Drug Utilization and Potentially Inappropriate Prescriptions Assessment Among Discharged Pediatric Patients in a Tertiary Care Hospital.

Abstract

Background and Aims: Drug utilization and appropriateness assessment among pediatrics is crucial and relies on relevant evidence generation. The study aimed to analyze drug utilization and prevalence of potentially inappropriate prescriptions (PIP) and determine the risk factors for PIP among discharged pediatric patients in a tertiary care hospital. Methods: The cross-sectional study included discharged pediatric (aged < 18 years) prescriptions received between March and May 2023. Drug utilization was assessed using World Health Organization (WHO) Prescribing Indicators. Appropriateness was evaluated using the prescription intervention categories (implicit tool) and 67-item Key Potentially Inappropriate Drugs in Pediatrics List (KIDs List; explicit tool). Categorical and continuous data were analyzed descriptively. Risk factors of PIP were determined by logistic regression analysis. Results: Overall, 1952 prescriptions (mean age 4.61 ± 4.72 years) containing 3304 drugs and 149 drug types were analyzed. The average number of drugs per prescription was 1.69. The use of generic names and drugs from the Malaysian National Essential Medicines List were 2061 (62.38%) and 2985 (90.35%), respectively. The number of antibiotics and injectables per prescription were 1338 (68.55%) and 1(0.05%), respectively. The prevalence of PIP was 8.15% (n = 159). Sixty-one (3.13%) prescriptions were intervened for inappropriate regimen, mainly involving inappropriate dose (n = 47, 2.41%), and inappropriate frequency (n = 15, 0.77%). Ten drugs (14.93%) from KIDs List were prescribed in 80 prescriptions (4.09%), primarily involving tramadol (n = 40, 2.05%). Number of drugs prescribed (adjusted odds ratio (aOR) = 1.63, 95% CI (1.40, 1.89), P < .001), and ages 28 days to 23 months (aOR = 0.15, 95% CI (0.05, 0.49), P = .001), and 2 to 11 years (aOR = 0.22, 95% CI (0.07, 0.71), P = .011) were identified as PIP risk factors. Conclusion: The study found inconsistencies with WHO recommendations for essential drugs, antibiotics, and generic names. Although PIP prevalence was low, the number of drugs prescribed and age categories were key risk factors, emphasizing the need for structured drug reconciliation and a country-specific safe prescribing tool to minimize PIP in pediatric patients.