Sorveglianza prospettica della produzione galenica di dosaggi pediatrici

Almost 80% of the drugs sold for adults are not licensed for use in children. Pharmacists and paediatricians are often faced with the difficulty of modifying pharmaceutical preparations created for adults patients in order to be able to use them in paediatric patients. In many cases, suitable information for using formulations not licensed in paediatrics lack. Therapeutic formularies often suggest dosages that don't take into consideration the formulations of pharmaceutical products available on the market. The reason for this lacking is partially linked to the specific uses for those formulations that make them less profitable from a commercial point of view. Where possible, and by request of the paediatric unit, the hospital pharmacy prepares these extemporaneous formulations. Many obstacles can limit the use of drugs known to be effective and necessary, such as the unavailability in the necessary paediatric dosages. At this purpose, a prospective, systematic study, of a period of 3 months, was carried out in the Ospedali Riuniti in Bergamo. Six paediatric units have took part: haematooncology, paediatric transplantation, neonatal pathology, paediatric ward, intensive care cardio-surgery, cardiology, and paediatric day hospital. 80 children were involved in the study and 6 of them were premature. The children received 97 galenic preparations, corresponding to a total of 2.821 extemporaneous preparations. The drugs most often used were: chlorhexedine, captopril and acetyl salicylic acid, prescribed for mouth disorder prophylaxis in patients in chemotherapy, antithrombotic prophylaxis, circulation problems. The preparations consisted of: 57% crushed tablets, 28% mouth washes, 8% syrups, 7% solutions. The total raw material cost was 237.502 lire and the preparation needed 3.728 minutes (62,1 hours). When comparing the estimated cost of certain extemporaneous preparations with the cost of corresponding drugs available on the market, the main factor resulting in the difference in cost is the constituent's value. The rationality behind the prescription, and not the cost of preparation should justify the request. During the surveillance period, situations were observed in which the request for galenic preparations was not always evidence- based.