Drug Use in Outpatient Children: Epidemiological Evaluations

Background: Pharmacoepidemiology can be a useful tool for evaluating the appropriateness of drug prescriptions and for estimating therapeutic needs. In particular, pharmacoepidemiology can be valuable in the paediatric setting, which is characterized by the availability of only limited information on the safety and effectiveness of drug use. Methods: Data collected in regional and multiregional administrative prescription databases were analysed. Prevalence data by sex and age were calculated by dividing the number of drug users by the total number of male and female residents in each age group. The number of packages of medications (boxes) was used as indicator of drug consumption. Univariate and multivariate analyses were performed with the aim to identify the determinants of drug prescriptions. Results: Drug utilization studies reported quantitative and qualitative differences between countries in drug prescription to children and adolescents. In particular, Italian children have a threefold greater chance of receiving an antibiotic or an anti-asthmatic compared with children living in the Netherlands. Large differences also were found within Italy between different geographical settings, with prevalence ranging between 57.3% in northern Italy and 68.3% in southern Italy. Prevalence varied also between the local health units (LHUs) of a single region and between district of a single LHU. In the Lombardy Region prevalence ranged between 38.4% in Milan and 54.8% in Brescia, and the residence of the child was one of the main determinant of drug exposure. Conclusions: The studies described in this thesis suggest that pharmacoepidemiology is a valuable tool for monitoring the appropriateness of drug prescribing. However, the epidemiological evaluation of drug prescriptions in children should be improved with regards to the methodological quality of studies