Review of Italian primary care paediatricians identifies 38 commonly prescribed drugs for children

Piovani, Daniele; Clavenna, Antonio; Bonati, Maurizio

doi:10.1111/apa.12783

Cited by 8 publications

(10 citation statements)

References 21 publications

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“…Fourth, confounding by indication is a main concern when studying the association between antibiotics and liver injury. Accordingly, the sensitivity analysis in which current exposure to amoxicillin was used as the reference category allowed to control for this potential confounding because amoxicillin is the most frequently used antibiotic in children [31] and is usually considered less hepatotoxic than other antibiotics [25, 32]. Thus, the risk estimate during amoxicillin exposure can be regarded as a proxy of the background risk of liver injury [32].…”

Section: Discussionmentioning

confidence: 99%

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Antibiotic-Induced Liver Injury in Paediatric Outpatients: A Case-Control Study in Primary Care Databases

Ferrajolo¹,

Verhamme²,

Trifirò

et al. 2016

Drug Saf

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IntroductionAntibiotics are the most commonly prescribed drug class in children. Real-world data mining on the paediatric population showed potential associations between antibiotic use and acute liver injury.ObjectiveWe assessed risk estimates of liver injury associated with antibiotic use in children and adolescent outpatients.MethodsA large, multi-database, population-based, case-control study was performed in people <18 years of age from two European countries (Italy and The Netherlands) during the period 2000–2008. All potential cases of liver injury were automatically extracted from three databases and then manually validated based on Council for International Organizations of Medical Sciences (CIOMS) criteria and by exclusion of all competing causes for liver injury. Up to 100 control participants were sampled for each case and were matched on index date of the event, age, sex and database. Based on prescription data, antibiotic exposure was categorized as current, recent or past use by calculating the time period between the end of prescription and the index date. Multivariate conditional logistic regression analyses were applied to calculate odds ratios (ORs) as a measure of the association (with 95% confidence interval [CI]).ResultsWe identified 938 cases of liver injury and matched to 93,665 controls. Current use of overall antibiotics is associated with a threefold increased risk of liver injury compared with past use (adjusted OR [ORadj] 3.22, 95% CI 2.57–4.03). With regard to individual antibiotics, the risk is significantly increased for current use of each antibiotic (p < 0.005), except for azithromycin. Risk estimates vary from the lowest ORadj of 1.86 (95% CI 1.08–3.21) for amoxicillin to the highest ORadj of 24.16 (95% CI 11.78–49.54) for cotrimoxazole (i.e. sulphamethoxazole/trimethoprim) and 26.70 (95% CI 12.09–58.96) for ceftriaxone. Sensitivity analyses confirm the associations for ceftriaxone, cotrimoxazole, and clarithromycin.ConclusionAntibiotic-induced liver injury in children is heterogeneous across the use of individual antibiotics. When prescribing ceftriaxone, cotrimoxazole and clarithromycin in children, paediatricians should definitely be aware of their potential risk of liver injury, even if for short periods.Electronic supplementary materialThe online version of this article (doi:10.1007/s40264-016-0493-y) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

“…Amoxicillin was chosen since it is the most commonly prescribed antibiotic in children [31] and is considered to be ‘non-hepatotoxic’ when used as a single ingredient compared with its combination with clavulanic acid [15, 32]. …”

Section: Methodsmentioning

confidence: 99%

Antibiotic-Induced Liver Injury in Paediatric Outpatients: A Case-Control Study in Primary Care Databases

Ferrajolo¹,

Verhamme²,

Trifirò

et al. 2016

Drug Saf

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“…I was interested to read Piovani et al. 's study , which showed that just 38 of the drugs prescribed by Italian primary care paediatricians accounted for 83% of the cartons of the 381 drugs prescribed. These results suggest the need to reflect on how the medical community, health policy makers and representatives of the pharmaceutical industry are involved in prescribing.…”

mentioning

confidence: 99%

“…Nowadays, substantial resources are invested in producing drugs that have similar pharmacological effects, even though those resources could be used for other high‐priority production lines. In addition, a considerable number of medical prescriptions are inappropriate and clinicians face harder decisions as they choose from large number of drugs to treat conditions .…”

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confidence: 99%

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