Prescription Cautions

Children At Higher Risk For Drug Errors

A whopping one out of every 17 times a medication is ordered to be given to a hospitalized child the child receives the wrong drug or dose according to a new study in JAMA. Potentially harmful medication errors occur 3 times more often among hospitalized children than adults. In the 6-week study at Children's Hospital Boston and Massachusetts General Hospital for Children, researchers found 616 medication errors out of 10,778 orders written -- an error rate of 5.7 percent. The overall error rate was similar to those found in previous studies of adult hospitals, but the number of potentially harmful errors was 3 times greater among children. The rate of potential adverse drug events was significantly higher in neonates in the neonatal intensive care unit. Most potential adverse drug events occurred at the stage of drug ordering (79%) and involved incorrect dosing (34%), anti-infective drugs (28%), and intravenous medications (54%). "Medication errors are common in pediatric inpatient settings, and further efforts are

Kausha R, Bates DW, Landrigan C, McKenna KJ, Clapp MD, Federico F, Goldmann DA   Medication errors and adverse drug events in pediatric inpatients   JAMA 2001 (Apr 25);   285 (16):   2114-2120

Prozac On The Increase For Children

The New York Times reported that Eli Lilly, the producer of Prozac, is submitting data to get the drug formally approved for use as a pediatric medicine.  Although it has not been approved in the past, Prozac prescriptions for teenagers increased 46% last year as compared to the previous year.  The use of Prozac by adults has been falling in the past two years.  "The companies are looking for expanded markets," said Barbara Ryan, managing director of a pharmaceutical analysis company.

Antibiotics Don't Help Sinusitis

Antibiotics do not help most children with acute sinusitis, according to a study in Pediatrics. Investigators studied 180 youngsters, aged 1 to 18 years, with acute sinusitis. The children were divided into three treatment groups:

1)   amoxicillin, 2)   amoxicillin-clavulanate, or 3)   placebo.

Treatment lasted 14 days. Seventy-nine percent of the youngsters on amoxicillin improved after 14 days, as did 79% of those taking placebo pills and 81% of those on amoxicillin-clavulanate "Most children with prolonged cold-like symptoms suggestive of acute sinus disease get better within three weeks, without antibiotic therapy," explains chief investigator, Jane Garbutt, MB, ChB. "Our study suggests that, for children with uncomplicated acute sinusitis, it makes sense to delay antibiotic treatment and watch carefully." "Antibiotics are expensive and can cause side effects, most commonly diarrhea," Garbutt says. "Another concern is that they are an important factor in the emergence and spread of antibiotic-resistant bacteria."

Garbutt JM, GoldsteinM, Gellman E, Shannon W, Littenberg B   A randomized, placebo-controlled trial of antimicrobial treatment for children with clinically diagnosed acute sinusitis   Pediatrics 2001 (Apr);   107 (4):   619-625

Inhaled Corticosteroids Increases Risk of Cataracts

The July issue of the New England Journal of Medicine reports that the use of inhaled corticosteroids for the treatment of asthma is associated with the development of posterior subcapsular cataracts.  In addition, there is a significantly greater risk with long term use of these drugs

According to a study reported in the March 1997 issue of the Journal of Pediatrics, a common antihistamine decongestant combination (ADC) was no more effective than a placebo in providing temporary relief of symptoms of the common cold in preschool children.

Children, ranging in ages from 6 months through 5 years were randomly assigned to receive an ADC (Dimetapp) or a look alike placebo for the common cold symptoms they were experiencing. Neither the parents nor the doctors involved in the study knew which of the children received the active preparation. Two hours after each dose, changes in the child's runny nose, nasal congestion, cough and sleep status were recorded. The results from the study indicated that there were no statistically significant differences in symptom improvement between the ADC and the placebo group. However, the ADC did have significantly greater sedative effects than did the placebo.

The side effects of these medications can cause headaches, appetite loss and excitability in addition to the sedative effects from the medication. The potential harm far outweighs any perceived benefits for the child.

Clemens CJ; Taylor JA; Almquist Jr; Quinn HC; Mehta A; Naylor GS   Is an antihistamine-decongestant combination effective in temporarily relieving symptoms of the common cold in preschool children?   J Pediat 1997 (Mar);   130 (3):   463-466

Prepulsid Causes Death in 15 year Old Girl

Read this moving article from the parents of a 15 year old and their research into the safety of prescriptions in children.