Ricerca
Il profilo prescrittivo della popolazione pediatrica italiana nelle cure primarie: il rapporto ARNO 2003
DRUG UTILIZATION PROFILE IN A LARGE OUT-HOSPITAL ITALIAN CHILDREN POPULATION
ANTONIO CLAVENNA1, MAURIZIO BONATI1, ELISA ROSSI2, ALESSANDRA BERTI2, MARISA DE ROSA2 E GRUPPO DI LAVORO ARNO-PEDIATRIA 2003*
1Laboratorio per la Salute Materno-Infantile, IRFMN, Milano
2CINECA, Consorzio Interuniversitario, Bologna
Maggio 2005 - pagg. 305 -311
Abstract
Objective: to evaluate the pattern of drug prescription reimbursed by the national health system
in the Italian paediatric population. Prescriptions involving 982.035 children <14 years
old, dispensed during 2003 by the retail pharmacies of 24 Italian local health units participating
in the ARNO project, were analysed. A total of 620.239 children (63%) received at
least a drug prescription. The prescription prevalence rate is highest in children 1 year old and
decreases with increasing age and it is higher in male. The antimicrobial for systemic use
(main anatomical group J in the ATC classification) and respiratory drugs are the more prescribed
drugs. Antibiotics and anti-asthmatics represent 80% of prescriptions. Amoxicillin +
clavulanic acid is the most prescribed drug (22% of children; 9% of boxes) and the drug
with the highest expenditure (5.1 million € ; 11% of the total expenditure). Despite some limitations
(only prescriptions for reimbursed drug were evaluated; the disease for which drug
are prescribed is lacking), the ARNO database, is a precious tool for evaluating the profiles
of major drug utilizations and expenditures and therapeutical needs. The analysis of data confirms
precedent findings: much drugs are prescribed, belonging to few therapeutic classes,
and without evidence based indication.
Classificazione MeSH
Bibliografia
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17. Abi Khaled L, Ahmad F, Brogan T, et al. Prescription medicine use by one million Canadian children. Paediatrics & Child Health 2003;8 (Suppl. A).
18. Marchetti F, Romero M. La prescrizione dei farmaci nella pratica pediatrica extraospedaliera. Prospettive in Pediatria 1993;92:313- 23.
19. Clavenna A, Rossi E, Berti A, Pedrazzi G, De Rosa M, Bonati M. Inappropriate use of anti- asthmatic drugs in the Italian paediatric population. Eur J Clin Pharmacol 2003;59: 565-9.
20. Chang AB, Phelan PD, Carlin JB, Sawyer ASM, Robertson CF. A randomised, placebo controlled trail of inhaled salbutamol and beclomethasone for recurrent cough. Arch Dis Child 1998;79:6-11.
21. Bonati M, Clavenna A, Rocchi F. Corticosteroidi in età pediatrica. Marketing e prescrizione. Informazione sui Farmaci 2001;2-3:79- 82.
22. Clavenna A, Rossi E, Berti A, Pedrazzi G, De Rosa M, Bonati M. Uso di farmaci antiasmatici nei bambini italiani. Quaderni acp 2002; 6:10-3.
23. Forum di Pediatria On Line. http:// www.pediatria.it.
24. AAVV. Guida all’uso dei farmaci per i bambini. Istituto Poligrafico e Zecca dello Stato, Roma 2003.
2. WHO/DAP. Operational research projects in DAP: an inventory. WHO/DAP, 1995.
3. The US. Pharmacopeia Drug Utilization Review Advisory Panel. Drug utilization review: mechanisms to improve its effectiveness and broaden its scope. J Am Pharm Assoc (Wash). 2000;40:538-45.
4. Choonara I, Nunn AJ, Kearns G (ed). Introduction to paediatric and perinatal drug therapy. Nottingham Univerity Press, Nottingham 2003.
5. Clavenna A, Pandolfini C, Bonati M. Public disclosure of clinical trials in children. Curr Ther Clin Exp 2002;63:707-16.
6. Caldwell PHY, Murphy SB, Butow PN, Craig JC. Clinical trials in children. Lancet 2004;364:803-11.
7. Pandolfini C, Bonati M. Off-label drug use in children in Europe. A major health issue. Pharm Dev Regul 2003;1:133-43.
8. Borgnolo G, Simon G, Francescutti C et al. Antibiotic prescription in Italian children: a population- based study in Friuli-Venezia Giulia, North-East Italy. Acta Pediatr 2001;90:1316-20.
9. Resi D, Milandri M, Moro ML, et al. Antibiotic prescriptions in children. Antimicrob Chemother 2003;52:282-6.
10. Campi R, Pandolfini C, Colombo F, et al. Tanto inchiostro per scrivere pochi principi. Occhio Clinico Pediatria 2000;7:12-14.
11. Rossi E, De Rosa M, Bonati M, et al. La prescrizione farmaceutica pediatrica nell’ambito delle cure primarie Rapporto dalla banca dati ARNO. Giornale Ital Farmacol Clinica 2001;15:26-9.
12. Cazzato T, Pandolfini C, Campi R, Bonati M, The ACP Puglia-Basilicata Working Group. Drug prescribing in out-patient children in Southern Italy. Eur J Clin Pharmacol 2001;57: 611-6.
13. Thrane N, Sørensen HT. A one-year population- based study of drug prescriptions for Danish children. Acta Paediatr 1999;88:1131-6.
14. McIntyre J, Conroy S, Avery A, Corns H, Choonara I. Unlicensed and off label prescribing of drugs in general practice. Arch Dis Child 2000;83:498-501.
15. Schirm E, van den Berg P, Gebben H, Sauer P, de Jong-van den Berg L. Drug use of children in the community assessed through pharmacy dispensing data. Br J Clin Pharmacol 2000;50:473-8.
16. Madsen H, Anderson M, Halls J. Drug prescribing among Danish children: a populationbased study. Eur J Clin Pharmacol 2001;57: 159-165.
17. Abi Khaled L, Ahmad F, Brogan T, et al. Prescription medicine use by one million Canadian children. Paediatrics & Child Health 2003;8 (Suppl. A).
18. Marchetti F, Romero M. La prescrizione dei farmaci nella pratica pediatrica extraospedaliera. Prospettive in Pediatria 1993;92:313- 23.
19. Clavenna A, Rossi E, Berti A, Pedrazzi G, De Rosa M, Bonati M. Inappropriate use of anti- asthmatic drugs in the Italian paediatric population. Eur J Clin Pharmacol 2003;59: 565-9.
20. Chang AB, Phelan PD, Carlin JB, Sawyer ASM, Robertson CF. A randomised, placebo controlled trail of inhaled salbutamol and beclomethasone for recurrent cough. Arch Dis Child 1998;79:6-11.
21. Bonati M, Clavenna A, Rocchi F. Corticosteroidi in età pediatrica. Marketing e prescrizione. Informazione sui Farmaci 2001;2-3:79- 82.
22. Clavenna A, Rossi E, Berti A, Pedrazzi G, De Rosa M, Bonati M. Uso di farmaci antiasmatici nei bambini italiani. Quaderni acp 2002; 6:10-3.
23. Forum di Pediatria On Line. http:// www.pediatria.it.
24. AAVV. Guida all’uso dei farmaci per i bambini. Istituto Poligrafico e Zecca dello Stato, Roma 2003.
Corrispondenza: mother_child@marionegri.it