title: Premedication Use Before Infliximab Administration: A Cross-sectional Analysis.
abstract: Premedications are commonly given to patients with inflammatory bowel disease before intravenous infliximab administration. We aimed to (1) describe practice variability; and (2) determine clinician rationale for premedicating patients with inflammatory bowel disease before infliximab administration.
  
  
  
  We developed a cross-sectional electronic survey after comprehensive literature review to assess practice variability and clinician rationale for premedication use before infliximab. An optional postsurvey quiz assessed clinicians' understanding of the available literature. The survey was distributed through members-only NASPGHAN and Crohn's and Colitis Foundation of America (CCFA) listservs and American Gastroenterological Association (AGA) and American College of Gastroenterology (ACG) web-based discussion boards.
  
  
  
  Three hundred seventy-nine unique respondents with a 93.3% survey completion rate comprised 331 (87%) and 45 (12%) pediatric and adult gastroenterologists. Among numerous options for premedications, acetaminophen (66%) and diphenhydramine (64%) were most often given before each infliximab infusion. Only 20% did not routinely use premedications. There was heterogeneity of premedication use between gastroenterologists within the same clinical practice. Of 328 (87%) respondents who completed the knowledge assessment quiz, only 18% identified the association of diphenhydramine use with increased reaction.
  
  
  
  There is high interpractice and intrapractice variability for premedication use before infliximab administration. Clinician rationale for premedicating patients seems to be driven by individual preference or group practice habit. Improved knowledge of the evidence may assist in decreasing overuse of premedications, particularly diphenhydramine.
authors.affiliation: *Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Columbia University Medical Center, New York, New York; †Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee; ‡Inflammatory Bowel Disease Center, Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; §Department of Pediatrics, Section of Gastroenterology, Hepatology and Nutrition, University of Manitoba, Winnipeg, Manitoba, Canada; ‖Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, UH Rainbow Babies and Children's Hospital, Cleveland, Ohio; ¶Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and **Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Stanford Children's Health, Palo Alto, California.
authors.forename: Joseph
authors.initials: J
authors.lastname: Picoraro
authors.forename: Gabriel
authors.initials: G
authors.lastname: Winberry
authors.forename: Corey A
authors.initials: CA
authors.lastname: Siegel
authors.forename: Wael
authors.initials: W
authors.lastname: El-Matary
authors.forename: Jonathan
authors.initials: J
authors.lastname: Moses
authors.forename: Andrew
authors.initials: A
authors.lastname: Grossman
authors.forename: K T
authors.initials: KT
authors.lastname: Park
mesh_terms: D061605:Administration, Intravenous; D000293:Adolescent; D000328:Adult; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D005762:Gastroenterology / Q000706:statistics & numerical data*; D005765:Gastrointestinal Agents / Q000008:administration & dosage*; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy*; D000069285:Infliximab / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011292:Premedication / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D005765:Gastrointestinal Agents; D000069285:Infliximab