Cross-sectional survey of off-label and unlicensed prescribing for inpatients at a paediatric teaching hospital in Western Australia

• Published in: PloS one Vol. 14; no. 1; p. e0210237
• Main Authors: Landwehr, Caitlin, Richardson, Jennifer, Bint, Lewis, Parsons, Richard, Sunderland, Bruce, Czarniak, Petra
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 08.01.2019; Public Library of Science (PLoS)
• Subjects: Age; Analgesics; Analysis; Archives & records; Australia - epidemiology; Child; Child health; Child, Preschool; Children; Children's hospitals; Clonidine; Clonidine - therapeutic use; Computer and Information Sciences; Cross-sectional studies; Digestive tract; Drug Administration Routes; Drug dosages; Drug labeling; Drug metabolism; Drug Prescriptions; Drug use; Drugs; Female; Fentanyl; Gastrointestinal tract; Handbooks; Hormones; Humans; Incentives; Inpatients; Isoxazoles - therapeutic use; Laws, regulations and rules; Legislation, Drug; Licensing, certification and accreditation; Male; Medicine and Health Sciences; Metabolism; Metabolites; Midazolam; Midazolam - therapeutic use; Off-Label Use - legislation & jurisprudence; Off-Label Use - statistics & numerical data; Organic chemistry; Oxycodone; Oxycodone - therapeutic use; Paracetamol; Pediatrics; Pediatrics - education; Pediatrics - legislation & jurisprudence; Pharmaceuticals; Pharmacy; Prescription drugs; Product information; Registration; Respiratory system; Sex hormones; Side effects; Studies; Toxicity; Urogenital system; Australia; Western Australia Australia
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0210237

To evaluate the prevalence of off-label and unlicensed prescribing in inpatients at a major paediatric teaching hospital in Western Australia and to identify which drugs are commonly prescribed off-label or unlicensed, including factors influencing such prescribing. A retrospective cross-sectional study was conducted in June, 2013. Patient and prescribing data were collected from 190 inpatient medication chart records which had been randomly selected from all admissions during the second week of February 2013. Drugs were categorised as licensed, off-label or unlicensed, according to their approved Australian registration product information (PI). All drugs were classified according to the Anatomical Therapeutic Chemical (ATC) code. There were 120 male and 70 female inpatients. The average age was 6.0 years (± 4.7). The study included 1160 prescribed drugs suitable for analysis. The number of drugs prescribed per patient ranged from 1 to 25 with an average of 6.1 (± 4.3). More than half (54%) were prescribed off-label. Oxycodone, clonidine, parecoxib and midazolam were always prescribed off-label. The most common off-label drugs were ondansetron (18.5%), fentanyl (12.9%), oxycodone (8.8%) and paracetamol (6.1%). Many ATC classifications included high off-label proportions especially the genitourinary system and sex hormones, respiratory system drugs, systemic hormonal preparations and alimentary tract and metabolism drugs. This study highlights that prescribing of paediatric drugs needs to be better supported by existing and new evidence. Incentives should be established to foster the conduct of evidence-based studies in the paediatric population. The current level of off-label prescribing raises issues of unexpected toxicity and adverse drug effects in children that are in some cases severely ill.