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Schmiedl, Sven; Fischer, Rainald; Ibáñez, Luisa; Fortuny, Joan; Klungel, Olaf H.; Reynolds, Robert; Gerlach, Roman; Tauscher, Martin; Thürmann, Petra; Hasford, Joerg; Rottenkolber, Marietta (2014): Utilisation and Off-Label Prescriptions of Respiratory Drugs in Children.
In: PLOS ONE 9(9), e105110
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Abstract

Respiratory drugs are widely used in children to treat labeled and non-labeled indications but only some data are available quantifying comprehensively off-label usage. Thus, we aim to analyse drug utilisation and off-label prescribing of respiratory drugs focusing on age- and indication-related off-label use. Patients aged <= 18 years documented in the Bavarian Association of Statutory Health Insurance Physicians database (approx. 2 million children) between 2004 and 2008 were included in our study. Annual period prevalence rates (PPRs) per 10,000 children and the proportion of age- and indication-related off-label prescriptions were calculated and stratified by age and gender. Within the study period, highest PPRs were found for the fixed combination of clenbuterol/ambroxol (between 374-575 per 10,000 children) and the inhaled short acting beta-2-agonist salbutamol (between 378-527 per 10,000 children). Highest relative PPR increase was found for oral salbutamol (approx. 39-fold) whereas the most distinct decrease was found for oral long-acting beta-2-agonist clenbuterol (-97%). Compound classes most frequently involved in off-label prescribing were inhaled bronchodilative compounds (91, 402;37.3%) and oral beta-2-agonists 26, (850;22.5%). The highest absolute number of off-label prescriptions were found for inhaled salbutamol (n=67, 084;42.0%) and oral clenbuterol/ambroxol (fixed combination, n=18, 897;20.7%). Off-label prescribing due to indication was of much greater relevance than age-related off-label use. Most frequently, bronchodilative compounds were used off-label to treat respiratory tract infections. Highest off-label prescription rates were found in the youngest patients without relevant gender-related differences. Off-label prescribing of respiratory drugs is common especially in young children. Bronchodilative drugs were most frequently used off-label for treating acute bronchitis or upper respiratory tract infections underlining the essential need for a more rational prescribing in this area.