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Do we prescribe medicines rationally?
  1. Michael Rieder
  1. Correspondence to Dr Michael Rieder, Department of Paediatrics, Children's Hospital, 800 Commissioner's Road East, London, Ontario, Canada N6C 2V5; mrieder{at}uwo.ca

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Drug therapy is one of the cornerstones of care for many common and important child health problems worldwide, as safe and effective pharmacotherapy has been one of the key strategies in improving child health over the past century alongside vaccination, public sanitation and child protection. They are also commonly used—for most children, as monotherapy for acute problems but for children with chronic disease ongoing and frequently complex pharmacotherapy is the rule.1 Prescription drugs are also costly—in 2014 the NHS spent £14 billion on prescription drugs, 40% being in-hospital.2 As well, adverse drug reactions are one of the top four causes of death.1 Consequently, it would be prudent to consider that, when we prescribe medications for children, it is done rationally. An important question in child healthcare and in public policy for children is––Is this true?

Dr Bénard-Laribière et al3 describe drug use among a sample of 133 800 children selected from a reimbursement claims database representing 90% of the French population. This is the first study to systematically look at drug use in children in France. Over a 1 year period, 84% of French children had a prescription for at least one drug; drug use was age-dependent, with 97% of children under the age of 2 years having at least one prescription and with the rate of drug use declining significantly with age. The median number of drugs prescribed per child over this year was 5. …

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