed in other Italian studies, in particular in Northern Italy [4][5][6][7][8][9]11].…”

Section: Discussionsupporting

confidence: 81%

“…In particular, pharmacoepidemiology can be valuable in the paediatric setting, which is characterized by the availability of only limited information on the safety and effectiveness of drug use [2,3]. Drug utilization studies performed in the Italian paediatric population have found a prescription profile that appears to be specific to Italy [4][5][6][7][8][9], especially concerning antibiotics, in which both quantitative and qualitative differences with other European countries were found. The prescription prevalence was three-to fourfold higher than in the Netherlands or the UK, with a wide use of secondchoice antibiotics such as cephalosporins [10].…”

Section: Introductionmentioning

confidence: 99%

“…The prescription prevalence was three-to fourfold higher than in the Netherlands or the UK, with a wide use of secondchoice antibiotics such as cephalosporins [10]. Moreover, wide, irrational use of anti-asthmatics, in particular inhaled steroids, has been observed [8,9].…”

Section: Introductionmentioning

confidence: 99%

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Determinants of the drug utilization profile in the paediatric population in Italy's Lombardy Region

Clavenna

Sequi

Bortolotti

et al. 2009

Brit J Clinical Pharma

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WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT • Drug utilization studies performed in the Italian paediatric population have found a prescription profile that appears to be specific to Italy. • Quantitative and qualitative differences with other European countries have been found. • The prevalence of drug prescription is higher in southern Italy compared with northern Italy. WHAT THIS STUDY ADDS • This is the first study to evaluate the geographical differences in the pattern of drug prescribing to children and adolescents in a large Italian region. • Large differences in the prescription prevalence rate were found between local health units. • Living in the eastern part of the Lombardy region is associated with the highest risk of drug exposure. AIMS To evaluate the intraregional differences in drug prescribing to children and adolescents. METHODS Prescriptions reimbursed by the National Health System, involving 1543 203 children and adolescents <18 years old and dispensed during 2005 by the retail pharmacies of 15 local health units (LHU) in the Lombardy Region, were analysed. Logistic regression analysis was performed to evaluate the association between drug prescription and age, gender, prescriber, and setting. RESULTS A total of 747 790 youths (48%) received at least one drug prescription. The prescription prevalence rate was highest in children 1–5 years old (65%), decreased with increasing age to 38% in adolescents, and was slightly higher in boys than in girls. Antibiotics and anti‐asthmatics were the most prescribed therapeutic classes. Amoxicillin + clavulanic acid was the most prescribed drug (18% of children; 20% of packages). Large differences were found in the drug prescription prevalence rate between the different LHUs. The rate ranged between 38.4 and 54.8%, and was not correlated to hospitalization rate in the paediatric population. Being 1–5 years old [odds ratio (OR) 4.51, 95% confidence interval (CI) 4.43, 4.58] and living in the eastern part of the region (OR 2.06, 95% CI 1.99, 2.13) were the factors associated with the highest risk of drug exposure. CONCLUSIONS The results resemble the profiles observed in other Italian contexts, in particular concerning the wide use of antibiotics and anti‐asthmatics. However, large differences were found between LHUs, highlighting the need for more detailed investigations on therapeutic needs, drug use, and related variables in different geographic contexts.

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“…However, the general prescribing profile is similar to that observed in other Italian studies, in particular in Northern Italy [4][5][6][7][8][9]11].…”

Section: Discussionsupporting

confidence: 81%

Section: Introductionmentioning

confidence: 99%

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Determinants of the drug utilization profile in the paediatric population in Italy's Lombardy Region

Clavenna

Sequi

Bortolotti

et al. 2009

Brit J Clinical Pharma

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“…International guidelines recommend ICS for longterm control of persistent asthma for all degrees of severity, and inhalatory short-acting β-agonists (SABA), such as salbutamol, as first choice in an acute attack [3][4][5]. Although adherence to guidelines reduces the number of outpatient and emergency department visits [6], [7][8][9][10]. In paediatric practice, the main inadequacy seems to be the use of ICS: over-prescribed in upper respiratory tract infections (URTI) and not prescribed enough for prevention or maintenance therapy between acute attacks in asthmatic children and adults [11,12].…”

Section: Incongruence Between Prescription Prevalence and Asthma Prevmentioning

confidence: 99%

Inter-country variations in anti-asthmatic drug prescriptions for children. Systematic review of studies published during the 2000–2009 period

Bianchi

Clavenna

Bonati

2010

Eur J Clin Pharmacol

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“…1 This high prescription rate is not surprising because wheezing is a common symptom at all ages and asthma is a frequent diagnosis during childhood. 3 Asthma drug use is highest, however, in preschool children, 1,4 the age category during which the least evidence for asthma drug efficacy has been documented. 5 Although antibiotics and asthma drugs are both frequently prescribed, there is no information available on the frequency of coprescription of these drugs.…”

mentioning

confidence: 99%

Coprescription of Antibiotics and Asthma Drugs in Children

et al. 2011

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WHAT THIS STUDY ADDS:In this study, antibiotic use was found to be 1.9 times more frequent in children who were treated with asthma drugs than those who were not. Among children who received an asthma drug, 35.6% were dispensed an antibiotic on the same day. abstract BACKGROUND: In children, antibiotics as well as asthma drugs are frequently prescribed. We investigated the effects of the codispensing of antibiotics and asthma drugs to children. METHODS:Using a health insurance database, we examined dispensing and codispensing of antibiotics and asthma drugs for the period of a 1 year in 892 841 Belgian children aged Ͻ18 years. RESULTS:For a 1-year period, an antibiotic was dispensed to 44.21% of children: 73.05% aged Ͻ3 years; 49.62% aged 3 to 7 years; and 34.21% aged 8 to Ͻ18 years. An asthma drug was dispensed to 16.04% of children: 44.81% aged Ͻ3 years; 17.90% aged 3 to 7 years; and 7.64% aged 8 to Ͻ18 years. Overall, an antibiotic was dispensed without an asthma drug to 38.62% of children versus with an asthma drug to 73.50% of children (P Ͻ .0001). More frequent dispensing of antibiotics to children who received an asthma drug (odds ratio: 1.90; 95% confidence interval: 1.89 -1.91) occurred in all age categories (P Ͻ .0001). In 35.64% of children with an asthma drug dispensed, an antibiotic was dispensed on the same day. CONCLUSIONS:In all age groups, dispensing of antibiotics is more likely in children who have an asthma drug dispensed in the same year. In all age groups, codispensing of antibiotics and asthma drugs is a common practice. Efforts to decrease antibiotic use in children could be improved by focusing on children who are being treated with asthma drugs.

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Inappropriate use of anti-asthmatic drugs in the Italian paediatric population

Abstract: The data suggest that anti-asthmatic drugs are often prescribed for diseases different from asthma and that many children are exposed to treatments for which there is no evidence of efficacy.

Cited by 33 publications

References 16 publications

Determinants of the drug utilization profile in the paediatric population in Italy's Lombardy Region

Determinants of the drug utilization profile in the paediatric population in Italy's Lombardy Region

Inter-country variations in anti-asthmatic drug prescriptions for children. Systematic review of studies published during the 2000–2009 period

Coprescription of Antibiotics and Asthma Drugs in Children

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