Some Hospitalized Children Exposed to Many Medications
Published on in CHOP News
Published on in CHOP News
September 6, 2011 — Some hospitalized pediatric patients, particularly those with rare conditions, may be exposed to many drugs and therapeutic agents, according to a report published Online First by Archives of Pediatrics and Adolescent Medicine, one of the JAMA/Archives journals.
According to background information in the article, many drugs used for children in the hospital setting do not have well-established pediatric efficacy and safety profiles. Some medication use in this population is for off-label indications. Further, medication errors do occur, the authors note.
In the past decade, lawmakers have endorsed measures to encourage the study of pediatric treatments, improve labeling of medications intended for children and reduce medication errors in hospitalized children.
“To advance this agenda, we need to refine our knowledge of the overall patterns of pediatric inpatient drug and therapeutic agent use, including what drugs and therapeutic agents are used most commonly, the number of different drugs and therapeutic agents that hospitalized children receive, and potential differences in drug and therapeutic agent exposures across different types of hospitals,” write the authors.
“This knowledge, especially if based on population-level data, would enhance efforts to prioritize and design research studies regarding the effectiveness and safety of pediatric inpatient medications.”
Chris Feudtner, MD, PhD, MPH, from The Children’s Hospital of Philadelphia, and colleagues conducted a retrospective study of 2006 data from the Pediatric Health Information System, which includes children’s hospitals in U.S. major metropolitan areas, and the Perspective Data Warehouse, which includes U.S. academic medical centers, community-based hospitals and large systems of multiple hospitals. The researchers reassigned the records into two categories:
These data represent roughly 19.9 percent of all U.S. pediatric inpatient hospitalizations. The researchers examined demographic and clinical characteristics as well as patients’ exposures to medications and therapeutic agents.
The most common exposures varied by patient age and by hospital type, with acetaminophen, albuterol and antibiotics the most prevalent medication exposures. There was an association between length of stay and the number of drug and therapeutic agent exposures.
On day one of hospitalization:
By day seven of hospitalization:
Pediatric patients with rare conditions appeared more likely than other pediatric patients to receive more exposures to drugs and other therapeutic agents.
“The findings and the data of this study offer at least three important means to improve pediatric inpatient medication efficacy, effectiveness, and safety,” write the authors.
This study was supported by a grant from the Agency for Healthcare Research and Quality’s Center for Education and Research on Therapeutics.
Feudtner C, Dingwei D, Hexem KR, Luan X, Metjian TA. Prevalence of polypharmacy exposure among hospitalized children in the United States. Arch Pediatr Adolesc Med. Published online September 5, 2011. doi:10.1001/archpediatrics.2011.161.