Prescription Drugs for Kids: What's Up, Down

Antibiotic Prescriptions Down; ADHD Drugs Up

By Kathleen Doheny
WebMD Health News

Reviewed by Laura J. Martin, MD

June 18, 2012 -- Children and teens got fewer prescriptions in 2010 than they did in 2010 -- but what they got changed.

Overall, the number of prescriptions dispensed for children and teens was down 7% during that time, according to the new study, published in Pediatrics.

When the researchers, from the U.S. Public Health Service, looked at individual drugs, however, they found some big increases.

Contraceptive prescriptions rose 93%. Prescriptions for ADHD drugs were up 46%.

Explaining the numbers is not part of the study. "This study was done to assess the wide variety of prescription drugs that are prescribed to U.S. children," says Sandy Walsh, an FDA spokeswoman. "The data we used do not allow us to understand the reasons behind these trends."

For that, WebMD turned to two independent experts.

Prescriptions for Children: A Closer Look

The researchers got the prescription information from two large commercial databases of drugs. All were dispensed from outpatient retail pharmacies.

The report doesn't include information on prescriptions given to children in the hospital. It doesn't include mail-order prescriptions.

The information is on drugs dispensed. There is no way to know if patients actually took them.

Among the prescriptions that declined in 2010 compared to 2002, and by how much:

  • Antibiotics, down 14%
  • Allergy medicines, down 61%
  • Pain medicine, down 14%
  • Depression medicines, down 5%
  • Cough and cold medicines without expectorants, down 42%

The researcher found increases in other drug prescriptions. Besides the 93% increase in contraceptive prescriptions, and the 46% in ADHD drugs, they found that asthma drug prescriptions rose 14%.

Prescriptions for Children, By Age

For infants and children, newborn to 11, the antibiotic amoxicillin (Amoxicot, Amoxil, others) was the top prescribed medication. That was found even though antibiotic prescriptions declined overall. It's used to treat bacterial infections such as those of the ears, nose, and throat.

For children and teens 12 to 17, methylphenidate (Ritalin, Methylin, Metadate, Concerta) was the most common prescription dispensed. It is used to treat ADHD.

The researchers found much off-label use of the drug Prevacid (lansoprazole) in infants under one year. The drug is approved to treat GERD (gastroesophageal reflux disease). Stomach contents leak backward, causing irritation.

Prescriptions for Children: Perspectives

The report has some good news and some concerning news, according to two experts not involved who reviewed the findings for WebMD.

The decline in antibiotic prescriptions is welcome news, says Allen Vaida, PharmD, executive vice president of the Institute for Safe Medication Practices.

"For the last decade, the pediatric professional societies and infection control groups have been pushing to say, 'Every time you have the sniffles or a cold, you don't need an antibiotic,'" he tells WebMD.

Antibiotics treat bacterial, not viral, infections.

It looks like that message is getting across, says Donna Halloran, MD, MSPH, assistant professor of pediatrics at St. Louis University.

As for the allergy medicine decline? "I think that's the movement to over-the-counter [medicines]," Vaida says. In the past several years, many allergy medicines previously available only by prescription have been approved for over-the-counter sales.

It might also reflect parents ordering allergy medicines, often needed on a constant basis, through mail-order pharmacies, he says.

Perspectives: Why Increases?

The finding that ADHD prescriptions are on the rise is more difficult to interpret, according to Halloran, who has also researched prescription drug trends in children. She is also a pediatrician at the Cardinal Glennon Children's Hospital, St. Louis.

It could be good news, she says, as "there are so many kids who respond so beautifully to the medicines," she says. The children can do better in school once on the medicine, she says.

It could also be disconcerting, she says, "because there is plenty of evidence out there that there are plenty of kids labeled as ADHD and it's not accurate."

Overall, she says, "my hope is that most of that 46% [increase] is due to better treatment."

The decline in cough and cold medicines is welcome, too, Halloran says. In children under 2 years, she says, "it's very clear that the risk outweighs the benefits.''

The FDA recommends against using cough and cold medicines in children younger than 2 years, due to potentially dangerous side effects.

The number of off-label Prevacid prescriptions in babies is concerning, Vaida says.

"If this drug is prescribed for your child under age one, I would question if there really is a need for it," he tells WebMD.


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SOURCES: Chai, G. Pediatrics, July 2012. Donna Halloran, assistant professor of pediatrics, St. Louis University and Cardinal Glennon Children's Hospital, St. Louis. Allen Vaida, PharmD, executive vice president, Institute for Safe Medication Practices, Horsham, Pa.

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