The use of prescription drugs among pediatric outpatients declined significantly between 2002 and 2010, by an average of 2.4 million prescriptions per year, according to a report published online June 18 in Pediatrics.
This trend was driven in part by a sharp decrease in the use of antibiotics, which account for approximately one-fourth of all prescriptions dispensed to the pediatric population, said Grace Chai, Pharm.D., of the office of surveillance and epidemiology at the center for drug evaluation and research, Food and Drug Administration, and her associates.
Notably, this trend is the opposite of that reported among adult outpatients during the same interval, which showed a dramatic increase of 86 million prescriptions per year, the investigators said.
Until now, few data have been available regarding nationwide drug utilization among children. Studies to date have relied on parental reports rather than more objective data and have been restricted to commercially insured patients; particular age groups; or certain types of medications, such as those for chronic conditions only.
Dr. Chai and her colleagues used two large prescription claims databases from retail pharmacies to examine national trends in drug use among patients aged 0-17 years whose medications were paid for by cash, Medicaid, or commercial insurance. Their study covered information on two-thirds of the approximately 59,000 retail pharmacies nationwide, which accounted for approximately half of all retail prescriptions dispensed in 2002-2010.
The data were deidentified, and patients were categorized into three age groups: infants (aged 0-23 months), children (aged 2-11 years), and adolescents (aged 12-17 years). Neonatal patients could not be distinguished from older babies using the available data.
This study did not include data on over-the-counter medications, herbal preparations, supplements, or mail order prescriptions, they noted (Pediatrics 2012;130:23-31 [doi:10.1542/peds.2011-2879]).
Among the study findings:
• Approximately 263 million prescriptions were dispensed to children in 2010, which is 7% fewer than the number dispensed in 2002. (In contrast, it has been reported that 3.3 billion prescriptions were dispensed to adults in 2010, a 22% increase over the number dispensed in 2002.)
• The use of systemic antibiotics, which accounted for 24%-27% of all pediatric prescriptions during the study period, steeply declined. This suggests that efforts to reduce the inappropriate use of antibiotics may be working, the researchers said.
• Allergy medications were the category of drugs that showed the single largest decline. However, several antihistamines, including loratadine and cetirizine, converted from prescription to OTC status during the study period. So even though the number of prescriptions for allergy medications may have decreased, pediatric use of the drugs may not have decreased.
• The use of prescription cough and cold products without expectorants also decreased significantly, an indication that recent critiques of the safety and efficacy of these agents in children may have been effective.
• The number of contraceptive prescriptions rose 93% during the study period, and prescriptions for norgestimate–ethinyl estradiol ranked among the top 10 prescriptions for adolescents in 2010. However, Centers for Disease Control and Prevention reports during the same interval have noted only a slight increase in the percentage of young women taking OCs. It may be that the large increase noted in this study reflects in part the use of OCs for indications other than contraception, such as for treating acne or for regulating menses, or an increase in the duration of use.
Dr. Chai and her associates also paid particular attention to two classes of prescription medicines that have come under scrutiny recently in the pediatric population: attention-deficit/hyperactivity disorder (ADHD) medications and proton pump inhibitors.
The use of ADHD agents increased markedly overall during the study period. Two drugs, methylphenidate and amphetamine/dextroamphetamine, accounted for the largest portion of ADHD agents prescribed, but their use remained relatively stable throughout the study interval. Instead, the increase in use occurred with newer agents such as lisdexamfetamine, dexmethylphenidate, and guanfacine. The use of atomoxetine initially increased after it was approved in 2002 but declined in 2005, after a boxed warning was added to the label regarding the risk of suicide in children and adolescents taking the drug.
Regarding proton pump inhibitors, 358,000 prescriptions for lansoprazole were dispensed to infants in 2010, even though the label states that the drug is not effective for gastroesophageal reflux in patients aged 1-12 months. Off-label lansoprazole use in the pediatric population is of interest as its safety is explored, the researchers said.
This study was sponsored by the FDA and included commercial proprietary drug utilization data obtained by the FDA under contract. Dr. Chai and her associates said they had no relevant financial disclosures.