Drug prescribing in out-patient children in Southern Italy

Objectives: The aim of this study was to investigate and evaluate the prescribing habits of family pediatricians in Southern Italy in order to determine which aspects need to be addressed for a more rational use of drugs in children. Methods: An observational prospective study was conducted for a 3-month period in 1998 in which family pediatricians were asked to record information regarding every patient-doctor contact on an index day of the week. The information was collected on a specifically designed data collection form and included the reason for the contact, the child's general characteristics, the drugs prescribed, and the purpose for which they were prescribed (therapeutic indication). The data were entered, prescribed drugs were classified according to the International Anatomic-Therapeutic-Chemical Classification system (ATC), and the therapeutic indications were coded using the International Classification of Diseases (ICD-9). Analyses were carried out using the EPI-Info software package and the SPSS statistical analysis program. Results: A total of 35 pediatricians participated and consulted with 9917 children, prescribing 8805 drugs to 6417 patients under 12 years old. Prescription rates were higher for younger children. In all, 288 different generic substances were prescribed, but the 20 most common made up two-thirds of the prescriptions and would have sufficed to cover almost 70% of all prescription purposes. Two-thirds of prescriptions concerned respiratory system drugs or anti-infectives. Acute pharyngotonsillitis, cough, and acute otitis media were the most common morbidities. Despite the free availability of drugs in the Italian health care system, the families paid for over half their cost mainly due to the incorrect manner in which they were prescribed. Conclusions: Although, according to current recommendations, most of the patients' needs could have been taken care of using few drugs, prescriptions involved a wide variety of compounds. Prescription practices did not follow guidelines and were widely "evidence unbased". Prescribing drugs is one of the most frequent interventions in general practice, yet more effort is needed to establish a rational use of drugs in children, as well as in adults.