http://pubs.jamanetwork.com/ en-us Sun, 01 Jan 2012 00:00:00 GMT Tue, 01 Jan 2013 00:51:05 GMT Silverchair editor@pubs.jamanetwork.com webmaster@pubs.jamanetwork.com http://pubs.jamanetwork.com/article.aspx?articleID=1107667 Sun, 01 Jan 2012 00:00:00 GMT Morden NE, Goodman D. <span class="paragraphSection">The use of therapeutic agents represents a trade-off between the benefits of symptom relief or disease modification that increase quality or length of life and the risk of short- and long-term adverse effects. While evidence suggests that complex medication combinations greatly increase the odds of incurring an adverse drug event, US Food and Drug Administration approval generally only requires testing of agents in isolation. As a consequence, we often do not know the net health outcomes associated with diverse and intense medication combinations. This uncertainty is magnified in the care of children for whom efficacy and safety studies are often lacking. Despite this therapeutic uncertainty, pediatric drug use is growing. A study in this issue of the Archives provides a critical examination of the drug exposure of pediatric inpatients. Polypharmacy is the norm for hospitalized infants and children. Should we be concerned?</span> 166 1 91 92 10.1001/archpediatrics.2011.162 http://pubs.jamanetwork.com/article.aspx?articleID=1107667 http://pubs.jamanetwork.com/article.aspx?articleID=1107673 Sun, 01 Jan 2012 00:00:00 GMT Feudtner C, Dai D, Hexem KR, et al. <span class="paragraphSection"><div class="boxTitle">Objective</div>To assess the prevalence and patterns of exposure to drugs and therapeutic agents among hospitalized pediatric patients.<div class="boxTitle">Design</div>Retrospective cohort study.<div class="boxTitle">Setting</div>A total of 411 general hospitals and 52 children's hospitals throughout the United States.<div class="boxTitle">Patients</div>A total of 587 427 patients younger than 18 years, excluding healthy newborns, hospitalized in 2006, representing one-fifth of all pediatric admissions in the United States.<div class="boxTitle">Main Outcome Measures</div>Daily and cumulative exposure to drugs and therapeutic agents.<div class="boxTitle">Results</div>The most common exposures varied by patient age and by hospital type, with acetaminophen, albuterol, various antibiotics, fentanyl, heparin, ibuprofen, morphine, ondansetron, propofol, and ranitidine being among the most prevalent exposures. A considerable fraction of patients were exposed to numerous medications: in children's hospitals, on the first day of hospitalization, patients younger than 1 year at the 90th percentile of daily exposure to distinct medications received 11 drugs, and patients 1 year or older received 13 drugs; in general hospitals, 8 and 12 drugs, respectively. By hospital day 7, in children's hospitals, patients younger than 1 year at the 90th percentile of cumulative exposure to distinct distinct medications had received 29 drugs, and patients 1 year or older had received 35; in general hospitals, 22 and 28 drugs, respectively. Patients with less common conditions were more likely to be exposed to more drugs (P = .001).<div class="boxTitle">Conclusion</div>A large fraction of hospitalized pediatric patients are exposed to substantial polypharmacy, especially patients with rare conditions.</span> 166 1 9 6 10.1001/archpediatrics.2011.161 http://pubs.jamanetwork.com/article.aspx?articleID=1107673