The influence over a period of 8 years of patterns of prescribing palivizumab for patients with and without congenitally malformed hearts, and in admissions to paediatric intensive care.
OBJECTIVE
To describe the pattern of prescribing for palivizumab in the Glasgow area over the period 1999 through 2007, and to compare recent prescribing to the current recommendations by the Joint Committee on Vaccination and Immunisation of the United Kingdom Department of Health. Our secondary objective was to describe admissions to paediatric intensive care in patients with respiratory syncytial virus receiving palivizumab.


METHODS
Tertiary children's hospital out-patient immunisation clinic and paediatric intensive care unit.


METHODS
Prospective analysis of prescribing and admissions data for the period 1999 through 2007.


METHODS
Number of prescriptions and admissions to the paediatric intensive care unit.


RESULTS
The number of children receiving palivizumab annually initially rose more than 5-fold, from 17 in the season of 1999 and 2000 versus 115 in 2004 and 2005, although it has declined in the past 2 years, to 63 in 2006 and 2007, following publication of the recommendations of the Joint Committee on Vaccination and Immunisation established by the United Kingdom Department of Health. There has been no significant change in demographics of patients during this period. Prior to publication of these recommendations, 35 of 44 (80%) patients with congenitally malformed hearts who received palivizumab in the season of 2005 and 2006 deviated from the current recommendations, compared to 5 of 51 (10%) who received palivizumab for non-cardiac indications. No patients who received palivizumab required admission to the paediatric intensive care unit with proven respiratory syncytial virus infection over the 8 year period.


CONCLUSIONS
The number of children receiving palivizumab initially increased significantly, although it has now fallen following implementation of national recommendations. Much prescribing, particularly for children with congenitally malformed hearts, did not fulfil current recommendations. The absence of admissions to paediatric intensive care reflects the success of targeted immunisation in our population.
Turner
Alastair
A
Department of Paediatric Intensive Care, Royal Hospital for Sick Children, Yorkhill, Glasgow, Scotland, UK. alastairturner@nhs.net
Begg
Colin
C
Smith
Benjamin
B
Coutts
Jonathan
J
D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D000998:Antiviral Agents / Q000627:therapeutic use; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000150:complications*; D006801:Humans; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D000069455:Palivizumab; D010343:Patient Admission / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D018357:Respiratory Syncytial Virus Infections / Q000150:complications / Q000517:prevention & control*; D012136:Respiratory Syncytial Viruses; D012606:Scotland; D013997:Time Factors
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000998:Antiviral Agents; D000069455:Palivizumab