Trends in Prescription Medication Use Among Children and Adolescents—United States, 1999-2014

Hales, Craig M.; Kit, Brian K.; Gu, Qiuping; Ogden, Cynthia L.

doi:10.1001/jama.2018.5690

Cited by 145 publications

(154 citation statements)

References 23 publications

Supporting

Mentioning

141

Contrasting

Unclassified

Order By: Relevance

“…25,26 Our findings were also consistent with declining trends in antibiotic prescribing over the last 20 years, particularly for certain drug classes, including penicillins and cephalosporins. 27,28 Our study also corroborates a recent US antibiotic use study in which it was shown that ∼1/3 of antibiotics dispensed for commercially insured children were either clinically inappropriate or without documented diagnoses, whereas nearly half of all fills were of questionable appropriateness. 29 On the other hand, certain classspecific changes in off-label orders (eg, for antihistamines, psychotropic agents) contrast with overall pediatric prescribing trends reported elsewhere.…”

Section: Discussionsupporting

confidence: 87%

“…29 On the other hand, certain classspecific changes in off-label orders (eg, for antihistamines, psychotropic agents) contrast with overall pediatric prescribing trends reported elsewhere. 28 These discrepancies may relate to our focus on off-label orders as well as differences in data source and exposure definitions; in our study using the NAMCS, we captured physician-reported data on prescribed and recommended OTC drugs, whereas in a study using the National Health and Nutrition Examination Survey, researchers were focused on self-reported data on prescribed (not OTC) drugs taken (not ordered) in the previous month.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Trends in Off-Label Drug Use in Ambulatory Settings: 2006–2015

et al. 2019

View full text Add to dashboard Cite

BACKGROUND: Off-label drug use in children is common and potentially harmful. In most previous off-label use research, authors studied hospitalized children, specific drug classes, or non-US settings. We characterized frequencies, trends, and reasons for off-label systemic drug orders for children in ambulatory US settings.METHODS: Using nationally representative surveys of office-based physicians (National Ambulatory Medical Care Surveys, 2006, we studied off-label orders of systemic drugs for children age ,18 based on US Food and Drug Administration-approved labeling for age, weight, and indication. We characterized the top classes and diagnoses with off-label orders and analyzed factors and trends of off-label orders using logistic regression.RESULTS: Physicians ordered $1 off-label systemic drug at 18.5% (95% confidence interval: 17.7%-19.3%) of visits, usually (74.6%) because of unapproved conditions. Off-label ordering was most common proportionally in neonates (83%) and in absolute terms among adolescents (322 orders out of 1000 visits). Off-label ordering was associated with female sex, subspecialists, polypharmacy, and chronic conditions. Rates and reasons for off-label orders varied considerably by age. Relative and absolute rates of off-label orders rose over time. Among common classes, off-label orders for antihistamines and several psychotropics increased over time, whereas off-label orders for several classes of antibiotics were stable or declined.CONCLUSIONS: US office-based physicians have ordered systemic drugs off label for children at increasing rates, most often for unapproved conditions, despite recent efforts to increase evidence and drug approvals for children. These findings can help inform education, research, and policies around effective, safe use of medications in children.WHAT'S KNOWN ON THIS SUBJECT: In past studies, pediatric off-label use was shown to be common and potentially harmful, but researchers have focused predominantly on acute care settings, specific classes of drugs, outpatient prescribing outside the United States, or older data sources. WHAT THIS STUDY ADDS:In 2006-2015, US office-based physicians ordered systemic drugs off label for children at rising rates, particularly for unapproved conditions. Updated data on common off-label drugs, classes, and unapproved conditions treated in children will help inform education, research, and policies.

show abstract

Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Trends in Off-Label Drug Use in Ambulatory Settings: 2006–2015

et al. 2019

View full text Add to dashboard Cite

show abstract

“…The outcome was the frequency of prescription of a given drug class. We extracted drug names from prescription text and classified the drugs according to the Multum Lexicon Plus drug database (Appendix Table 1) 13,14 . An additional category was created for fluoride‐based drugs by separating the drugs from the broader class of “Throat and Mouth Preparation.” This was done because of their relevance to oral health and their high usage.…”

Section: Methodsmentioning

confidence: 99%

Prescribing patterns in a US dental school from 2010 to 2017

Ticku

Starr

Silva

et al. 2020

Journal of Dental Education

View full text Add to dashboard Cite

Objective: Dental education has an essential role in helping combat the opioid and antibiotic resistance crises. This study evaluates the prescribing practices of clinical instructors, advanced graduate residents, and predoctoral students in an academic dental setting. Methods: A retrospective chart review was conducted of electronic dental records from the years 2010 to 2017. The proportions of prescriptions for each drug group was calculated by prescribers' training level and specialty. Descriptive statistics were calculated for the daily opioid Morphine Milligram Equivalent (MME) dose prescribed across years and provider characteristics. Results: Over the 8 years, 65,160 prescriptions were written for 10,374 patients by 625 prescribers. The most commonly prescribed drugs were for fluoride-based medications (30%) and antibiotics (24%). Periodontists had the greatest absolute number of opioid analgesics prescriptions (n = 2712); oral maxillofacial surgeons (OMFS) prescribed more opioids than other classes of drug (49%) as a proportion of within-specialty prescriptions. Antibiotics were the most common drugs prescribed by endodontists (46%) and second most common drugs prescribed by periodontists (25%), OMFS (28%), and prosthodontists (21%). From 2010 to 2017, the proportion of prescriptions for antibiotics remained unchanged, while that of fluoride-based drugs increased from 2010 to 2014 and plateaued thereafter. The proportion of prescriptions for opioid analgesics decreased from 18% to 7%. The median daily MME dose across year and provider characteristics stayed constant (<50 MME). Conclusion: These results demonstrate encouraging prescription trends for opioid and fluoride-based drugs. Due to the high prevalence of antibiotic prescriptions in academic dental settings, stewardship approaches should be emphasized. K E Y W O R D Sanalgesics, dental health services research, opioid, pharmacology 660

show abstract

“…Prescription stimulants such as methylphenidate and nonstimulants such as atomoxetine are labeled for the treatment of attention-deficit/hyperactivity disorder (ADHD) from age approximately 6 and above years, and are also commonly used in medical practice for the management of non-core symptoms of autism spectrum disorder (ASD) [1]. In the USA and in Europe, there has been a trend toward higher prescription rates of these drugs (hereon referred to as "ADHD medications") for both children and adults over the past 2 decades; nevertheless, use remains most common in middle childhood, and not all ADHD diagnosed individuals are prescribed ADHD medications [2][3][4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Psychostimulants/Atomoxetine and Serious Cardiovascular Events in Children with ADHD or Autism Spectrum Disorder

2019

View full text Add to dashboard Cite

Background Psychostimulants and atomoxetine have been shown to increase blood pressure, heart rate, and QT interval in children and adolescents; however, based on current literature, it is unclear if these "attention-deficit/hyperactivity disorder (ADHD) medications" are also associated with serious cardiovascular (SCV) events. We addressed this question in commonly exposed groups of children and adolescents with either ADHD or autism spectrum disorder (ASD). Methods Using commercial (years 2000-2016) and Medicaid (years 2012-2016) administrative claims data from the United States (US), we conducted two case-control studies, nested within respective cohorts of ADHD and ASD children aged 3-18 years. We defined cases by a composite outcome of stroke, myocardial infarction, or serious cardiac arrhythmia. For each case, we matched ten controls on age, sex, and insurance type. We conducted conditional logistic regression models to test associations between SCV outcomes and a primary exposure definition of current ADHD medication use. Additionally, we controlled for resource use, cardiovascular and psychiatric comorbidities, and use of medications in a variety of sensitivity analyses. Results We identified 2,240,774 children for the ADHD cohort and 326,221 children for the ASD cohort. For ADHD, 33.9% of cases (63 of 186) versus 32.2% of controls (598 of 1860) were exposed, which yielded an odds ratio (OR) and 95% confidence interval (CI) of 1.08 (0.78-1.49). For ASD, 12.5% of cases (6 of 48) versus 22.1% of controls (106 of 480) were exposed ]. Covariate-adjusted results and results for individual outcomes and other exposure definitions were consistent with no increased risk of SCV events. Conclusion Using large US claims data, we found no evidence of increased SCV risk in children and adolescents with ADHD or ASD exposed to ADHD medications. Key PointsAttention-deficit/hyperactivity disorder (ADHD) medications increase blood pressure, heart rate, and QT interval. It is unclear if they increase serious cardiovascular event rates.Current literature is based mainly on pre-2006 data and small samples, and has not considered subgroups of children with different medical diagnoses.Using data from 2000-2016, for US children aged 3-18 years, we found no evidence of increased serious cardiovascular risk in those exposed to ADHD medications.Findings were consistent for children with either ADHD or autism spectrum disorder.Presentation Information A partly similar analysis to the one shown here (ASD cohort only) has been accepted for poster presentation at the

show abstract

Trends in Prescription Medication Use Among Children and Adolescents—United States, 1999-2014

Cited by 145 publications

References 23 publications

Trends in Off-Label Drug Use in Ambulatory Settings: 2006–2015

Trends in Off-Label Drug Use in Ambulatory Settings: 2006–2015

Prescribing patterns in a US dental school from 2010 to 2017

Psychostimulants/Atomoxetine and Serious Cardiovascular Events in Children with ADHD or Autism Spectrum Disorder

Contact Info

Product

Resources

About