Use of oral medicines for short-term illnesses in children - Perspectives on prescribing, dispensing and administration
MetadataShow full item record
Summary About half of all children receive one or more prescriptions per year, most commonly oral medicines for short-term illnesses. Choosing an appropriate medicine for a specific child can be challenging due to the variation in children’s developmental stage and ability to take medicines. Young children are commonly given liquid dosage forms due to dose flexibility and ease of swallowing, but masking bad taste in liquids can be problematic. Solid dosage forms can mask bad taste better, but can be difficult to swallow. Despite this being a common challenge, there is a lack of knowledge of which oral dosage forms children are prescribed and how the challenges related to the use of medicines for short-term illnesses are met in real life. The main aim of this thesis was to investigate the use of oral medicines for the treatment of short term illnesses in children, as it plays out when medicines are prescribed, dispensed and administered to children. The specific aims were to investigate: 1. The considerations GPs and pharmacists made regarding formulation characteristics when prescribing and dispensing medicines for children 0-6 years. 2. The age when prescriptions of oral antibiotic formulations for children 0-12 years changed from being mostly liquid to mostly solid, and the relationship between prescription of solid formulations and characteristics related to the child, prescriber and antibiotic. 3. The strategies used by parents to administer medicines to children. 4. The prescriptions of oral liquid and solid antibiotics that were changed within two days to antibiotics with different characteristics in children 0-12 years. Furthermore, to explore the relationships between prescription changes and characteristics related to the child, prescriber and antibiotic separately for solid and liquid antibiotics. Both qualitative and quantitative studies were conducted. The first study gathered data from three focus groups totaling 15 GPs and three focus groups totaling 15 pharmacists, which were analyzed qualitatively using systematic text condensation (STC). The second registerbased study used data from just over 1.2 million systemic antibiotic prescriptions obtained from the Norwegian Prescription Database (NorPD) between 2004 and 2016. For analysis, we used multivariable adjusted logistic regression models fit with generalized estimating equations. In the third study, 4581 postings from parental Internet discussion forums were analyzed using STC. The fourth population based study used data from 2.6 million antibiotic prescriptions from the NorPD and similar analyses as in study two GPs and pharmacists considered children’s and parents’ ability and willingness to take and give medicines when prescribing and dispensing medicines for children. Children’s inability to use first-choice medicines could lead to the prescription of second-choice medicines. There was a distinct increase in the average age when children changed from mostly being prescribed liquids to mostly being prescribed solid oral antibiotic dosage forms, from 5.7 years in 2004-5 to 7.9 years in 2015-16. Based on Internet postings, parents’ techniques for giving children medicines were categorized into three main strategies; hide the medicine, give it openly by use of negotiations or play, or with the use of force. Some parents said they would request a new prescription if the child was unable to use the first medicine. It was found that new prescriptions were issued within two days for 3% of the initial prescriptions. New prescriptions were associated with younger children, bad taste and prescribers born after 1970. Penicillin V was most commonly followed by a new prescription, and macrolides and lincosamides were most commonly new prescriptions. There is a sizable proportion of children experiencing problems with the available dosage forms, indicating a clear potential for improvement both in the manufacturing, prescription, dispensing and administration process. The studies indicate a feedback loop where negative experiences may inform which medicines children use. Measures to promote increased use of solid formulations suitable for younger children are necessary to improve the current situation. Also including children more in the whole process, from listening to their views when prescribing and dispensing, to use play when administering can be encouraged. For practices to change, information on medicine use in children should be tailored for all the actors involved; children, parents and healthcare professionals.