RESUMEN
OBJECTIVE:To evaluate the effects of PDCA cycle management on standardizing rational use of ribavirin in children,and to investigate the effectiveness and safety of ribavirin in children. METHODS:By adopting 4 times of PDCA cycle, clinical pharmacists conducted continuous intervention to ribavirin use in pediatric department;authoritative guideline and evidence-based evidence were reviewed;List of Antiviral Therapy Plans in Qutpatient Department of Prediatrics was formulated in our hospital,which provided antiviral therapy plan of common pediatric infectious disease. By compared the rationality of ribavirin prescription in the pre and post PDCA cycle management(intervention group and non-intervention group)to evaluate the effects of standard management. RESULTS & CONCLUSIONS:After 4 times of PDCA cycle,the consumption amount of ribavirin both reduced significantly. The proportion of ribavirin prescriptions decreased from 3.10％ to 0.80％(P<0.01);the proportion of suitable medication indication prescriptions increased from 56.14％ to 90.30％(P<0.01);diagnosed disease types of commonly prescribed ribavirin prescriptions decreased from 26 to 5;the proportion of suitable administration route prescriptions increased from 73.43％ to 93.75％. The proportion of ribavirin combined with antibiotics prescriptions decreased from 59.74％ to 12.91％(P<0.01). PDCA is an effective and feasible method for pediatric medication management by clinical pharmascits. Ribavirin is not recommended as routine antiviral drug for children due to its unclear clinical benefit and distinct toxicity.
RESUMEN
Introducción. En ausencia de un análisis integral de la edad pediátrica, se propone una clasificación que analiza el uso o administración de drogas en tres etapas para la población mexicana: 1) intrauterina, 2) neonatal hasta escolar y 3) adolescencia. Métodos. La información se investigó en: Medline, Pub-Med, Embase, INBIOMED, LILACS, ARTEMISA. Resultados. En la etapa 1 se describen los efectos del consumo de drogas por la madre en el feto, como muerte fetal, síndrome de abstinencia, prematurez y trastornos del aprendizaje. En la etapa 2 se refieren los daños de la administración de medicamentos de venta libre por los padres, como opiáceos, dextrometorfano o psicoestimulantes. En la etapa 3 se destaca que el consumo de drogas se incrementa en adolescentes respecto a años previos, que se acentúa conforme se tiene más edad (en el año 2008 fue del 5.7%) y que predominan la mariguana, la cocaína, los inhalables y la heroína. Conclusiones. Se propone realizar una encuesta nacional en México que incluya las tres etapas, ampliando la investigación de la etapa 3, desde los 7 hasta los 21 años. Simultáneamente, se debe instaurar un programa de educación y de difusión nacional, inteligente y permanente, que permita impactar a la población como un todo.
Background. In the absence of a comprehensive analysis of the pediatric age population, a classification is proposed that analyzes the use or administration of drugs in three stages: (1) intrauterine; (2) newborn to school-age and (3) adolescence, with special emphasis on the Mexican population. Methods. Information was searched for in Medline, PubMed, EMBASE, INBIOMED, LILACS, and ARTEMISA. Results. Stage 1 describes the effects of maternal drugs on the fetus such as fetal death, withdrawal syndrome, prematurity, and learning disorders. Stage 2 reports the damage due to the administration by the parents of overthe-counter (OTC) medications such as opioids, dextromethorphan, or psychostimulants. Stage 3 emphasizes that drug use among adolescents has increased in recent years and is accentuated in older ages. In 2008 it was reported as 5.7%, with marijuana, cocaine, inhalants and heroin being dominant. Conclusions. We propose to conduct a national survey in Mexico that includes the three stages, extending the investigation of stage 3 by 7 years to 21 years. Simultaneously, a national outreach and educational program should be established, enabling an intelligent and permanent impact on the population as a whole.