Off-Label Drug Use in Children

Objective. To determine the extent and nature of off-label drug use in children admitted to a pediatric general ward in a tertiary health care centre Methods. Consecutive patients aged 1mo-12 years admitted to the general wards in a tertiary care center in Mumbai over a two-month period were prospectively enrolled in the study. British National Formulary [BNF] version 2005 was used to ascertain if the drug use was "off-label". The off-label use was categorized as: administration of a greater/lesser dose, administration at a higher/lower frequency than indicated, administration for indications not described, administration of a drug not licensed for use in that age group and/or use of alternative routes of administration. Descriptive statistics was used for calculating the off-label drug use. Results. Two thousand prescriptions received by 600 subjects (M: F= 1.47:1) were analyzed. One thousand and forty-five (50.62%) prescriptions were off-label. The off-label drug use rate was 1.74 +/- 1.56 per patient. The maximum rate of off-label drugs was in infants (2.33/patient). 'Alteration in dosage' was by far the commonest reason for off-label use; followed by 'age' and 'indication'. Furosemide (i. v.), diazepam (i.v), cefotaxime (i.v), ethambutol (tab) and prednisolone (tab) were the five commonest off-label drugs used in the study population. Conclusion. Off-label drug use was highly prevalent in general pediatric ward of a tertiary care hospital in India. [Indian J Pediatr 2008; 75 (11) : 1133-1136] Email: drsbavdekar@vsnl.com