title: The impact of pediatric labeling changes on prescribing patterns of cough and cold medications.
abstract: OBJECTIVE
  To evaluate the impact of initiatives created by the pharmaceutical industry and the Food and Drug Administration to limit the use of over-the-counter (OTC) cough and cold medications (CCMs) in young children in emergency departments (EDs) and ambulatory clinics.
  
  
  METHODS
  Analysis of the National Hospital Ambulatory Medical Care Survey and National Ambulatory Medical Care Survey was performed comparing 2005-2006 and 2009-2010 in children aged ≤ 12 years with a reason for visit consistent with cough or cold-related symptoms. Data were stratified by age (<2 years, 2-6 years, and 6-12 years). Descriptive frequencies and survey-weighted χ(2) tests were used to assess OTC and prescription CCM prescription rates in ED and ambulatory clinic settings.
  
  
  RESULTS
  Comparing 2005-2006 and 2009-2010 revealed no changes in ED use of OTC CCMs; however, the use of prescription CCMs decreased, from 6.7% to 2.9% (P = .001). In ambulatory clinics, the overall rate of OTC CCM use increased from 6.3% to 11.1% (P = .001); however, use by children aged <2 years was unchanged. Prescription CCM use in EDs declined in all age groups, but in ambulatory clinics, decreases were significant only in patients aged <2 years.
  
  
  CONCLUSIONS
  Implementation of pharmaceutical industry and Food and Drug Administration initiatives did not decrease the use of OTC CCMs in children aged <2 years in EDs or ambulatory clinics. The use of prescription CCMs was decreased in both settings, however.
authors.affiliation: Department of Clinical Pharmacology, Children's National Medical Center, Washington, DC; Department of Emergency Medicine, MedStar Washington Hospital Center, Washington, DC. Electronic address: maryannmazer@gmail.com.
authors.forename: Maryann
authors.initials: M
authors.lastname: Mazer-Amirshahi
authors.affiliation: School of Medicine and Health Sciences, George Washington University, Washington, DC.
authors.forename: Irit
authors.initials: I
authors.lastname: Rasooly
authors.affiliation: Department of Emergency Medicine, George Washington University, Washington, DC.
authors.forename: Gill
authors.initials: G
authors.lastname: Brooks
authors.affiliation: School of Medicine and Health Sciences, George Washington University, Washington, DC; Department of Emergency Medicine, George Washington University, Washington, DC.
authors.forename: Jesse
authors.initials: J
authors.lastname: Pines
authors.affiliation: School of Medicine and Health Sciences, George Washington University, Washington, DC; Department of Emergency Medicine, George Washington University, Washington, DC.
authors.forename: Larissa
authors.initials: L
authors.lastname: May
authors.affiliation: Department of Clinical Pharmacology, Children's National Medical Center, Washington, DC; Department of Pediatrics, George Washington University, Washington, DC; Department of Pediatric Pharmacology, University Children's Hospital Basel, Basel, Switzerland.
authors.forename: John
authors.initials: J
authors.lastname: van den Anker
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003139:Common Cold / Q000188:drug therapy*; D003371:Cough / Q000188:drug therapy*; D004348:Drug Labeling; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007223:Infant; D008297:Male; D004366:Nonprescription Drugs / Q000008:administration & dosage*; D010044:Outpatient Clinics, Hospital / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014481:United States; D014486:United States Food and Drug Administration
chemical_list: D004366:Nonprescription Drugs