| Summary: | 碩士 === 國立成功大學 === 臨床藥學研究所 === 87 === Background: Drug utilization in children has received limited attention. Little information is available about drug utilization by pediatric outpatients. According to the previous studies, the prescription percentages in the pediatric age groups covered by NHI South Bureau, i.e. 0-4 & 5-14, were 99.4% and 91.3% respectively. Although the prescription percentages were very high, the prescription contents in nearly half of the data base was absent. This study is undertaken to investigate the drug use pattern and prescription quality among the pediatric population.
Objectives: To examine the prescribing patterns and to access the quality of prescribing for pediatric outpatients.
Design: Retrospective cross-sectional study.
Method: The prescribing of the medications for ambulatory children below 12 years of age has been included. The study material was obtained from National health insurance ambulatory claim data of June 1997. The prescription patterns were presented as the distributions of principal diagnosis for each consultation, the age and sex of the patient and ATC classification of the prescribed medications. Furthermore, the antibiotic prescribing for upper respiratory tract infections was analyzed more specifically. Besides, the indicator drugs and/or combinations were defined for accessing the quality of prescribing. SAS for windows 6.12 was used for descriptive statistics.
Results: There were 1,813,348 office visits and 9,398,514 prescriptions recorded in this study. The majority of diagnoses was "other acute upper respiratory infections". Half of the medications prescribed were cough and cold preparations, antihistamines and antibiotics. Pediatric patients who received averaged 5 drugs in ambulatory service in Taiwan. Antibiotics were prescribed to 39.6% of visits with common cold, 46.3% with non-specific upper respiratory tract infections, 61.2% with bronchitis. For children diagnosed as having cold, URIs, and bronchitis, antibiotics prescribing rate was higher in ENT physicians (78.9%) and lower in pediatricians (46.6%).
The common concurrent drug classifications were antihistamines (21.5%), expectorants (16.5%), and cough suppressants (15.0%). There were 184,563 visits prescribed erythromycin, 1.5% combined with terfenadine, 1.4% combined with cisapride. There were 12% visits received at least one drug which was not approved by FDA for its use among the pediatric age groups.
Conclusions: There was more extensive exposure to drugs in pediatric outpatients in Taiwan compared to other countries. Antibiotic prescribing for children diagnosed as having cold, URIs, and bronchitis, that typically do not benefit from antibiotics, represents a substantial proportions of total antibiotic prescriptions to children in Taiwan.
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