Variation of the prevalence of pediatric polypharmacy: A scoping review

Abstract

Purpose To examine the range of prevalence of pediatric polypharmacy in literature through a scoping review, focusing on factors that contribute to its heterogeneity in order to improve the design and reporting of quality improvement, pharmacovigilance, and research studies. Methods We searched Ovid Medline, PubMed, EMBASE, CINAHL, Ovid PsycINFO, Cochrane CENTRAL, and Web of Science Core Collection databases for studies with concepts of children and polypharmacy, along with a hand search of the bibliographies of six reviews and 30 included studies. We extracted information regarding study design, disease conditions, and prevalence of polypharmacy. Results Two hundred eighty‐four studies reported prevalence of polypharmacy. They were more likely to be conducted in North America (37.7%), published after 2010 (44.4%), cross‐sectional (67.3%), in outpatient settings (59.5%). Prevalence ranged from 0.9% to 98.4%, median 39.7% (interquartile range [IQR] 22.0%‐54.0%). Studies from Asia reported the highest median prevalence of 45.4% (IQR 27.3%‐61.0%) while studies from North America reported the lowest median prevalence of 30.4% (IQR 14.7%‐50.2%). Prevalence decreased over time: median 45.6% before 2001, 38.1% during 2001 to 2010, and 34% during 2011 to 2017. Studies involving children under 12 years had a higher median prevalence (46.9%) than adolescent studies (33.7%). Inpatient setting studies had a higher median prevalence (50.3%) than studies in outpatient settings (38.8%). Community level samples, higher number and duration of medications defining polypharmacy, and psychotropic medications were associated with lower prevalence. Conclusions The prevalence of pediatric polypharmacy is high and variable. Studies reporting pediatric polypharmacy should account for context, design, polypharmacy definition, and medications evaluated.

Use of Chronic Prescription Medications and Prevalence of Polypharmacy in Survivors of Childhood Cancer

“…Notably, 15% of our pediatric survivors were found to have been prescribed two or more concurrent chronic medications. This estimate is comparable to the rate of polypharmacy previously reported in children with autism spectrum disorder, psychiatric conditions, and epilepsy ( 40 – 42 ). The definition of polypharmacy for the pediatric population should have a lower threshold number of medications than that for the adult population, as children are expected to have a lower disease burden than adults.…”

Prevalence and Age Structure of Polypharmacy in Poland: Results of the Analysis of the National Real-World Database of 38 Million Citizens

“…On the other hand, as studies show, polypharmacy is not limited to the elderly. With more and more conditions being subject to effective pharmacotherapy (e.g., ADHD), it may be observed across all age groups, e.g., in pediatric population (Baker et al, 2019). Apart from age, several other drivers have been found to significantly affect the probability of polypharmacy.…”

Effects of the number of drugs used on the prevalence of adverse drug reactions in children

“…In contrast, polypharmacy has been reported as the use of two or more prescribed medications for children recently 11 . Although the increased risks may be extrapolated to children, most reports on the increased risks are limited to polypharmacy involving psychotropic medications or for psychiatric patients [11][12][13][14][15] . There are a few studies on the effects of polypharmacy on ADR prevalence in children with various disease types 16,17 .…”