Analysis of Off-label Use of Doxycycline in Pediatric Outpatient and Emergency Departments of a Hospital
Objective:To analyze the off-label use of doxycycline in pediatric outpatient and emergency departments of a hospital,and provide reference for the clinical safe use of doxycycline in children.Methods:68 660 prescriptions from pediatric outpatient and emergency departments of the First Affiliated Hospital of Sun Yat-sen University from November 2023 to June 2024 were selected as research data.The information on the prescriptions such as patient age,gender,clinical diagnosis,medication and laboratory test results was collected to analyze the characteristics and rationality of off-label use of doxycycline.Results:Among 68 660 prescriptions from pediatric outpatient and emergency departments,there were 605 prescriptions(0.88%)that contained doxycycline.Among 605 prescriptions containing doxycycline,the clinical diagnosis of involved children included upper respiratory tract infection(373 prescriptions,61.65%)and lower respiratory tract infection(232 prescriptions,38.35%).There were 287 prescriptions(47.44%)for off-label use,of which the main type was"use of drugs beyond the suitable groups"(189 prescriptions,65.85%),followed by"use of drugs beyond the indications"(99 prescriptions,34.49%).Among 287 prescriptions for off-label use,195 prescriptions contained drug combination,of which the most common was combined use with anti-cold drugs(145 prescriptions,50.52%),and there were 11 prescriptions for combined use with antiviral drugs and 12 prescriptions for combined use with other antibacterial drugs.Among the children involved in 605 prescriptions for doxycycline,533 cases were tested for Mycoplasma pneumoniae,with a positive detection rate of 86.12%,while the positive detection rates of children with off-label use and those who used drugs beyond the suitable groups were 75.21%and 93.82%respectively.There were 297 cases who received testing for Mycoplasma pneumoniae resistance genes,with a positive detection rate of 86.53%,while the positive detection rates of children with off-label use and those who used drugs beyond the suitable groups were 83.46%and 92.92%respectively.In addition,395 children(65.29%)had taken macrolides within 7 days before using doxycycline,while 157 children(83.07%)had taken macrolides within 7 days among those who used doxycycline beyond the suitable groups.The evidence-based analysis results showed that 266 prescriptions(92.68%)had evidence-based medicine support among 287 prescriptions for off-label use of doxycycline.Conclusion:There are many cases of off-label use of doxycycline in pediatric department,especially more cases with use of drugs beyond the suitable groups.Although only a few cases are not supported by evidence-based medicine,the relevant clinical training on off-label use should be strengthened to ensure the safe medication for children.
doxycyclineoff-label usepediatric departmentrational use of drugs
万方数据
维普
