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At Thobari J, Satria CD, Ridora Y, Watts E, Handley A, Standish J, Bachtiar NS, Buttery JP, Soenarto Y, Bines JE. Non-antibiotic medication use in an Indonesian community cohort 0-18 months of age. PLoS One 2020; 15:e0242410. [PMID: 33206684 PMCID: PMC7673523 DOI: 10.1371/journal.pone.0242410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 10/30/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Rational medication use for treatment is mandatory, particularly in children as they are vulnerable to possible hazards of drugs. Understanding the medication use pattern is of importance to identify the problems of drug therapy and to improve the appropriate use of medication among this population. METHODS A post-hoc study of the RV3-BB Phase IIb trial to children aged 0-18 months which was conducted in Indonesia during January 2013 to July 2016. Any concomitant medication use and health events among 1621 trial participants during the 18 months of follow-up were documented. Information on medication use included the frequency, formulation, indication, duration of usage, number of regimens, medication types, and therapeutic classes. RESULTS The majority of participants (N = 1333/1621; 82.2%) used at least one non-antibiotic medication for treatment during the 18-month observation period. A total of 7586 medication uses were recorded, mostly in oral formulation (90.5%). Of all illnesses recorded, 24.7% were treated with a single drug regimen of non-antibiotic medication. The most common therapeutic classes used were analgesics/antipyretics (30.1%), antihistamines for systemic use (17.4%), cough and cold preparations (13.5%), vitamins (8.6%), and antidiarrheals (6.6%). The main medication types used were paracetamol (29.9%), chlorpheniramine (16.8%), guaifenesin (8.9%), zinc (4.6%), and ambroxol (4.1%). Respiratory system disorder was the most common reason for medication use (51.9%), followed by gastrointestinal disorders (19.2%), pyrexia (16.9%), and skin disorders (7.0%). CONCLUSION A large number of children were exposed to at least one medication during their early life, including those where evidence of efficacy and safety in a pediatric population is lacking. This supports the need for further research on pediatric drug therapy to improve the appropriate use of medication in this population.
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Affiliation(s)
- Jarir At Thobari
- Department of Pharmacology and Therapy, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Special Region of Yogyakarta, Indonesia
- Pediatric Research Office, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Special Region of Yogyakarta, Indonesia
- Department of Paediatrics, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Special Region of Yogyakarta, Indonesia
| | - Cahya Dewi Satria
- Pediatric Research Office, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Special Region of Yogyakarta, Indonesia
- Department of Paediatrics, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Special Region of Yogyakarta, Indonesia
| | - Yohanes Ridora
- Pediatric Research Office, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Special Region of Yogyakarta, Indonesia
| | - Emma Watts
- RV3 Rotavirus Vaccine Program, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
| | - Amanda Handley
- RV3 Rotavirus Vaccine Program, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Medicines Development for Global Health, Melbourne, Victoria, Australia
| | - Jane Standish
- RV3 Rotavirus Vaccine Program, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of General Medicine, Royal Children’s Hospital Melbourne, Parkville, Victoria, Australia
| | | | - Jim P. Buttery
- RV3 Rotavirus Vaccine Program, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Pediatrics, University of Melbourne, Melbourne, Victoria, Australia
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
- Department of Infection and Immunity, Monash Children’s Hospital, Clayton, Victoria, Australia
| | - Yati Soenarto
- Pediatric Research Office, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Special Region of Yogyakarta, Indonesia
- Department of Paediatrics, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Special Region of Yogyakarta, Indonesia
| | - Julie E. Bines
- RV3 Rotavirus Vaccine Program, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Pediatrics, University of Melbourne, Melbourne, Victoria, Australia
- Department of Gastroenterology and Clinical Nutrition, Royal Children’s Hospital Melbourne, Parkville, Victoria, Australia
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Maniero HK, Martins AA, Melo AC, Paz LPDS, Schraiber RDB, Galato D. USE OF DRUGS IN CHILDREN AGED ZERO TO FIVE YEARS OLD IN TUBARÃO, SANTA CATARINA, BRAZIL. REVISTA PAULISTA DE PEDIATRIA 2018; 36:437-444. [PMID: 30462777 PMCID: PMC6322813 DOI: 10.1590/1984-0462/;2018;36;4;00008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 10/01/2017] [Indexed: 11/22/2022]
Abstract
Objective: To analyze the context of drug use in children aged zero to five years
old. Methods: Cross-sectional study based on interviews conducted at home with caregivers
(parents, uncles or grandparents) of the children enrolled in ten Family
Health Strategy units across different geographical points of the city of
Tubarão, Santa Catarina, Brazil. Results: A total of 350 caregivers were interviewed, whose children’s mean age was
2.6 years. Of these, 56.9% had used at least one drug in the 15 days prior
to the interview, 31.1% had been exposed to self-medication and 35.7% had
used at least one medication obtained by current prescription. The use of
medication was associated with the age range up to 24 months, periodic
consultation with pediatricians and diagnosis of chronic and acute diseases.
Among medicated children, 19.1% inappropriately had been exposed to at least
one medication (considering dose, dose interval or period of treatment).
Regarding medication storage, 55.2% of interviewees stored them in unsafe
places that could be accessed by children and 32.0% in inappropriate places,
with exposure to light, heat or humidity. Moreover, 45.2% of the
interviewees stored drugs out of their packages, 38.9% without secondary
packaging, and 1.6% of drugs had expired date. Conclusions: Drug use is high among children in this age range, and actions aimed at the
safe and rational use of these substances in this population should be
encouraged.
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Italia S, Brüske I, Heinrich J, Berdel D, von Berg A, Lehmann I, Standl M, Wolfenstetter SB. A longitudinal comparison of drug use among 10-year-old children and 15-year-old adolescents from the German GINIplus and LISAplus birth cohorts. Eur J Clin Pharmacol 2015; 72:301-10. [PMID: 26581761 PMCID: PMC4751195 DOI: 10.1007/s00228-015-1977-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 11/01/2015] [Indexed: 11/29/2022]
Abstract
Purpose The purpose of this study was to compare longitudinal data on drug utilization between 10-year-old children and 15-year-old adolescents and to analyse the association of drug use at the age of 15 years with drug use at the age of 10 years. Methods Based on the German GINIplus (German infant study on the Influence of Nutrition Intervention plus environmental and genetic influences on allergy development) and LISAplus (Influence of lifestyle factors on the immune system and allergies in East and West Germany plus the influence of traffic emissions and genetics) birth cohorts, data on drug utilization (past 4 weeks) were collected using a self-administered questionnaire for 3642 children (10-year follow-up) and 4677 adolescents (15-year follow-up). The drugs were classified by therapeutic categories (conventional drugs, homeopathic drugs, etc.) and by codes according to the anatomical therapeutic chemical (ATC) classification system. Associations of adolescents’ drug use with gender, study area, maternal education, parental income, presence of chronic conditions, and prior drug use at the age of 10 years were analysed using a logistic regression model. Results The 4-week prevalence rates of overall drug use were similar for adolescents (41.1 %) and children (42.3 %). However, adolescents used noticeably more anti-inflammatory drugs, analgesics, and systemic antihistamines. Exactly 3194 children/adolescents participated in both follow-ups. Adolescents’ use of anti-inflammatory drugs was predicted (OR = 3.37) by use of anti-inflammatory drugs as a child. In summary, the strongest predictor of adolescents’ use of specific therapeutic categories or ATC groups was the previous use of the same therapeutic drug category or ATC group as a 10-year-old child. Conclusions Despite similar prevalence rates of overall drug utilization among both age groups, there is a noticeable difference concerning the use of drugs from specific ATC groups. Drug use as a child may partly determine what they use as an adolescent. Electronic supplementary material The online version of this article (doi:10.1007/s00228-015-1977-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Salvatore Italia
- Department of International Health, School for Public Health and Primary Care (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Duboisdomein 30, 6229 GT, Maastricht, The Netherlands. .,Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Health Economics and Health Care Management, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany.
| | - Irene Brüske
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Epidemiology I, Neuherberg, Germany
| | - Joachim Heinrich
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Epidemiology I, Neuherberg, Germany
| | - Dietrich Berdel
- Research Institute, Department of Pediatrics, Marien-Hospital Wesel, Pastor-Janßen-Str. 8-38, 46483, Wesel, Germany
| | - Andrea von Berg
- Research Institute, Department of Pediatrics, Marien-Hospital Wesel, Pastor-Janßen-Str. 8-38, 46483, Wesel, Germany
| | - Irina Lehmann
- Department of Environmental Immunology, UFZ - Helmholtz Centre for Environmental Research Leipzig, Permoserstr. 15, 04318, Leipzig, Germany
| | - Marie Standl
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Epidemiology I, Neuherberg, Germany
| | - Silke B Wolfenstetter
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Health Economics and Health Care Management, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany
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Matuz M, Benko R, Elseviers M, Hajdu E, Doro P, Viola R, Soos G. Dosage Form Data Used for Estimating Pediatric Antibiotic Use. Sci Pharm 2015; 83:511-8. [PMID: 26839835 PMCID: PMC4727769 DOI: 10.3797/scipharm.1511-05] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 07/01/2015] [Indexed: 11/22/2022] Open
Abstract
We aimed to report a simple estimation method to enable quantification of pediatric antibiotic exposure in large aggregated datasets. Secondly, we aimed to quantify and benchmark Hungarian pediatric antibiotic use. First we intended to examine whether a correlation existed between dosage form data and the patient's age. Therefore, issued prescriptions were analyzed in pharmacies. As a correlation was found between the share of liquid oral antibacterial products and the rate of pediatric antibiotic prescriptions (R=0.884; p<0.001), we extrapolated this finding to a large aggregated dataset and estimated that 34.6% of prescriptions were issued for pediatric cases (95% confidence interval: 19.7-60.0). Taking into account the demography of the population, children were exposed to antibiotics three times more often than adults with a corresponding annual prescription rate of 2.6. We demonstrated that simple drug-related data can be linked to a patient-related measure as we found strong associations between dosage form data and patients' age. Based on this association, massive pediatric antibiotic exposure was found. Due to the general availability of dosage form data and the ease of the estimation method, the reported concept can be used to quantify pediatric antibiotic use in large aggregated datasets or when age stratification is absent.
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Affiliation(s)
- Maria Matuz
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, Szikra utca 8., H-6725 Szeged, Hungary
| | - Ria Benko
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, Szikra utca 8., H-6725 Szeged, Hungary
| | - Monique Elseviers
- Centre for Research and Innovation in Care (CRIC), Faculty of Medicine and Health Sciences, University of Antwerp, CDE R3.29, Universiteitsplein 1, B-2610 Wilrijk, Belgium
| | - Edit Hajdu
- First Internal Medicine, Infectiology Unit, Faculty of Medicine, University of Szeged, Kálvária sgt 57, H-6724 Szeged, Hungary
| | - Peter Doro
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, Szikra utca 8., H-6725 Szeged, Hungary
| | - Reka Viola
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, Szikra utca 8., H-6725 Szeged, Hungary
| | - Gyongyver Soos
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, Szikra utca 8., H-6725 Szeged, Hungary
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Aagaard L, Hansen EH. Adverse drug reactions associated with asthma medications in children: systematic review of clinical trials. Int J Clin Pharm 2014; 36:243-52. [PMID: 24562976 DOI: 10.1007/s11096-014-9924-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 02/11/2014] [Indexed: 01/29/2023]
Abstract
BACKGROUND Respiratory medications are frequently prescribed for use in children. Several studies have reported information on the safety of asthma medications in clinical studies in adults, but information about safety in children is scarce. OBJECTIVE To review published clinical trials on the occurrence and characteristics of adverse drug reactions (ADRs) in children, reported for asthma medications licensed for paediatric use. METHODS We systematically reviewed the literature following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines. PubMed, Embase, Cochrane Library, PsycINFO, IPA, and CINAHLs databases were searched from origin until July 2013 for studies reporting ADRs for beta2-receptor agonists, inhaled corticosteroids, leukotriene receptor antagonists and combination products in children from birth to age 17. Information on ADR reporting rates, age and gender, type and seriousness of ADRs, design, setting, observation period, type of assessors, and funding sources was extracted from the articles. RESULTS Literature searches resulted in 162 potential relevant articles. However only 12 of these studies were included in this review as they reported information about ADR rates from use of salmeterol, formoterol, fluticasone, montelukast, zafirlukast and budesonide/formoterol in children. The total population was approximately 3,000 children; the majority was 6- to 11-year-olds and two thirds of these were boys. The observation period varied from 1 to 22 months. The most frequently reported ADRs were exacerbation of asthma, respiratory tract infection, cough, fever and headache. Only few ADRs were rated as being serious, however a number of children dropped out of the clinical trials due to serious ADRs, and, therefore, the real number of serious ADRs is probably higher. CONCLUSIONS Few clinical trials reporting ADRs from use of asthma medications in children were identified in the literature. These studies reported only a few types of ADRs, the majority being non-serious.
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Affiliation(s)
- Lise Aagaard
- Faculty of Health Sciences, Institute of Public Health, University of Southern Denmark, J.B. Winsløws Vej 19, 5000, Odense C, Denmark,
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Johannesdottir SA, Horváth-Puhó E, Ehrenstein V, Schmidt M, Pedersen L, Sørensen HT. Existing data sources for clinical epidemiology: The Danish National Database of Reimbursed Prescriptions. Clin Epidemiol 2012. [PMID: 23204870 PMCID: PMC3508607 DOI: 10.2147/clep.s37587] [Citation(s) in RCA: 279] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The Danish health care system provides partial reimbursement of most prescription medications in Denmark. The dispensation of prescription medications is registered in administrative databases. Each time a prescription is redeemed at a pharmacy, an electronic record is generated with information related to the user, prescriber, the pharmacy, and the dispensed drug. The National Health Service gathers this information for administration of the drug reimbursement plan. Recently, this information became the basis for the establishment of a new research database, the Danish National Database of Reimbursed Prescriptions (DNDRP). In this paper, we review the content, coverage, quality, linkage, access, and research possibilities of this new database. The database encompasses the reimbursement records of all reimbursed drugs sold in community pharmacies and hospital-based outpatient pharmacies in Denmark since 2004. On average, approximately 3.5 million users are recorded in the database each year. During the coverage period, the number of annual prescription redemptions increased by 15%. Most dispensed prescriptions are in the categories "alimentary tract and metabolism", "cardiovascular system", "nervous system", and "respiratory system". Individuals are identified by the unique central personal registration (CPR) number assigned to all persons born in or immigrating to Denmark. The new database fully complies with Denmark's Act on Processing of Personal Data, while avoiding additional restrictions imposed on data use at the Danish National Prescription Registry, administered by Statistics Denmark. Most importantly, CPR numbers are reversibly encrypted, which allows re-identification of drug users; furthermore, the data access is possible outside the servers of Statistics Denmark. These features open additional opportunities for international collaboration, validation studies, studies on adverse drug effects requiring review of medical records, studies involving contact to general practitioners, and linkage of prescription data to other clinical and research databases. The DNDRP thus is a valuable data source for pharmacoepidemiological research.
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Affiliation(s)
- Sigrun Alba Johannesdottir
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
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Methods in pharmacoepidemiology: a review of statistical analyses and data reporting in pediatric drug utilization studies. Eur J Clin Pharmacol 2012; 69:599-604. [PMID: 22832725 DOI: 10.1007/s00228-012-1354-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Accepted: 07/10/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE To evaluate the quality of data reporting and statistical methods performed in drug utilization studies in the pediatric population. METHODS Drug utilization studies evaluating all drug prescriptions to children and adolescents published between January 1994 and December 2011 were retrieved and analyzed. For each study, information on measures of exposure/consumption, the covariates considered, descriptive and inferential analyses, statistical tests, and methods of data reporting was extracted. An overall quality score was created for each study using a 12-item checklist that took into account the presence of outcome measures, covariates of measures, descriptive measures, statistical tests, and graphical representation. RESULTS A total of 22 studies were reviewed and analyzed. Of these, 20 studies reported at least one descriptive measure. The mean was the most commonly used measure (18 studies), but only five of these also reported the standard deviation. Statistical analyses were performed in 12 studies, with the chi-square test being the most commonly performed test. Graphs were presented in 14 papers. Sixteen papers reported the number of drug prescriptions and/or packages, and ten reported the prevalence of the drug prescription. The mean quality score was 8 (median 9). Only seven of the 22 studies received a score of ≥10, while four studies received a score of <6. CONCLUSIONS Our findings document that only a few of the studies reviewed applied statistical methods and reported data in a satisfactory manner. We therefore conclude that the methodology of drug utilization studies needs to be improved.
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8
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Aagaard L, Hansen EH. Adverse drug reactions reported for systemic antibacterials in Danish children over a decade. Br J Clin Pharmacol 2011; 70:765-8. [PMID: 21039770 DOI: 10.1111/j.1365-2125.2010.03732.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Verhamme K, Sturkenboom M. Study designs in paediatric pharmacoepidemiology. Eur J Clin Pharmacol 2010; 67 Suppl 1:67-74. [PMID: 21107830 DOI: 10.1007/s00228-010-0930-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Accepted: 10/16/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE Few data on the efficacy and safety of drugs in children are available as in the past, these children were not included in randomized controlled trials (RCTs). Data on the efficacy and safety of drugs in children are extrapolated from adults. The EMA recognizes the need for long-term safety studies on various drugs, a need that can best be answered by pharmacoepidemiological studies. In this article, we provide currently available information on study designs within the field of paediatric drug research. METHODS A PubMed search was conducted on all pharmacoepidemiological studies in children. In addition, data from handbooks on pharmacoepidemiology were consulted. Data were reviewed and the relevant literature on study designs in paediatric pharmacoepidemiology is described. RESULTS The various study designs in pharmacoepidemiology have their specific indications, all with their specific limitations. Case reports and case series are mainly used for signal detection of safety issues whereas case control and cohort studies are used for safety hypothesis testing. Observational studies can be conducted using data from automated databases that guarantee large sample size and long-term follow-up, which is ideal for safety studies, especially in case of rare events. CONCLUSION Pharmacoepidemiological studies are crucial in research on the safety of drugs in children. Knowledge of the different pharmacoepidemiological methods is important to guarantee optimal use and correct interpretation of the data.
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Affiliation(s)
- Katia Verhamme
- Department of Medical Informatics, Erasmus MC, Rotterdam, The Netherlands.
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Carrasco-Garrido P, Jiménez-García R, Barrera VH, de Andrés AL, de Miguel AG. Medication consumption in the Spanish paediatric population: related factors and time trend, 1993-2003. Br J Clin Pharmacol 2010; 68:455-61. [PMID: 19740404 DOI: 10.1111/j.1365-2125.2009.03449.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
AIMS To ascertain the prevalence of consumption of medications in the Spanish paediatric population and to identify the factors associated with such consumption. METHODS This was a descriptive, cross-sectional study covering the Spanish adult population, using data drawn from the 1993 and 2003 Spanish National Health Surveys (SNHS). The 1993 and 2003 SNHS include data on 5280 and 6463 children, respectively, age range 0-15 years. The independent variables were sociodemographic and health-related, and the dependent variable was medications use. Using logistic multivariate regression models, we analysed the temporal evolution of medication consumption between 1993 and 2003. RESULTS The 1993 SNHS data revealed that 36.81% of the paediatric population had consumed some type of medication, whereas in 2003 this figure had dropped to 34%. Over the decade of study, there was a significant decrease in use of medications for catarrh, influenza, throat (P < 0.05), and an increase in consumption of pain-relieving drugs and/or fever-lowering, antibiotics and anti-allergy remedies. Multivariate analysis highlighted the association between medication consumption, negative perception of the child's health [odds ratio (OR) 2.84, 95% confidence interval (CI) 2.16, 3.72 in 1993, and OR 3.54, 95% CI 2.74, 4.56 in 2003] and medical visits to the physician across the 2 years (OR 12.09, 95% CI 10.13, 14.42 in 1993, and OR 7.17, 95% CI 6.06, 8.47 in 2003). CONCLUSIONS Although there was a significant decline in overall drug consumption in the Spanish paediatric population from 1993 to 2003, the prevalence of consumption of certain groups, such as analgesics, antipyretics and antibiotics, has risen.
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Affiliation(s)
- Pilar Carrasco-Garrido
- Unit of Preventive Medicine and Public Health, Rey Juan Carlos University, Alcorcón, Madrid, Spain
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11
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Sturkenboom MCJM, Verhamme KMC, Nicolosi A, Murray ML, Neubert A, Caudri D, Picelli G, Sen EF, Giaquinto C, Cantarutti L, Baiardi P, Felisi MG, Ceci A, Wong ICK. Drug use in children: cohort study in three European countries. BMJ 2008; 337:a2245. [PMID: 19029175 PMCID: PMC2593449 DOI: 10.1136/bmj.a2245] [Citation(s) in RCA: 160] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/01/2008] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To provide an overview of drug use in children in three European countries. DESIGN Retrospective cohort study, 2000-5. SETTING Primary care research databases in the Netherlands (IPCI), United Kingdom (IMS-DA), and Italy (Pedianet). PARTICIPANTS 675 868 children aged up to 14 (Italy) or 18 (UK and Netherlands). MAIN OUTCOME MEASURE Prevalence of use per year calculated by drug class (anatomical and therapeutic). Prevalence of "recurrent/chronic" use (three or more prescriptions a year) and "non-recurrent" or "acute" use (less than three prescriptions a year) within each therapeutic class. Descriptions of the top five most commonly used drugs evaluated for off label status within each anatomical class. RESULTS Three levels of drug use could be distinguished in the study population: high (>10/100 children per year), moderate (1-10/100 children per year), and low (<1/100 children per year). For all age categories, anti-infective, dermatological, and respiratory drugs were in the high use group, whereas cardiovascular and antineoplastic drugs were always in the low use group. Emollients, topical steroids, and asthma drugs had the highest prevalence of recurrent use, but relative use of low prevalence drugs was more often recurrent than acute. In the top five highest prevalence drugs topical inhaled and systemic steroids, oral contraceptives, and topical or systemic antifungal drugs were most commonly used off label. CONCLUSION This overview of outpatient paediatric prescription patterns in a large European population could provide information to prioritise paediatric therapeutic research needs.
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Affiliation(s)
- Miriam C J M Sturkenboom
- Department of Medical Informatics, Erasmus University Medical Centre, 3000CA Rotterdam, Netherlands.
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12
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Boots I, Sukhai RN, Klein RH, Holl RA, Wit JM, Cohen AF, Burggraaf J. Stimulation programs for pediatric drug research--do children really benefit? Eur J Pediatr 2007; 166:849-55. [PMID: 17225950 PMCID: PMC1914295 DOI: 10.1007/s00431-006-0381-z] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2006] [Accepted: 11/16/2006] [Indexed: 11/25/2022]
Abstract
Most drugs that are currently prescribed in pediatrics have not been tested in children. Pediatric drug studies are stimulated in the USA by the pediatric exclusivity provision under the Food and Drug Administration Modernization Act (FDAMA) that grants patent extensions when pediatric labeling is provided. We investigated the effectiveness of these programs in stimulating drug research in children, thereby increasing the evidence for safe and effective drug use in the pediatric population. All drugs granted pediatric exclusivity under the FDAMA were analyzed by studying the relevant summaries of medical and clinical pharmacology reviews of the pediatric studies or, if these were unavailable, the labeling information as provided by the manufacturer. A systematic search of the literature was performed to identify drug utilization patterns in children. From July 1998 to August 2006, 135 drug entities were granted pediatric exclusivity. Most frequent drug groups were anti-depressants and mood stabilizers, ACE inhibitors, lipid-lowering preparations, HIV antivirals, and non-steroidal anti-inflammatory and anti-rheumatic drugs. The distribution of the different drugs closely matched the distribution of these drugs over the adult market, and not the drug utilization by children. Many drug studies in children have been performed since the introduction of the FDAMA. However, children infrequently use the drugs granted pediatric exclusivity. The priorities for pediatric drug research should be set by the need of the patients, not by market considerations.
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Affiliation(s)
- Isabelle Boots
- Department of Pediatrics, Leiden University Medical Center, Willem Alexander Kinder- en Jeugdcentrum, LUMC, Postbus 9600, 2300 RC Leiden, The Netherlands
| | - Rám N. Sukhai
- Department of Pediatrics, Leiden University Medical Center, Willem Alexander Kinder- en Jeugdcentrum, LUMC, Postbus 9600, 2300 RC Leiden, The Netherlands
| | - Richard H. Klein
- Department of Pediatrics, Leiden University Medical Center, Willem Alexander Kinder- en Jeugdcentrum, LUMC, Postbus 9600, 2300 RC Leiden, The Netherlands
- Centre for Human Drug Research, Leiden, The Netherlands
| | - Robert A. Holl
- Department of Pediatrics, Leiden University Medical Center, Willem Alexander Kinder- en Jeugdcentrum, LUMC, Postbus 9600, 2300 RC Leiden, The Netherlands
| | - Jan M. Wit
- Department of Pediatrics, Leiden University Medical Center, Willem Alexander Kinder- en Jeugdcentrum, LUMC, Postbus 9600, 2300 RC Leiden, The Netherlands
| | - Adam F. Cohen
- Centre for Human Drug Research, Leiden, The Netherlands
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Hansen DL, Tulinius D, Hansen EH. Adolescents' struggles with swallowing tablets: barriers, strategies and learning. ACTA ACUST UNITED AC 2007; 30:65-9. [PMID: 17594531 DOI: 10.1007/s11096-007-9142-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2007] [Accepted: 06/01/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To explore adolescents' struggles with taking oral medications. SETTING Copenhagen, Denmark. METHOD Semi-structured qualitative interviews were conducted with 89 adolescents (33 boys, 56 girls) between the ages of 11 and 20. Adolescents were recruited through four public schools. To identify struggles with taking oral medication, interview transcripts were systematically searched for statements including the terms swallow, chew, crush and eat. Thematic analysis of the identified statements was carried out to reveal dominant themes in the adolescents' accounts. RESULTS Over one-third of the adolescents spontaneously provided accounts of the difficulties they experienced with taking oral medications, especially with swallowing tablets. Three themes were dominant in their narratives: barriers, strategies and learning. Barriers experienced by the adolescents involved the medications' properties, e.g. taste. Adolescents developed strategies to overcome these barriers, e.g. crushing tablets. Via a process of learning-by-doing and the acquisition of increased experience and autonomy, many adolescents mastered the skill of swallowing tablets. CONCLUSION Many adolescents experienced barriers in their attempts to swallow tablets. They developed various strategies to overcome these barriers and gradually mastered taking medicines in a learning-by-doing process.
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Affiliation(s)
- Dana Lee Hansen
- Faculty of Pharmaceutical Sciences, Department of Pharmacology and Pharmacotherapy, FKL-Research Centre for Quality in Medicine Use, University of Copenhagen, Universitetsparken 2, Copenhagen DK-2100, Denmark.
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Novak PH, Ekins-Daukes S, Simpson CR, Milne RM, Helms P, McLay JS. Acute drug prescribing to children on chronic antiepilepsy therapy and the potential for adverse drug interactions in primary care. Br J Clin Pharmacol 2005; 59:712-7. [PMID: 15948936 PMCID: PMC1884874 DOI: 10.1111/j.1365-2125.2004.02237.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
AIMS To investigate the extent of acute coprescribing in primary care to children on chronic antiepileptic therapy, which could give rise to potentially harmful drug-drug interactions. DESIGN Acute coprescribing to children on chronic antiepileptic drug therapy in primary care was assessed in 178 324 children aged 0-17 years for the year 1 November 1999 to 31 October 2000. Computerized prescribing data were retrieved from 161 representative general practices in Scotland. SETTING One hundred and sixty-one general practices throughout Scotland. RESULTS During the study year 723 (0.41%) children chronically prescribed antiepileptic therapy were identified. Fourteen antiepileptic agents were prescribed, with carbamazepine, sodium valproate and lamotrigine accounting for 80% of the total. During the year children on chronic antiepileptic therapy were prescribed 4895 acute coprescriptions for 269 different medicines. The average number of acute coprescriptions for non-epileptic drug therapy were eight, 11, six, and six for the 0-1, 2-4, 5-11, and 12-17-year-olds, respectively. Of these acute coprescriptions 72 (1.5%) prescribed to 22 (3.0%) children were identified as a potential source of clinically serious interactions. The age-adjusted prevalence rates for potentially serious coprescribing were 86, 26, 22, and 33/1000 children chronically prescribed antiepileptic therapy in the 0-1, 2-4, 5-11, and 12-17-year-old age groups, respectively. The drugs most commonly coprescribed which could give rise to such interactions were antacids, erythromycin, ciprofloxacin, theophylline and the low-dose oral contraceptive. For 10 (45.5%0 of the 20 children identified at risk of a potentially clinically serious adverse drug interaction, the acute coprescription was prescribed off label because of age or specific contraindication/warning. CONCLUSIONS In primary care, 3.0% of children on chronic antiepileptic therapy are coprescribed therapeutic agents, which could give rise to clinically serious drug-drug interactions.
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Affiliation(s)
- Philipp H Novak
- Department of Medicine and Therapeutics, The University of Aberdeen, Foresterhill Health Centre, Foresterhill, Aberdeen AB25 2ZD, UK
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Helms PJ, Ekins Daukes S, Taylor MW, Simpson CR, McLay JS. Utility of routinely acquired primary care data for paediatric disease epidemiology and pharmacoepidemiology. Br J Clin Pharmacol 2005; 59:684-90. [PMID: 15948933 PMCID: PMC1884863 DOI: 10.1111/j.1365-2125.2005.02404.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The majority of medicines prescribed for children are prescribed in primary care for common acute and chronic conditions. This is in contrast to prescribing in secondary care where the population of children admitted is small but where a large number of different medicines are prescribed to treat more serious and less common conditions. METHODS Data on prescribing was extracted from the General Practice Administration System for Scotland (GPASS) for the year November 1999 to October 2000 and prescribing patterns for children aged 0-16 years expressed as percentages. A comparison of age specific consultations for asthma, as an example of a common paediatric condition, was also made between two separate general practice data sets, the General Practice Research Database (GRPD) and the continuous morbidity recording (CMR) subset of GPASS. RESULTS Of 214 medicines investigated for unlicensed and off-label prescribing no unlicensed prescribing was identified. Off-label prescribing due to age was most common among younger and older children. The most common reasons for off-label prescriptions were, in order of frequency, lower than recommended dose, higher than recommended dose, below the recommended age, and unlicensed formulation. Age and gender specific consultations for asthma were similar in the two representative databases, GPRD and CMR, both showing disappearance of the male predominance in the teenage years. CONCLUSIONS Large primary care data sets available within a unified health care system such as the UK National Health Service (NHS) are likely to be broadly compatible and produce similar results. The prescribing of off-label medicines to children is common in primary care, most commonly due to prescribing out with the recommended dosage regimen.
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Affiliation(s)
- Peter J Helms
- Department of Child Health, School of Medicine, University of Aberdeen, UK.
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Sanz E, Hernández MA, Ratchina S, Stratchounsky L, Peiré MA, Lapeyre-Mestre M, Horen B, Kriska M, Krajnakova H, Momcheva H, Encheva D, Martínez-Mir I, Palop V. Drug utilisation in outpatient children. A comparison among Tenerife, Valencia, and Barcelona (Spain), Toulouse (France), Sofia (Bulgaria), Bratislava (Slovakia) and Smolensk (Russia). Eur J Clin Pharmacol 2004; 60:127-34. [PMID: 15022033 DOI: 10.1007/s00228-004-0739-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2003] [Accepted: 01/31/2004] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Scarce information about comparative diagnostic and therapeutic patterns in paediatric outpatients of different countries is found in the literature. OBJECTIVE To describe the similarities and differences observed in diagnosis and therapeutic patterns of paediatric patients of seven locations in different countries. DESIGN Cross-sectional, prospective, international comparative, descriptive study. PATIENTS AND METHODS A randomly selected sample of 12,264 paediatric outpatients seen in consultation rooms of urban and rural areas and attended by paediatricians or general practitioners of the participating locations. Data on patient demographic information, diagnosis and pharmacological treatment were collected using pre-designed forms. Diagnoses were coded using the ICD-9 and drugs according to the ATC classification. RESULTS Among the ten most common diagnoses, upper respiratory tract infections are in the first position in all locations; asthma prevalence is highest in Tenerife (8.4%). Tonsillitis, otitis, bronchitis and dermatological affections are the most common diagnoses in all locations. Pneumonia is only reported in Sofia (3.8%) and Smolensk (2.3%). The average number of drugs prescribed per child varied from 1.3 in Barcelona to 2.9 in Smolensk. There are no great differences in the profile of pharmacological groups prescribed, but a considerable range of variations in antibiotic therapy is observed: prescription of cephalosporins is low in Smolensk (0.7%) and higher in the other locations, from 16.5% (Bratislava) to 28% (Tenerife). Macrolides prescriptions range from 12.6% (Toulouse) to 24.7% (Smolensk), except in Sofia where they drop to 5.6%. Trimethoprim and its combinations are used in Smolensk (23.3%), Sofia (11.8%) and Bratislava (8.7%). Check-up consultations are not recorded in Smolensk and Bratislava, whereas in Toulouse these visits account for 16.2% of all consultations and in the other locations the percentage varies from 6.1% (Tenerife) to 1.9% (Sofia). Homeopathic treatments are registered only in Toulouse. CONCLUSION Except in asthma prevalence, there are no great differences in diagnostic maps among locations. Significant variations in the number of drugs prescribed per child and antibiotic therapies are observed. Areas for improvement have been identified.
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Affiliation(s)
- E Sanz
- Department of Clinical Pharmacology, School of Medicine, University of La Laguna, 38071 La Laguna, Tenerife, Spain.
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't Jong GW, Eland IA, Sturkenboom MCJM, van den Anker JN, Stricker BHC. Determinants for drug prescribing to children below the minimum licensed age. Eur J Clin Pharmacol 2003; 58:701-5. [PMID: 12610748 DOI: 10.1007/s00228-002-0554-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2001] [Accepted: 11/28/2002] [Indexed: 10/20/2022]
Abstract
OBJECTIVES In the light of the undesired effects that unlicensed and off-label drug use might have, it is necessary to study the determinants affecting the prescribing of such drugs. Prescription of drugs to children younger than the minimum licensed age may carry the highest risk of adverse reactions. To obtain insight into the factors that affect prescription of drugs to children below the minimum licensed age, we conducted a population-based case-control study. METHODS The case-control study was nested in a cohort of 13,426 children aged 0-16 years, who were registered in the Integrated Primary Care Information (IPCI) project, a longitudinal observational general practitioners' database in the Netherlands. "Cases" were children who received a drug prescription for which they were below the minimum licensed age. To each case we matched up to four controls based on GP practice and patient age. As potential risk factors we evaluated the use of health care resources, and acute and chronic morbidity. RESULTS We identified 447 cases who were matched to 1355 controls. The cases consulted their GPs significantly more often during the preceding half year, had more drug prescriptions, and had more specialist referrals than the controls. Respiratory diseases were the most important determinants for the prescription of drugs to children below the minimum licensed age. In adolescents, migraine and other headaches were the most important reasons. CONCLUSIONS This study showed that children suffering from respiratory disease or migraine have the highest risk of receiving a drug prescription for which the patient is below the minimum licensed age. Regulatory authorities and the pharmaceutical industry should be stimulated to improve the evaluation of drug efficacy and safety in children.
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Affiliation(s)
- Geert W 't Jong
- Pharmacoepidemiology Unit, Department of Epidemiology, Erasmus MC, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands
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Horen B, Montastruc JL, Lapeyre-Mestre M. Adverse drug reactions and off-label drug use in paediatric outpatients. Br J Clin Pharmacol 2002; 54:665-70. [PMID: 12492616 PMCID: PMC1874497 DOI: 10.1046/j.1365-2125.2002.t01-3-01689.x] [Citation(s) in RCA: 203] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
AIMS To investigate the potential relationship between off-label drug use and increased risk of adverse drug reactions in paediatric outpatients. METHODS A prospective pharmacovigilance survey of drug prescribing in office based paediatricians was carried out in Haute-Garonne County (south west of France). RESULTS The study involved a sample of 1419 children under 16 years old. Forty-two percent of patients were exposed to at least one off-label prescription. The incidence of adverse drug reactions was 1.41% (95% CI 0.79, 2.11). Off-label drug use was significantly associated with adverse drug reactions (relative risk 3.44; 95% CI 1.26, 9.38), particularly when it was due to an indication different than that defined in the Summary Product Characteristics (relative risk 4.42; 95% CI 1.60, 12.25). CONCLUSIONS Our data suggest an increasing risk of adverse drug reactions related to off-label drug use. This risk would be acceptable if further studies prove the potential benefit of such a drug use.
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Affiliation(s)
- Benjamin Horen
- Laboratoire de Pharmacologie Médicale et Clinique, Centre Midi-Pyrénées de Pharmacovigilance, de Pharmacoépidémiologie et dInformations sur le médicament, Faculté de Médecine
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Schirm E, van den Berg P, Gebben H, Sauer P, De Jong-van den Berg L. Drug use of children in the community assessed through pharmacy dispensing data. Br J Clin Pharmacol 2000; 50:473-8. [PMID: 11069442 PMCID: PMC2014415 DOI: 10.1046/j.1365-2125.2000.00275.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
AIMS : To determine the extent of drug use in children and the types of drugs that children use. METHODS Cross-sectional study and cohort study, using computerized pharmacy dispensing records for all children aged 0-16 years in the northern part of The Netherlands in 1998. The main outcome measures were proportion of children that used drugs (per sex and age group), mean number of drugs per child, 10 most widely used drug groups and cumulative proportions of drugs users (per drug group) during the first 2 years of life. RESULTS Drug use was the highest among infants, decreased till adolescence and increased from there. Overall, approximately 60% of all children used at least one drug in 1998. At younger ages, boys used more drugs than girls and at older ages girls used more drugs than boys. Systemic antibiotics were used by 21% of the children and were by far the most widely used drugs. Other frequently used drugs were analgesics (10%), corticosteroids for dermatologic use (9%), anthistamines (8%) and antiasthmatics (7%). Approximately 10% of the children had used at least one drug at the age of 1 month and at the age of 2 years this proportion was 81%. CONCLUSIONS The majority of children was exposed to one or more drugs and this exposure started at very young age. This shows the importance of good guidelines for drug use in children and emphasizes the necessity of research of pharmacokinetic and pharmacodynamic properties in children to obtain safety, efficacy and quality evidence of these drugs.
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Affiliation(s)
- E Schirm
- Groningen Institute for Drug Exploration (GUIDE), University of Groningen, University Centre for Pharmacy, Section of Social Pharmacy and Pharmacoepidemiology, Groningen, The Netherlands.
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