Eric Schirm

Lack of appropriate formulations of medicines for children in the community

Aim: Appropriate formulations are essential in pharmacotherapy. This study surveyed the use of different formulations by children in the community, and examined the reported lack of appropriate formulations (oral solutions) in relation to the licensing status of drugs. Methods: A crosssectional study based on 68 019 pharmacy dispensing records was performed in The Netherlands. For each prescription the formulation was assessed, and all prescriptions were categorized: unlicensed (no product licence), off‐label (licensed drugs used outside the licence terms) and authorized (licensed drugs used according to the licence). The types of formulation used were assessed in relation to age and licensing status. Results: In all age groups, approximately half of all prescriptions were for oral drugs. The only major age‐related trend was within oral drugs: younger children were more likely to be prescribed oral solutions. For authorized drugs the proportion of tablet/capsules exceeded oral solutions at the age of 7 y, whereas for off‐label drugs this occurred at 3 y of age. For those medicines prepared by the pharmacy, tablets and capsules were more likely to be prescribed from the age of 9 y.

Unlicensed and off label drug use by children in the community: cross sectional study

Editorial by Banner and pp 1311, 1313 Studies in various hospital settings showed that many drugs taken by children either are not licensed or are used outside the terms of the product licence.1–3 Information on the extent of paediatric labelling of drugs taken by children in the community is, however, limited and based on small study populations. 4 5 We studied drugs taken by children in the community, based on the pharmacy records of prescriptions from both general practitioners and outpatient departments. We aimed to determine the number of prescriptions for unlicensed drugs for children in the community and to investigate paediatric labelling of all drugs with a product licence to determine the extent of off label use. In the Netherlands …

Drug use during breastfeeding. A survey from the Netherlands.

Objective: To survey drug use by breastfeeding women, and to compare this with nonbreastfeeding women. In addition, we were interested whether drug use was of influence on the decision to give breastfeeding, and the other way around.Design and setting: During a 6-week period in 2002, a questionnaire was handed out to all women with a child not older than 6 months, who visited a Well-Baby Clinic in the province of Friesland, the Netherlands, eventually resulting in 549 returned questionnaires (response 43%).Results: In all, 82.1% of the participants breastfed their baby at least at any time during the first 6 months after birth. More than half (65.9%) of all breastfeeding women had used drugs; however, they used drugs less frequently than nonbreastfeeding women (79.6%). The pattern of drug use differed: oral contraceptives, iron preparations, drugs for peptic ulcer, and several psychotropic drugs were more frequently used by nonbreastfeeding women, while vitamins were more frequently used by breastfeeding women. Drugs play an important role in womens decision to start or continue breastfeeding: women frequently hesitated to use drugs during breastfeeding, stopped either breastfeeding or drug use to avoid combining the two, took a measure to minimise exposure to the child, did not use any drug because of breastfeeding, or did not breastfeed because of drug use.Conclusions: Drugs are frequently though reluctantly used during breastfeeding, and play an important role in the decision to start and stop breastfeeding. Information how to deal with drugs seems therefore indispensable in efforts to promote breastfeeding.Sponsorship: All authors are employed by the University of Groningen. No funding was received for this study.

Anti-asthmatic drugs dosage forms in children: a cross-sectional study

Objective: To describe the choice of drugs as well as the dosage forms of anti-asthmatic drugs in children with regard to different age groups.Methods: Cross-sectional study based on computerized pharmacy dispensing records of 1999 for children aged 0–16 years in the north of the Netherlands. All children were selected and divided in the following age groups: 0–1, 2–5, 6–11 and 12–16-year-olds.Results: Inhaled beta2-agonists and inhaled corticosteroids were the most widely used anti-asthmatic drugs in all age groups (respectively 59 and 58 users per 100 anti-asthmatic using 0–16 year-olds). Cromones were rarely used. Up to four years of age the use of treatment with aerosol inhalers increased simultaneously with a decrease of oral dosage forms. The use of dry powder inhalers started at the age of approximately 4 years old and increased to about 85% of the users at the age of 11, with the strongest increase around the age of 6 and 7.Conclusion: The choice of drugs and dosage forms corresponds with what might be expected based on guidelines for the treatment of asthma in children, except for the high use of deptropine in the youngest age group. Anti-asthmatic drugs for preventive treatment are used so frequently without beta2-agonists that questions about possible overtreatment need to be raised.

Low use of medication in home deliveries in the Netherlands

Objectives: In view of the growing concern for de‐medicalizing childbirth, the aim of this study is to give detailed figures on the use of medication during home deliveries in the Netherlands. Methods: A prospective study of medication use by 68 community midwives during 716 home births in the Netherlands. Results: Medication was used in 58.4% of the home deliveries, with an average of 1.4 drugs per delivery. The drugs used were mostly oxytocin (in 35.6% of all deliveries) and local anesthetics (in 32.9%). When medication was used, it was administered before cutting the umbilical cord in 16.7% of the cases. Prophylactic or routine administration of local anesthesia, postpartum hemorrhages, and retained placenta were the most frequent indications for using medication. Conclusions: The use of medication during home deliveries in the Netherlands is low and newborns are minimally exposed to medication. This illustrates the Dutch birth culture, which tends to minimize the medical aspect of childbirth.

Pharmacotherapy in the perinatal period - an exploratory study in midwifery

Objective: To gather information on the adherence to the Dutch national neonatal vitamin K policy and on the administration of prescription medication during labor by community midwives.Methods: A telephone questionnaire under community midwives in the North of the Netherlands.Results: In the main, the vitamin K practices follow the guidelines with respect to who receives the first dose and maintenance therapy. There is possibly underdosing. Midwives use their license to administer medicines during labor in moderation: 91% report to never use tocolytics, oxytocics or analgesics.Conclusion: In general, the national vitamin K policy is followed. Information gathered prospectively is needed on the use of pharmacotherapy by community midwives in the perinatal period.