title: A survey of the use of off-label and unlicensed drugs in a Dutch children's hospital.
abstract: BACKGROUND
  The treatment of pediatric patients with drugs in hospitals is being impeded by a shortage in the availability of licensed drugs in an appropriate formulation. We have studied the extent of use of drugs that are not licensed for use in children (unlicensed) and drugs that are used outside the terms of the product license (off-label). We conducted this study in a Dutch academic children's hospital.
  
  
  METHODS
  In a prospective study of 5 weeks' duration, we reviewed drug prescriptions in a pediatric ward and 3 intensive care units. We classified the prescribed drugs in 3 main categories-licensed, unlicensed, and off-label-and determined the nature of their unlicensed and off-label use.
  
  
  RESULTS
  Two thousand one hundred thirty-nine courses of drugs were administered to 237 patients in 442 patient-days. Of 2139 prescriptions, 725 (34%) were licensed, 1024 (48%) were unlicensed, and 390 (18%) were off-label. In 392 (90%) of 435 patient-days, children received 1 or more courses of an unlicensed or off-label drug prescription in hospital.
  
  
  CONCLUSIONS
  With regard to the availability of drugs of proven quality and adequate license for pediatric patients in hospital, dramatic shortcomings exist. As a result, drug legislation originally designed to protect patients and prescribing physicians against unsafe drug use and unjustified claims has turned into an insurmountable threshold to make proper drugs available for a vulnerable minority of patients.
authors.affiliation: Department of Pediatrics, Sophia Children's Hospital, Erasmus Medical Center Rotterdam (EMCR), Rotterdam, The Netherlands.
authors.forename: G W
authors.initials: GW
authors.lastname: 't Jong
authors.forename: A G
authors.initials: AG
authors.lastname: Vulto
authors.forename: M
authors.initials: M
authors.lastname: de Hoog
authors.forename: K J
authors.initials: KJ
authors.lastname: Schimmel
authors.forename: D
authors.initials: D
authors.lastname: Tibboel
authors.forename: J N
authors.initials: JN
authors.lastname: van den Anker
mesh_terms: D000293:Adolescent; D002626:Chemistry, Pharmaceutical; D002648:Child; D002675:Child, Preschool; D004348:Drug Labeling; D011307:Drug Prescriptions; D004358:Drug Therapy; D016568:Drugs, Generic / Q000627:therapeutic use; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007362:Intensive Care Units; D008004:Licensure; D008297:Male; D009426:Netherlands; D004364:Pharmaceutical Preparations; D011446:Prospective Studies
chemical_list: D016568:Drugs, Generic; D004364:Pharmaceutical Preparations