Daniele Piovani

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

Most Italian children are cared for by a family paediatrician until they are 14 years old, and their duties include prescribing drugs recommended by specialists so that they are free. This study aimed to draw up a list of the drugs most commonly prescribed by family paediatricians.

In Italy anti-asthmatic drug prescription is not always a reliable proxy of asthma

We read with interest the article by Pitter et al. [1], in which an association was found between antibiotics therapy during the first year of life and an increased risk of subsequent treatment-required asthma. The association between early exposure to antibiotics and asthma is still debated, however, in our opinion the study by Pitter et al. has a relevant limitation. Healthcare databases can be a valuable tool for monitoring diseases, and in this regard strategies for estimating asthma prevalence have been developed, also in Italian context [2]. It is well known that in Italy anti-asthmatic drugs, in particular nebulised steroids, are commonly prescribed as symptomatic treatment of upper respiratory tract infections. An analysis of drugs prescribed by paediatricians found that, in 60 % of the cases, the reasons for prescribing nebulised steroids were cough, pharyngotonsillitis, rhinitis, otitis media and sinusitis [3]. This pattern of prescription is even more frequent in pre-school children. Moreover, independently of age, in Italy the number of non asthmatic children and adolescents treated with inhaled corticosteroids is ten times higher than in UK or in The Netherland [4]. Thus, the criteria ‘‘at least two anti-asthmatic drug prescriptions within a period of 12 months’’ overestimates the number of children with asthma, and it is likely that many of them had respiratory tract infections only (false positives). Also the choice to restrict to ‘‘at least two inhaled corticosteroids or combination of asthma drugs’’ did not reduce the risk of overestimation. This bias is greater in children 13–35 months group, were an IRR of 2.07 was found. In this age group it should be considered also the presence of viral wheezing as a further confounding factor. Anyway, it is likely that an overestimation exists also in children C6 years old, in which a current prevalence of asthma of 13.2 % was estimated, as well as in those C13 years old. In order to identify asthmatic patients we previously proposed criteria different from those adopted by Pitter et al.: age C6 years AND at least one prescription of appropriate age formulation of anti-asthmatic drugs (i.e. metered dose inhalers, dry powder inhalers) [2]. Children who received nebulised formulation only were not considered as ‘‘potential asthmatics’’. These criteria have been validated: the sensitivity was 0.91 (95 % CI 0.67–1.00), and the specificity was 0.98 (95 % CI 0.96–1.00) [5]. Using the above criteria we identified 2518 potential asthmatic (5.2 %) patients at 6 years of age in a cohort of 48,020 Italian children born in 2000–2001 living in the Lombardy Region. A total of 5036 non-asthmatic controls were randomly selected from the same cohort and matched (with a case–control 1:2 ratio) for gender, year of birth, and local health unit of residence. In all, 29 % of cases and 27 % of controls received at least one antibiotic drug prescription during the first 6 months of life (OR 1.13, 95 % CI 1.01–1.26, p = 0.02) http://pediatrics.aappublications.org/ content/127/6/1125.comments). In our analysis, a statistically significant increased risk of asthma was found, but the magnitude was lower than that found in the study by Pitter et al. It is likely that the difference in magnitude is due to the overestimation of & Marina Bianchi marina.bianchi@marionegri.it

Psicofarmaci in età adolescenziale

Nonostante studi internazionali abbiano evidenziato un aumento dell’uso di psicofarmaci in eta pediatrica, in Italia la prevalenza di prescrizione e inferiore e stabile nel tempo. Ad oggi mancano ancora studi adeguati per documentare l’efficacia e la sicurezza degli psicofarmaci nella popolazione pediatrica, soprattutto a lungo termine, dal momento che gli studi disponibili hanno breve durata. Il trattamento dei disturbi psichiatrici in eta evolutiva richiede un approccio multimodale e multidisciplinare, in cui raramente la terapia farmacologica costituisce il primo approccio terapeutico. La sindrome da iperattivita e deficit di attenzione (ADHD) e il disturbo psichiatrico per cui esistono maggiori evidenze a supporto dell’efficacia dei farmaci. I disturbi di tipo endocrino-metabolici (frequenti con gli antipsicotici), il rischio di suicidalita (di possibile comparsa con antidepressivi e atomoxetina) e i rischio di abuso/uso inappropriato sono i piu rilevanti effetti indesiderati da monitorare nell’adolescente in trattamento con psicofarmaci.

DRUG PRESCRIPTION PROFILE AND PERINATAL DETERMINANTS DURING THE FIRST YEAR OF LIFE

The aim of the study was to investigate the drug prescription profile during the first year of life in a cohort of newborns, and the influence of perinatal and socio-demographic factors on drug prescription. A total of 61,479 neonates born in 2011 were included. The data source was the database of reimbursed prescriptions of the Lombardy region, Italy. Drug prescriptions were classified according to the Anatomical Therapeutic Chemical (ATC) classification system. Drug prevalence was calculated as the percentage of neonates receiving at least one drug prescription in one year. Chi-square test was used to compare prevalence of drug prescription in males and females. In all, 42,204 infants (68.7%) received at least one drug prescription, with a prevalence slightly higher in males than females (71.1% versus 66.1%; χ2=178 p<0.01). The drug classes most commonly prescribed in the first year of life were antibiotics (39.5% of infants), anti-asthmatics (32.6%), and corticosteroids for systemic use (9.8%). The median age of first prescription was 20.6 (Interquartile range: 9.4–33.3) weeks. Males received the first prescription about one week before females (20.1 versus 21.3, respectively). The first prescription concerned mainly anti-asthmatics (40.5%), and antibiotics (37.9%), and amoxicillin (16.3%), beclomethasone (16.0%), and amoxicillin+clavulanic acid (15.0%) were the most prescribed drugs. In conclusion, in the first year of life, 7 out of 10 infants received drug prescriptions. Males were more exposed than females, a finding consistent with the epidemiology of diseases in infancy. The analysis concerning the influence of maternal and perinatal factors is ongoing.