Evaluation of rational prescribing in paediatrics

Evidence-based medicine is recognised as being important. Clinical trials and subsequent systematic reviews of clinical trials are the key determinants of efficacy of an intervention. Medicines have made a major contribution to the health of children. Antibiotics are essential for the treatment of sepsis and are life-saving medicines. Similarly, antiasthmatic drugs and antiepileptic drugs can be both life-saving and also significantly enhance the quality of life, reducing morbidity from asthma and epilepsy, respectively. Inappropriate use of medicines, however, may result in problems such as increased resistance to antibiotics or side effects.1 The rational use of medicines has been recognised as important for the health and well-being of all by the WHO for a long time. Irrational prescribing remains a problem in paediatric patients of all ages. Studies of drug utilisation in neonates have highlighted inappropriate use of new broad spectrum antibiotics and polypharmacy as major problems in neonates.2 3 There have been more studies of irrational prescribing in children than in neonates. Overuse of antibiotics in children has been reported in both high-income4 and low-income countries.5 Other examples of inappropriate use of medicines are the widespread use of cough medicines in children6 and polypharmacy.7 Polypharmacy is associated with an increased risk of drug toxicity. A systematic review of the toxicity of levetiracetam found that polypharmacy was associated …