Ricerca
Prescrizione di antiacidi, anti-H2 e IPP nei primi tre anni di vita nella Regione Piemonte
Prescription of antiacid, ant-H2 and PPI in the first three years of life in the Piedmont Region
Alberto Borraccino1, Aldo Ravaglia2
1Dipartimento di Scienze della Sanità Pubblica e Pediatriche, Università di Torino 2Pediatra di libera scelta, ASL TO4, Chivasso, Torino
Dicembre 2014 - pagg. 647 -651
Abstract
Background - Despite the dissemination of guidelines and recommendations the treatment
of gastroesophageal reflux (GER) in the paediatric population is continuously increasing.
In Italy the phenomenon is still poorly documented.
Objective - Aim of this paper is to describe the occurrence and the frequency distribution of the prescription of antiacids, anti-H2 and PPI in the 0 and 36 months infant population in the Piedmont Region.
Materials and methods - All ATC A02 prescriptions archived in the regional pharmaceutical data system assigned to a 0 to 3 years child in the period 2011-2013 were recovered. All prescriptions were grouped into three main pharmacological categories: antiacids, anti- H2 and PPI. Overall prescription, age and year specific rates were calculated.
Results - A total of 18,523 prescriptions of approximately 60 treatments per thousand children were retrieved. The prescription rates were respectively in the three age 75.8 vs 12.7 and 10.5 prescriptions per thousand children in 2011; 68.5, 11.5 and 9.0 in 2012 and 61.7, 10.9 and 9.3 in 2013. Children aged 0-1 years were exposed to treatment 6/7 times more than those aged 1 to 2 and 2 to 3 years of age. The majority of these children (70% vs 53% and 61% in the three age groups) had only one prescription in the course of the year. The antiacid and anti-H2 were the most prescribed drugs, the observed trend in the studied period is slightly lowering.
Conclusions - One child out of 14 new-borns is being treated for GERD in the Piedmont Region. This high rate of prescriptions in the first year of life reinforces the already known: GER in infants is physiological and resolves spontaneously, for this reason its treatment is incongruous. To deal with the observed phenomenon multiple initiatives are needed, starting from the legislative down to the clinical level. It is also of utmost importance to consolidate a robust interregional surveillance system.
Objective - Aim of this paper is to describe the occurrence and the frequency distribution of the prescription of antiacids, anti-H2 and PPI in the 0 and 36 months infant population in the Piedmont Region.
Materials and methods - All ATC A02 prescriptions archived in the regional pharmaceutical data system assigned to a 0 to 3 years child in the period 2011-2013 were recovered. All prescriptions were grouped into three main pharmacological categories: antiacids, anti- H2 and PPI. Overall prescription, age and year specific rates were calculated.
Results - A total of 18,523 prescriptions of approximately 60 treatments per thousand children were retrieved. The prescription rates were respectively in the three age 75.8 vs 12.7 and 10.5 prescriptions per thousand children in 2011; 68.5, 11.5 and 9.0 in 2012 and 61.7, 10.9 and 9.3 in 2013. Children aged 0-1 years were exposed to treatment 6/7 times more than those aged 1 to 2 and 2 to 3 years of age. The majority of these children (70% vs 53% and 61% in the three age groups) had only one prescription in the course of the year. The antiacid and anti-H2 were the most prescribed drugs, the observed trend in the studied period is slightly lowering.
Conclusions - One child out of 14 new-borns is being treated for GERD in the Piedmont Region. This high rate of prescriptions in the first year of life reinforces the already known: GER in infants is physiological and resolves spontaneously, for this reason its treatment is incongruous. To deal with the observed phenomenon multiple initiatives are needed, starting from the legislative down to the clinical level. It is also of utmost importance to consolidate a robust interregional surveillance system.
Parole chiave
Suggerite dall'AI
Classificazione MeSH
Contenuto riservato
Per leggere l'articolo completo è necessario effettuare il login.
Non sei ancora registrato? Registrati
Bibliografia
1. Hassall E. Uses and abuses of acid-suppression
therapy in children. J Pediatr Gastroenterol
Nutr 2011;53:S8-9.
2. van der Pol RJ, Smits MJ, van Wijk MP,
Omari TI, Tabbers MM, Benninga MA. Efficacy
of proton-pump inhibitors in children
with gastroesophageal reflux disease: a systematic
review. Pediatrics 2011;127(5):925-35.
3. Marchetti F. Indicazioni per l’utilizzo razionale
dei farmaci antiacidi (anti-H2 e IPP). Medico
e Bambino 2009;28(4):250-4.
4. Marchetti F, Gherarduzzi T, Barbi E, Martelossi
S, Ventura A. Gli inibitori della pompa
protonica. Medico e Bambino 2002;21(8):521-
6.
5. Murgia V. Efficacia degli inibitori di pompa
protonica nei bambini con reflusso gastroesofageo:
una revisione sistematica. Medico e
Bambino Pagine Elettroniche 2013;16(6).
http://www.medicoebambino.com/?id=AP13
06_10.html.
6. Marchetti F. L’eccesso di diagnosi e trattamento
per il presunto reflusso gastroesofageo.
Medico e Bambino 2012;31(2):99-101.
7. Valletta M, Fornaro M, Bissolo F. Gli inibitori
di pompa protonica in pediatria. Dialogo
sui farmaci 2009;6:270-3.
8. Ventura A. Il pediatra e il reflusso gastroesofageo.
Medico e Bambino 2009;28(4):211-2.
9. Ruigómez A, Wallander MA, Lundborg P,
Johansson S, Rodriguez LAG. Gastroesophageal
reflux disease in children and adolescents
in primary care. Scand J Gastroenterol
2010;45(2):139-46.
10. Forgacs I, Loganayagam A. Overprescribing
proton pump inhibitors. BMJ 2008;336
(7634):2-3.
11. Vandenplas Y, Rudolph CD, Di Lorenzo C,
et al. Pediatric gastroesophageal reflux clinical
practice guidelines: joint recommendations of
the North American Society for Pediatric Gastroenterology,
Hepatology, and Nutrition
(NASPGHAN) and the European Society for
Pediatric Gastroenterology, Hepatology, and
Nutrition (ESPGHAN). J Pediatr Gastroenterol
Nutr 2009;49(4):498-547.
12. Cavallo R (a cura di). Linee guida per la
diagnosi e la terapia del reflusso gastroesofageo.
Medico e Bambino 2012;31(2):89-98.
13. Orenstein SR, Hassall E. Infants and proton
pump inhibitors: tribulations, no trials. J
Pediatr Gastroenterol Nutr 2007;45(4):395-8.
14. Guillet R, Stoll BJ, Cotten CM, et al. Association
of H2-blocker therapy and higher incidence
of necrotizing enterocolitis in very low
birth weight infants. Pediatrics 2006;117(2):
e137-e142.
15. Saiman L, Ludington E, Pfaller M, et al. Risk
factors for candidemia in neonatal intensive
care unit patients. Pediatr Infect Dis J 2000;
19(4):319-24.
16. Osservatorio ARNO Bambini. I profili assistenziali
delle popolazioni in età pediatrica.
Bologna: Centauro Srl - Edizioni Scientifiche,
2011.
17. Dent J, El-Serag H, Wallander MA, Johansson
S. Epidemiology of gastro-oesophageal reflux
disease: a systematic review. Gut 2005;54
(5):710-7.
Corrispondenza: alberto.borraccino@unito.it