Many hospitalized children receive numerous medications, raising potential safety concernsIn the hospital setting, the efficacy and safety of many pediatric medications have not been well established, and much of their use is for off-label indications. A new study reveals that many hospitalized children are receiving a substantial number of drugs. This use is a concern, given that exposure to multiple medications has been linked to a greater risk of drug reactions in adult patients in intensive care units and other settings.
The researchers examined pediatric drug use at 411 general hospitals and 52 children's hospitals, representing nearly one-fifth of all pediatric hospitalizations across the United States. They found that the most common generic drugs and therapeutic agents to which children were exposed included intravenous fluids; analgesics such as the narcotics fentanyl and morphine; the antipyretics/analgesics acetaminophen and ibuprofen; and anti-infective agents such as ampicillin, gentamicin, and cephalosporins. Also common were anesthetic agents such as lidocaine and propofol and gastrointestinal drugs such as ranitidine, ondansetron, and metoclopramide.
On the first day of hospitalization in children's hospitals, patients younger than 1 year at the 90th percentile of daily exposure to distinct medications received 11 drugs and patients 1 year or older received 13 drugs; in general hospitals, 8 and 12 drugs, respectively. By the seventh hospital day in children's hospitals, patients younger than 1 year at the 90th percentile of cumulative exposure to distinct medications had received 29 drugs, and patients 1 year or older had received 35; in general hospitals, 22 and 28 drugs, respectively. The researchers caution that the level of polypharmacy among hospitalized children raises patient safety concerns, given the relationship between polypharmacy and adverse drug events already documented among adults in hospital settings.
This study was supported by a grant to the University of Pennsylvania Center for Education and Research on Therapeutics (CERT) by the Agency for Healthcare Research and Quality (HS17991). For more information on the CERTs program, go to http://www.certs.hhs.gov.
See "Prevalence of polypharmacy exposure among hospitalized children in the United States" by Chris Feudtner, M.D., PhD, Dingwei Dai, PhD, Kari R. Hexem, M.P.H., and others in the January 2012 Archives of Pediatrics 166(10), pp. 9-16.