Affiliations: Department of Pediatrics, Shaheed Beheshti University
of Medical Sciences, Tehran, Islamic Republic of Iran
Note: [] Correspondence: Farideh Shiva, MD, Department of Pediatrics,
Taleghani Medical Center, Evin, Tehran, Islamic Republic of Iran. Tel.: +98 21
284 9571; E-mail: shivahfa@yahoo.com
Abstract: Optimal medical care requires that patients receive medications
appropriate to their clinical needs. To achieve this objective it is essential
that irrational patient management practices are identified, and attempts made
towards their correction. A study was done in Tehran to identify prescribing
practices in common acute infections in children. Data collected from reviewing
the prescriptions given to children in three different settings of ambulatory
care, and from interviewing their parents, was documented on a structured
questionnaire. Five hundred prescriptions were reviewed. Three hundred and
eight were for acute gastroenteritis and 192 for acute respiratory tract
infection. The average number of drugs/prescription was 3.33 ± 1.2;
general practitioners prescribed 3.47 ± 1.2 and pediatricians 3.2
± 1.1 drugs, (P=0.032). Antibiotics were written in 79.4%, and 42.8%
included injections. In respiratory infections, antihistamines were prescribed
in 73.4%. In gastroenteritis anti-emetics were written for 62% and 61.4% were
not given oral rehydration solution (ORS). General practitioners prescribed
more medications and less ORS than pediatricians. The difference was
statistically significant for injections, ORS and anti-emetic medications
(P<0.05). More drugs/prescription and more antibiotics were given in private
clinics as compared to public hospitals (P<0.05). We identified
inappropriate drug use in acute respiratory and gastrointestinal infections in
children receiving outpatient care in Tehran. Before planning successful
intervention strategies, it is crucial to develop insight in the socio-cultural
incentives that result in irrational prescriptions.