Child; Humans; Great Britain; Drug Utilization; Prospective Studies; Hospitals; Pediatric; Pain/drug therapy; Analgesics/therapeutic use; Drug Approval
Description
BACKGROUND: The management of pain in children has advanced enormously in recent years. Pharmacological treatment of pain is complicated however, by the widespread use of unlicensed and off label medicines in the paediatric population, leading to everyday practical problems. This study aimed to document the incidence and nature of unlicensed and off label analgesic agents in children. METHODS: Data regarding analgesic use were collected prospectively over a 4-week period from two wards. The data were analysed to determine whether the drug use was licensed, unlicensed or off label. RESULTS: Seven hundred and fifteen prescription episodes were analysed. Some 480 of these (67%) were licensed; 235 were licensed medicines used in an off label manner (33%). No medicines were unlicensed. Paracetamol was the most common analgesic used. CONCLUSION: Issues regarding the use of off label drugs in children at risk of pain are discussed. Suggestions are made regarding the way forward for the future.
2001
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Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
OBJECTIVE: The purpose was to describe the use of drugs with a possible or certain life-shortening effect in end-of-life care in infants and to evaluate the possibly lethal effect. DESIGN: For 292/298 deaths of live born infants (<1 year), in a 1-year period (between 1 August 1999 and 31 July 2000) in Flanders, Belgium, the attending physician could be identified and was sent an anonymous questionnaire. The questionnaires relating to deaths directly preceded by the administration of drugs were reviewed by a multi-disciplinary panel. RESULTS: The response rate was 86.6% (253/292). In 57 cases (22.5%), drugs were administered directly before death. In 17/57 cases, the physician explicitly intended to hasten death. In 16/17 cases information about the drug(s) was available: opioids were administered in 14, a muscle relaxant in 5 and potassium chloride in 3 cases. In 13 cases where the lethal effect could be evaluated, the panel judged that the drugs were effective in hastening death in 10 cases. In most cases the estimated life-shortening was <24 h. In 40/57 cases the physician administered drugs to alleviate pain and/or symptoms, taking into account a possible life-shortening effect without explicitly intending it. Opioids were administered in all 30 cases where information about the drug(s) was supplied. In 13 cases the lethal effect could be evaluated, and in 6 cases the panel judged that the drugs had hastened death. CONCLUSIONS: When life-shortening was explicitly intended, (dosages of) drugs were likely to be lethal. Drugs administered also clearly hastened death in some cases where life-shortening was not explicitly intended.
Rights
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Provoost, Veerle Cools, Filip Bilsen, Johan Ramet, Jose Deconinck, Peter Vander Stichele, Robert Vande Velde, Anne Van Herreweghe, Inge Mortier, Freddy Vandenplas, Yvan Deliens, Luc Comment in: Intensive Care Med. 2006 Jan;32(1):6-8; PMID: 16311743