A major review of prescriptions to children has found that while fewer antibiotics are being prescribed to children, prescriptions for antidepressants to teenagers have increased.
Researchers from the Best Practice Advisory Centre (BPAC) and University of Otago analysed the national pharmaceutical database to see trends between 2010 and 2015 in prescriptions written for nearly 1.5 million children aged up to 17 years old.
The findings, published recently in the journal Pediatric Drugs, showed a 50 per cent increase in the antidepressant fluoxetine being prescribed to children aged 12-17.
One of the researcher David Woods said the numbers involved remained small but the trend may be viewed a positive response to increased awareness about depression in young people as well as prescriber education about fluoxetine.
“We can’t say why, but it is possible that depressive illness in children is being better picked up and prescriber confidence and experience with fluoxetine has increased,” says Woods, a Professional Practice Fellow with the university’s School of Pharmacy. The analysis showed an increase from a prevalence of about 10 fluoxetine prescriptions per 1,000 teenagers in 2010 to 15 prescriptions per 1,000 teenagers in 2015.
To put the numbers into proportion, the most commonly prescribed medicine in the study period was paracetamol, with a prevalence of about 400 prescriptions per 1,000 children a year.
Overall, the number of children using any medicine increased from 69.7 per cent in 2010 to 73.1 per cent in 2015, with the most common medicines prescribed being antibiotics, analgesics (like paracetamol), non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen), antihistamines and topical corticosteroids for skin conditions. The study found that the highest number of prescriptions were for under-two-year-olds, with 90 per cent of under-twos prescribed medicines compared with 65 per cent of young people aged 12-17.
Woods said in line with the international push to reduce anti-microbial resistance, the study found that prescriptions for systemic antibiotics had reduced by 2 per cent and there had been a significant 10 per cent decrease in the prescribing of topical antibiotics for skin infections. He said this was a positive trend as the vast majority of skin infections will respond to antiseptics and over-use of antibiotic creams could promote antibacterial resistance. Another positive trend was a slight decrease in the prescribing of broad spectrum, combination antibiotic medicines in favour of single antibiotic treatments.
The use of methylphenidate to treat attention-deficit disorder, mainly in children older than six, increased by 37.7 per cent, which Woods said seemed high but the increase was found to be in line with international trends. An editorial in the journal also noted that methylphenidate had a lower prevalence than similar high income countries and particularly less than “overzealous management” of ADD in the US.
The study found an increased use of analgesics (10 per cent), NSAIDs (39 per cent), antihistamines (15 per cent) and anti-nausea and vertigo agents (36 per cent).
There was also a significant increase in the use of ondansetron (an anti-nausea medication), assumed to be for acute gastroenteritis. While this initially surprised the researchers, they found similar trends have been seen in other countries.
Of potential concern was the overall increase in the prescribing of the opioids codeine and tramadol, the latter of which has potential for unintentional overdose. Recent recommendations advise against the use of codeine and tramadol in children. The researchers plan a follow-up study to ascertain if these recommendations are being followed.
Lead author Andrew Tomlin of BPAC says the research is important to identify patterns of usage in relation to educational strategies, concerns over potential excessive use, requirement for practitioner education, and for making comparisons with international trends.
It also provides reassurance that there are several strategies in place to monitor the use of medicines in New Zealand.
“Rather than raise undue concerns about the use of medicines in children in New Zealand, the results have identified areas where practitioner response to education and best practice recommendations appears good,” said Tomlin.
“In other areas where medicine usage has increased, further research is possible to see if these medicines are being used appropriately.
“The results, and associated discussion, may also encourage individual practitioners to review and even question their own prescribing, which is always a positive thing to do.”
Along with further research into the area, the researchers believe medicines used by children need to be monitored on a regular basis in order to evaluate which therapies are effective and which may have harmful consequences.
They also believe the research results signal the need for more focused investigation into the actual reasons for prescribing.