Authors: Clavenna, Antonio¹; Sequi, Marco¹; Bortolotti, Angela²; Merlino, Luca²; Fortino, Ida²; Bonati, Maurizio¹

Source: British Journal of Clinical Pharmacology, Volume 67, Number 5, May 2009 , pp. 565-571(7)

Publisher: Wiley-Blackwell

Abstract:

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT

• Drug utilization studies performed in the Italian paediatric population have found a prescription profile that appears to be specific to Italy.

• Quantitative and qualitative differences with other European countries have been found.

• The prevalence of drug prescription is higher in southern Italy compared with northern Italy.

WHAT THIS STUDY ADDS

• This is the first study to evaluate the geographical differences in the pattern of drug prescribing to children and adolescents in a large Italian region.

• Large differences in the prescription prevalence rate were found between local health units.

• Living in the eastern part of the Lombardy region is associated with the highest risk of drug exposure. AIMS

To evaluate the intraregional differences in drug prescribing to children and adolescents. METHODS

Prescriptions reimbursed by the National Health System, involving 1543 203 children and adolescents <18 years old and dispensed during 2005 by the retail pharmacies of 15 local health units (LHU) in the Lombardy Region, were analysed. Logistic regression analysis was performed to evaluate the association between drug prescription and age, gender, prescriber, and setting. RESULTS

A total of 747 790 youths (48%) received at least one drug prescription. The prescription prevalence rate was highest in children 1-5 years old (65%), decreased with increasing age to 38% in adolescents, and was slightly higher in boys than in girls. Antibiotics and anti-asthmatics were the most prescribed therapeutic classes. Amoxicillin + clavulanic acid was the most prescribed drug (18% of children; 20% of packages). Large differences were found in the drug prescription prevalence rate between the different LHUs. The rate ranged between 38.4 and 54.8%, and was not correlated to hospitalization rate in the paediatric population. Being 1-5 years old [odds ratio (OR) 4.51, 95% confidence interval (CI) 4.43, 4.58] and living in the eastern part of the region (OR 2.06, 95% CI 1.99, 2.13) were the factors associated with the highest risk of drug exposure. CONCLUSIONS

The results resemble the profiles observed in other Italian contexts, in particular concerning the wide use of antibiotics and anti-asthmatics. However, large differences were found between LHUs, highlighting the need for more detailed investigations on therapeutic needs, drug use, and related variables in different geographic contexts.

Keywords: adolescent; child; drug utilization; family practice; Italy

Document Type: Research article

DOI: http://dx.doi.org/10.1111/j.1365-2125.2009.03380.x

Affiliations: 1: Laboratory for Mother and Child Health, Department of Public Health, Mario Negri Institute for Pharmacological Research and 2: 2Regional Health Ministry, Lombardy Region, Milan, Italy

Publication date: 2009-05-01

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