A literature review to identify interventions to improve the use of medicines in children.
BACKGROUND
It is estimated that 200 million prescriptions for children and adolescents were issued in the UK during 2002. Therefore, it is important for the National Service Framework for Children (NSFC) to include advice on managing medicines effectively for children. This literature review was performed at the request of the NSFC Medicines External Working Group in order to provide underpinning evidence in the development of advice on managing medicines.


METHODS
Detabases, websites and conference abstracts were searched systematically to identify information on managing medicines in children in 2003. This article reported the results on medication review, concordance, enhanced medicines access through community pharmacy services and the use of medicines in schools.


CONCLUSIONS
Although there is little evidence specific to paediatrics, the objectives and rationale of medication review could be expected to apply to chronic diseases in children. Issues such as polypharmacy, wastage, repeat prescriptions and medication problems could be similar. The benefits seen in adults may also occur in children, and medication review may possibly have a role in the management of medicines in children. There is an obvious role for pharmacists in ensuring the safety of over-the-counter medications and provision of information and education to parents, carers and adolescents. Evaluation and provision of necessary education and training to community pharmacists is needed, even in the most basic paediatric issues such as sugar-free medications. The evidence suggests that treatment compliance and adherence are generally lower in children than in adults, particularly in adolescents as they approach independence. Those with learning disabilities and infants are likely to be at risk of non-compliance, although little work has been done in these populations. Children and adolescents need appropriate parental and professional support in taking control of their medication and treatment. The management of medicines in school would appear to be far from ideal. Further research into school-based medicines education and outreach clinics would also be beneficial.
Costello
I
I
Centre for Paediatric Pharmacy Research, School of Pharmacy, University of London & the Institute of Child Health, University College London, London, UK.
Wong
I C K
IC
Nunn
A J
AJ
D000293:Adolescent; D002648:Child; D002908:Chronic Disease; D004358:Drug Therapy; D004512:Education, Pharmacy; D019317:Evidence-Based Medicine / Q000379:methods; D006801:Humans; D010372:Pediatrics; D019338:Polypharmacy; D010818:Practice Patterns, Physicians'; D006113:United Kingdom