Adverse drug reactions and off-label and unlicensed medicines in children: a nested case-control study of inpatients in a pediatric hospital.
BACKGROUND
Off-label and unlicensed (OLUL) prescribing has been prevalent in pediatric practice. Using data from a prospective cohort study of adverse drug reactions (ADRs) among pediatric inpatients, we aimed to test the hypothesis that OLUL status is a risk factor for ADRs.


METHODS
A nested case?control study was conducted within a prospective cohort study. Details of all medicines administered were recorded, including information about OLUL status. The odds ratio for OLUL medicines being implicated in a probable or definite ADR was calculated. A multivariate Cox proportional hazards regression model was fitted to the data to assess the influence that OLUL medicine use had on the hazard of an ADR occurring.


RESULTS
A total of 10,699 medicine courses were administered to 1,388 patients. The odds ratio (OR) of an OLUL medicine being implicated in an ADR compared with an authorized medicine was 2.25 (95% confidence interval (CI) 1.95 to 2.59). Medicines licensed in children but given to a child below the minimum age or weight had the greatest odds of being implicated in an ADR (19% of courses in this category were implicated, OR 3.54 (95% CI 2.82 to 4.44). Each additional OLUL medicine given significantly increased the hazard of an ADR (hazard ratio (HR) 1.3 95% CI 1.2 to 1.3, P <0.001). Each additional authorized medicine given also significantly increased the hazard (HR 1.2 95% CI 1.2 to 1.3, P <0.001).


CONCLUSIONS
OLUL medicines are more likely to be implicated in an ADR than authorized medicines. The number of medicines administered is a risk factor for ADRs highlighting the need to use the lowest number of medicines, at the lowest dose for the shortest period, with continual vigilance by prescribers, in order to reduce the risk of ADRs.
Research and Development, Alder Hey Children?s NHS Foundation Trust, Eaton Road, Liverpool L12 2AP, UK. jennifer.bellis@alderhey.nhs.uk.
Jennifer R
JR
Bellis
Jamie J
JJ
Kirkham
Signe
S
Thiesen
Elizabeth J
EJ
Conroy
Louise E
LE
Bracken
Helena L
HL
Mannix
Kim A
KA
Bird
Jennifer C
JC
Duncan
Matthew
M
Peak
Mark A
MA
Turner
Rosalind L
RL
Smyth
Anthony J
AJ
Nunn
Munir
M
Pirmohamed
D000293:Adolescent; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology* / Q000209:etiology; D004739:England / Q000453:epidemiology; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007297:Inpatients / Q000706:statistics & numerical data; D008297:Male; D056687:Off-Label Use / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D012307:Risk Factors