Novembre 2010 - Volume XXIX - numero 9
Focus
1Laboratorio per la Salute Materno-Infantile, Dipartimento di Salute Pubblica,
Istituto di Ricerche Farmacologiche “Mario Negri”, Milano
2Governo dei Servizi Sanitari Territoriali e Politiche di Appropriatezza e Controllo,
Direzione Generale Sanità, Regione Lombardia, Milano
Indirizzo per corrispondenza: clavenna@marionegri.it
Key words: Essential drugs, Family paediatricians, Rational use
The objective of the study was to identify which drugs are considered “essential” by Italian family paediatricians based on their prescriptions. So, prescriptions reimbursed by the National Health System, involving 923,177 children <14 years old, and dispensed during 2005 by the retail pharmacies of 15 local health units (LHUs) in Lombardy Region, were analysed. The percentage of family paediatricians prescribing each single drug was calculated. In all, 634 different drugs were prescribed to 486,405 children < 14 years old (52.7%). The median number of drugs prescribed by each paediatrician was 60 (interquartile range 51-71). The number of drugs prescribed by each paediatrician was correlated with the number of children in charge. A total of 42 drugs from 13 therapeutic classes was prescribed by at least 50% of family paediatricians. Six drugs were prescribed by all the paediatricians: amoxicillin + clavulanic acid, amoxicillin, beclometasone, clarithromycin, salbutamol, and cefaclor. In all, 95% of the family paediatricians prescribed four or more cephalosporins and 92% prescribed four inhaled steroids. Only 17 of the 42 most frequent drugs are included in the World Health Organization Essential Medicines for children list. Despite the huge number of drugs prescribed, only 42 were shared by half of the family paediatricians. Initiatives to evaluate and promote a more rational use of drugs in Italian children are necessary. A replication of the study at the international level could identify drugs for which a consensus exists, with the aim of creating a practice based international formulary.
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Focus
Associazione Culturale Pediatri, Milano e Provincia
Indirizzo per corrispondenza: maurilaur@tin.it
Key words: Respiratory tract infections, Antibiotic prescription, Self-help, Primary care
Aims - Assessing the primary care paediatricians (PCPs) antibiotic prescriptions and the self-help use during respiratory infections in children. Methods - 58 PCPs have registered diagnosis, self-help and therapy of the respiratory infections observed during 2007, one week a month. Results - In a total of 49,525 children, 23,801 were visited by PCPs for respiratory infections. In 14.7% cases (3,489) self-help was utilized. According to the self-help test results, no antibiotic prescription has been done in 47.5% cases. Penicillins were prescribed in 76.2% cases, macrolides in 13.4% and cephalosporins in 10.3%. Amoxicillin was the most used active principle, indeed it was prescribed in 58% cases. Conclusions - The progressive self-help spread could be a determining factor in diagnostic accuracy improving and appropriateness in PCPs prescriptive practice.
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