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LETTER TO EDITOR
Year : 2018  |  Volume : 2  |  Issue : 3  |  Page : 123

Comment on the article “pharmacovigilance for pediatric outpatient prescriptions in Tripoli Children Hospital”


Ghent University Department of Biomedical Molecular Biology and VIB Inflammation Research Center, Ghent, Belgium

Date of Web Publication4-Oct-2018

Correspondence Address:
Dr. Amin Bredan
Boesdaalveldweg 34, 1652 Alsemberg
Belgium
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/LJMS.LJMS_39_18

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How to cite this article:
Bredan A. Comment on the article “pharmacovigilance for pediatric outpatient prescriptions in Tripoli Children Hospital”. Libyan J Med Sci 2018;2:123

How to cite this URL:
Bredan A. Comment on the article “pharmacovigilance for pediatric outpatient prescriptions in Tripoli Children Hospital”. Libyan J Med Sci [serial online] 2018 [cited 2018 Dec 13];2:123. Available from: http://www.ljmsonline.com/text.asp?2018/2/3/123/242734



I read with interest the article “Pharmacovigilance for pediatric outpatient prescriptions in Tripoli Children Hospital” published in volume 2, issue 2 (2018) of Libyan Journal of Medical Sciences.[1] The authors examined the errors in prescriptions retained by the hospital's pharmacy after dispensing the drugs.

The authors state “Our data show that antiepileptics, antibiotics, and analgesics and antipyretics are the most frequently prescribed drugs”.[1] ranks antiepileptics highest (~62% of prescriptions). The authors do not discuss this extremely high rate. In contrast, in a multinational European study conducted on children <18 years old and analyzing the prescription patterns by 64 drug categories,[2] systemic antibacterials and analgesics ranked first and fifth, respectively (270.7 and 63.9 prescriptions per 1000 person-years), whereas antiepileptics ranked 35th with a rate of only 3.5. The reported ~62% rate of antiepileptic prescription is counterintuitive. Most likely, the prescriptions analyzed do not represent the prescriptions written by the physicians, and there are two indications of that.

First, the authors state “during the study period, prescriptions were collected daily from the pharmacy main plastic box where all the prescriptions coming from hospital outpatients' clinic are kept.” Therefore, their collection rate averages a little over five prescriptions per day, which is unreasonable for the outpatient department of a major pediatric hospital working 24/7. Personal communications estimated the number of patients at 100–200 daily, and even above 200. This suggests that the examined prescriptions are an undefined small subset of the prescriptions issued during the collection period.

Second, Libyan government pharmacies (as in this case) have been unable for a long time to provide many or most of the prescribed drugs, so in general, the patients retain the prescriptions to seek the unavailable drugs from private pharmacies. Exceptions include narcotics prescriptions (and possibly some others), which remain at the pharmacy. Several studies have addressed the abuse potential of newer antiepileptics, some of which are now categorized as controlled substances in the United States,[3],[4] and the Libyan pharmacy might routinely retain prescriptions containing epileptics. However, implemented policies seem to differ from one institution to another, but regardless of the specific policy, selective retention of prescriptions is a direct source of sampling bias.

In addition to the above, the number of prescriptions for the less frequently prescribed drugs was too small for analysis of dose sufficiency and dose duration. In the evaluation of the doses as adequate, underdose, overdose, or omitted, estimates.[1] Show that the number of available prescriptions for half of the analyzed drugs or categories was only about 8–30 each. In contrast, >300 antiepileptic prescriptions were analyzed. For the less frequently prescribed drugs, the confidence intervals (which were not reported) for the percentage estimates of dose assessment are expected to be too wide for the prescription quality evaluation to be meaningful.

The topic of this research is of great importance, but there is a need for other studies using prescriptions at the prescription level to corroborate or refute the results reported in this study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Taher YA, Faraj SF, Samud AM, El Taher FE, Sherif FM. Pharmacovigilance for pediatric outpatient prescriptions in Tripoli Children Hospital. Libyan J Med Sci 2018;2:62-7.  Back to cited text no. 1
  [Full text]  
2.
Sturkenboom MC, Verhamme KM, Nicolosi A, Murray ML, Neubert A, Caudri D, et al. Drug use in children: Cohort study in three European countries. BMJ 2008;337:a2245.  Back to cited text no. 2
    
3.
Gidal B, Blum D. Abuse potential of antiepileptic drugs: A review using the vigibaseTM pharmacovigilance database (P1.233). Neurology 2015;84 (14 Suppl p 1.233).  Back to cited text no. 3
    
4.
Hawkins KL, Gidal BE. When adverse effects are seen as desirable: Abuse potential of the newer generation antiepileptic drugs. Epilepsy Behav 2017;77:62-72.  Back to cited text no. 4
    




 

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