Dataset Information

Underdosing of antiretrovirals in UK and Irish children with HIV as an example of problems in prescribing medicines to children, 1997-2005: cohort study.

ABSTRACT:

Objective

To measure the extent of underdosing of antiretroviral drugs in children.

Design

Multicentre cohort study.

Setting

Clinical centres in hospitals in the United Kingdom and Ireland in the collaborative HIV paediatric study (CHIPS).

Participants

615 HIV infected children aged 2-12 years receiving antiretrovirals.

Main outcome measures

Doses relative to weight and height compared with current recommended doses in 2004 European guidelines.

Results

The CHIPS cohort of 934 children comprises 80% of diagnosed HIV infected children in the UK and Ireland between January 1997 and March 2005, of which 66% (615) aged 2-12 years were prescribed antiretrovirals. Actual doses standardised to weight or surface area varied widely across individual drugs, antiretroviral class, and calendar time, with children underdosed (prescribed less than 90% of current recommended doses) from 6-62% child time at risk. Three serious issues in prescribing antiretrovirals, which may also be relevant to paediatric prescribing in general, were identified. Firstly, dosing was inadequate before incorrect recommendations at licensing were later revised when important pharmacokinetic results emerged. Secondly, guidelines stating dosage alternatives (by weight/surface area) for the same drug led to different and inconsistent doses. And, thirdly, ongoing growth was not adjusted for.

Conclusions

Largely inadvertently, HIV infected children in the United Kingdom and Ireland have been underdosed with antiretrovirals, highlighting problems applicable throughout paediatric prescribing.

SUBMITTER: Menson EN

PROVIDER: S-EPMC1463938 | biostudies-literature | 2006 May

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Underdosing of antiretrovirals in UK and Irish children with HIV as an example of problems in prescribing medicines to children, 1997-2005: cohort study.

Menson Esse N EN Walker A Sarah AS Sharland Mike M Wells Carole C Tudor-Williams Gareth G Riordan F Andrew I FA Lyall E G Hermione EG Gibb Diana M DM

BMJ (Clinical research ed.) 20060501 7551

<h4>Objective</h4>To measure the extent of underdosing of antiretroviral drugs in children.<h4>Design</h4>Multicentre cohort study.<h4>Setting</h4>Clinical centres in hospitals in the United Kingdom and Ireland in the collaborative HIV paediatric study (CHIPS).<h4>Participants</h4>615 HIV infected children aged 2-12 years receiving antiretrovirals.<h4>Main outcome measures</h4>Doses relative to weight and height compared with current recommended doses in 2004 European guidelines.<h4>Results</h4> ...[more]

PMID: 16709991

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Project description:IntroductionConcerns over serious respiratory depression in children led to two European Union (EU) referral procedures (in 2013 and 2015) to review the benefit-risk balance of codeine in this population when used for pain relief, cough or cold. Consequently, codeine should no longer be used in children aged < 12 years and restrictions were introduced for treatment in children ≥ 12 years.ObjectiveThis multinational collaborative study aimed to assess the effectiveness of these risk minimisation measures by evaluating changes in prescribing of codeine and alternative treatments.MethodChildren under 12 and 12-18 years old were followed between 2010 and 2017 to analyse quarterly trends in prescribing of codeine and alternative treatments in electronic health records from France, Germany, Norway, Spain and the United Kingdom using interrupted time series analysis.ResultsOverall prescribing of codeine in children decreased in all five countries, reaching near zero prevalence in children under 12 years of age. This was accompanied by an increase in use of other opioid analgesics in France (from 0.15 to 0.56 prevalence per 100 person-years immediately after the first referral), Norway (from 0.0006 to 0.0013 at the end of the study), the United Kingdom (from 0.018 to 0.05 at the end of the study), and an increase in non-opioid analgesics in Norway (from 0.045 to 0.075 at the end of the study) after the referral on pain relief indication. The referral on cough/cold indication led to a decrease in use of opioid and non-opioid antitussives in children aged < 12 years in France (from 10 to 7 and 20 to 16, respectively) and had no impact in other countries. Overall prescribing trends for codeine and alternatives were similar across both age groups within each country.ConclusionThe decrease in use of codeine shows that healthcare professionals followed the adopted measures and switched prescribing practices for pain management in children aged < 18 years towards opioid or non-opioid analgesics depending on national clinical and reimbursement settings. Whist the magnitude of the first referral on pain differed between countries, the second referral on cough/cold had only a minimal impact on the use of codeine and antitussives.

Dataset Information

Underdosing of antiretrovirals in UK and Irish children with HIV as an example of problems in prescribing medicines to children, 1997-2005: cohort study.

Objective

Design

Setting

Participants

Main outcome measures

Results

Conclusions

Publications

Underdosing of antiretrovirals in UK and Irish children with HIV as an example of problems in prescribing medicines to children, 1997-2005: cohort study.

Similar Datasets

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