Prescribers' indications for drugs in childhood: a survey of five European countries (Spain, France, Bulgaria, Slovakia and Russia).
BACKGROUND
Indication-based, in comparison to diagnoses-based, drug utilization studies in children are scarce in the literature.


OBJECTIVE
To determine the adequacy of the prescriber's indications for specific drug treatments compared to the current literature in five different European countries; and to show the possibilities of performing indication-based drug utilization studies.


METHODS
a descriptive, cross-sectional, international study.


METHODS
Randomly selected sample of 12,264 paediatric outpatients seen in consultation rooms attended by paediatricians or general practitioners. Data on patient demographics, diagnoses, and pharmacological treatment, with therapeutic indications for each drug, were collected in pre-designed forms. Diagnoses and indications were coded using the ICD-9 and drugs according to the ATC classifications.


RESULTS
Indications were registered for every drug prescribed in all locations. Antibiotic indications considered incorrect (common cold, upper respiratory tract infections, viral infections, general symptoms or "not specified") accounted from 24.1% of the total antibiotics prescribed in Tenerife to 67.4% in Slovakia. Incorrect indication of first-choice antibiotics prescribed in acute otitis media and tonsillitis ranged from 28.9% of total antibiotics use in Russia to 75.4% in Tenerife. Correct antibiotic indications ranged from 23.4% of total antibiotics used in Slovakia to 65.7% in Tenerife. Aspirin use in febrile viral conditions was detected mainly in Toulouse and Russia.


CONCLUSIONS
The main areas for improvement detected were high use of mucolytics, prescription of aspirin in potential or established viral infections, overuse of antibiotics and identification of specific patterns of incorrect antibiotic prescription and clinical entities associated with each location.
Sanz
Emilio J
EJ
Department of Clinical Pharmacology, School of Medicine, University of La Laguna, La Laguna, Tenerife, Spain. esanz@ull.es
Hernández
Miguel A
MA
Ratchina
Svetla
S
Stratchounsky
Leonid
L
Peiré
Maria Asuncion
MA
Lapeyre Mestre
Maryse
M
Horen
Bernard
B
Kriska
Milan
M
Krajnakova
Halina
H
Momcheva
Hristina
H
Encheva
Daniela
D
Martínez-Mir
Inocencia
I
Palop
Vicente
V
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002031:Bulgaria; D002648:Child; D003430:Cross-Sectional Studies; D004363:Drug Utilization; D005100:Expectorants / Q000627:therapeutic use; D005602:France; D019538:Health Care Surveys; D006801:Humans; D010033:Otitis Media / Q000188:drug therapy; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012426:Russia; D018154:Slovakia; D013030:Spain; D014069:Tonsillitis / Q000188:drug therapy
D000900:Anti-Bacterial Agents; D005100:Expectorants