Polypharmacy in children hospitalized due to respiratory problems: data from a university hospital

Introduction: Polypharmacy is increasing among hospitalized children and is considered as a major risk factor for potential drug-drug interactions. Aims and Objectives: Our aim is to investigate prevalence and risk factors of polypharmacy among children hospitalized due to respiratory problems. Methods: We reviewed medical records of 163 children (median age 17 months) hospitalized in a university pediatric clinic of a tertiary hospital during the years 2017-2018. Results: Diagnoses included pneumonia (40 children), bronchiolitis (71 children), asthma (12 children), non-specific lower respiratory infections (23 children), laryngotracheobronchitis (10 children) and upper respiratory infections (7 children). Children were exposed to 3.8±1.4 distinct drugs each hospital day and to 5.1±1.96 drugs cumulatively during their hospitalization. The most frequently used drugs were nebulized salbutamol (85.2%), macrolides (78.5%), nebulized ipratropium (61.9%), penicillins (61.9%), antipyretics (49.6%). Cumulative drug exposure presented a positive correlation with length of hospital stay (p=0.003) and tended to be positively correlated with the presence of fever (p=0.08). Polypharmacy was defined as the 90th percentile of the cumulative number of distinct drugs during hospitalization (=7 drugs). Polypharmacy was observed in 34 children (20.8%) and was significantly associated with the length of hospital stay. Age, abnormal chest x-ray, leukocytosis or specific diagnoses were not significant predictors of polypharmacy. Conclusions: Drug exposure increases with long hospital stay and fever. The effect of other factors (e.g. physicians9 experience or skills) on polypharmacy needs investigation.