title: Off-label prescribing in pediatric outpatients.
abstract: OBJECTIVE
  To study the characteristics of off-label prescribing and adverse drug reaction (ADR) occurrence in a sample of pediatric outpatients treated by general practitioners.
  
  
  METHODS
  A survey on pediatric drug prescribing was implemented in 46 general practices in southwestern France. All consecutive patients aged 0 to 16 years were included. Patient characteristics, reasons for consultation, and drug prescribed (including indications) were collected. ADRs occurring ≤10 days after the date of consultation were recorded by the general practitioners (spontaneous notification). Off-label prescription was defined as prescribing outside the specifications of the Summary of Product Characteristics.
  
  
  RESULTS
  Among the 2313 children seen between March 8, 2011 and July 31, 2011, 1960 were exposed to ≥1 prescribed drug. Mean age was 5.6 years, with a gender ratio of 1.1. Among children with prescriptions, 37.6% (n = 736) were exposed to ≥1 off-label prescription and 6.7% (n = 132) to ≥1 unlicensed drug. Off-label prescribing involved an unapproved indication in 56.4% of cases (n = 416), a lower dosage (26.5%, n = 195) or higher dosage (19.5%, n = 144) than specified, age not labeled (7.2%, n = 53), incorrect route of administration (3.5%, n = 26), and contraindication (0.3%, n = 2). A total of 23 ADRs were reported (1.5% of patients with off-label prescriptions). ADR occurrence was not significantly related to off-label drug prescribing.
  
  
  CONCLUSIONS
  Despite the numerous initiatives implemented for promoting rational medicine use in children, the prevalence of off-label prescription in outpatient pediatric practice remains high.
authors.affiliation: Laboratoire de Pharmacologie Médicale et Clinique, Centre Midi-Pyrénées de PharmacoVigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament, Equipe de Pharmacoépidémiologie, INSERM U1027, Centre Hospitalier Universitaire, Faculté de Médecine, Université de Toulouse, France; and.
authors.forename: Aurore
authors.initials: A
authors.lastname: Palmaro
authors.affiliation: Département Universitaire de Médecine Générale des Facultés de Médecine de Toulouse, France.
authors.forename: Raphael
authors.initials: R
authors.lastname: Bissuel
authors.affiliation: Laboratoire de Pharmacologie Médicale et Clinique, Centre Midi-Pyrénées de PharmacoVigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament, Equipe de Pharmacoépidémiologie, INSERM U1027, Centre Hospitalier Universitaire, Faculté de Médecine, Université de Toulouse, France; and.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Renaud
authors.affiliation: Laboratoire de Pharmacologie Médicale et Clinique, Centre Midi-Pyrénées de PharmacoVigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament, Equipe de Pharmacoépidémiologie, INSERM U1027, Centre Hospitalier Universitaire, Faculté de Médecine, Université de Toulouse, France; and.
authors.forename: Geneviève
authors.initials: G
authors.lastname: Durrieu
authors.affiliation: Département Universitaire de Médecine Générale des Facultés de Médecine de Toulouse, France.
authors.forename: Brigitte
authors.initials: B
authors.lastname: Escourrou
authors.affiliation: Département Universitaire de Médecine Générale des Facultés de Médecine de Toulouse, France.
authors.forename: Stephane
authors.initials: S
authors.lastname: Oustric
authors.affiliation: Laboratoire de Pharmacologie Médicale et Clinique, Centre Midi-Pyrénées de PharmacoVigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament, Equipe de Pharmacoépidémiologie, INSERM U1027, Centre Hospitalier Universitaire, Faculté de Médecine, Université de Toulouse, France; and.
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Montastruc
authors.affiliation: Laboratoire de Pharmacologie Médicale et Clinique, Centre Midi-Pyrénées de PharmacoVigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament, Equipe de Pharmacoépidémiologie, INSERM U1027, Centre Hospitalier Universitaire, Faculté de Médecine, Université de Toulouse, France; and maryse.lapeyre-mestre@univ-tlse3.fr.
authors.forename: Maryse
authors.initials: M
authors.lastname: Lapeyre-Mestre
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology*; D005260:Female; D058006:General Practice; D006801:Humans; D007223:Infant; D008297:Male; D056687:Off-Label Use / Q000706:statistics & numerical data*; D010045:Outpatients; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies
keywords: France; child; drug prescriptions; drug-related side effects and adverse reactions; outpatients; prospective studies