Pediatrician’s Cough And Cold Medication Prescription For Hypothetical Cases: A Cross-Sectional Multi-Centric Case Study

Abstract:

Cough and cold is the most common cause for hospital visits, and so is the use of cough and cold medication (CCM). A cough and cold medication has been considered to contain a single ingredient (SI) or multiple ingredients (MI) like promethazine (PRZ), chlorpheniramine (CPM), pseudoephedrine (PS), phenylephrine (PE), diphenhydramine (DPH), dextromethorphan (DXT), guanfeneisin and ambroxol. These ingredients have many deleterious side effects like respiratory depression, apnea, seizures, stroke and cerebral hemorrhage as well as cardiac adverse effects like hypertension dysrhythmias and even death.

Overuse and potential health hazards of CCM are well recognized. The Centers for Disease Control reported deaths associated with use of pseudoephedrine and dextromethorphan.

Furthermore, Wingert et al. linked the death of 13 infants and 2 toddlers with administration of OTC CCM. The adverse events are linked to erroneous overdosing and self-medication by parents/caregivers but the exact prescription burden in our country, by paediatricians is not known. Hence this study was done to evaluate and document the current burden of CCM use by paediatricians so that interventions can be formulated to reduce such preventable deaths.

Background

Concerns over inappropriate use of cough and cold medication (CCM) in children have been raised. In addition to being ineffective, these are now considered toxic for young children. Despite this fact studies from some regions have shown high use of these medications by physicians. However data on paediatricians and from India are negligible.

Aim

To study the burden and patterns of cough and cold medications use by paediatricians for hypothetical cases.

Methods

In this cross-sectional study; 172 paediatricians of various hospitals of Delhi and Haryana were enrolled from February 15 to March 15, 2012. They were contacted personally by authors and asked to write their prescriptions for two hypothetical case scenarios [having cough and cold] of two different age groups; (1) less than 2 years and (2) 2–5 years.

We made two categories as recommendations exist for children less than 2 years while recommendations for the second category are underway. Results were summarized as percentages, counts and; presented in tables and figures. Chi square test was used to establish association between categorical variables of subgroups.

Results

Response rate was 93%. The most used CCM was antihistaminic (82%) and systemic sympathomimetics (48%). The use of CCM was significantly less in teaching hospitals as compared to non-teaching ones. However there was no statistical difference in the practice of post graduates and more senior paediatricians (p value-0.895). No difference in CCM use in two age groups {(82% (less than 2 years) vs. 85% (2–5 years); p-value – 0.531} was observed.

Conclusion

Overall use of CCM is still high irrespective of patient age, paediatrician’s seniority or hospital setting. Efforts should be made to create awareness among the paediatricians regarding cautious use of these medications.

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