In 2010, 263.6 million prescriptions were dispensed for children in the US, a drop of 7% compared to 2002, while prescriptions dispensed to US adult patients totalled 3.3 billion for 2010, an increase of 22% over the same period, according to government researchers.

Prescriptions dispensed for US infants, children and adolescents aged 0-17 dropped by an average of 2.4 million each year during 2002-10, and particularly sharp declines were reported for antibiotics, pain relievers and allergy treatments. However, prescriptions for asthma rose 14% during the period, while those for attention-deficit hyperactivity disorder (ADHD) increased 46%, and prescriptions for contraceptives soared 93%, according to the researchers from the Food and Drug Administration (FDA), who report their findings on-line this week in the journal Pediatrics. 

By 2010, prescriptions for systemic antibiotics dispensed for patients aged 0-17 had fallen 14% compared with 2002, although antibiotics remained the most frequently-prescribed medicines for these patients, accounting for 24%-27% of the total, authors Grace Chai and colleagues report. They also find that, during 2002-2010, antibiotic prescriptions for US adult patients were increasing by some 86 million each year. 

A sharp drop of 61% was seen in the dispensing of allergy medicines to children during 2002-10, but the authors point out that a number of antihistamines were switched from prescription to over-the-counter (OTC) status during the period, including Claritin (loratadine) products in 2002 and Zyrtec (cetirizine) products in 2007. Also, paediatric prescriptions for pain relievers slumped 14% and those for depression declined 5%. A 42% drop was also reported for cough/cold medications without expectorant - in January 2008 the FDA had issued a Public Health Advisory which recommended that these should not be used in patients aged up to two years.

In 2010, amixicillin was the most frequently dispensed prescription in infants (aged 0-23 months) and children (2-11 years) in the US, while methylphenidate was the top prescription dispensed for adolescents (12-17 years). The researchers also found off-label drug use, particularly for Takeda’s Prevacid (lansoprazole), for which 358,000 prescriptions were dispensed in 2010 for infants aged up to one year, even though the product's labelling states that it is not effective in such patients with symptomatic gastroesophageal reflux.

“Lansoprazole use in patients in whom the drug has been labeled as not effective is of interest as the safety of paediatric proton pump inhibitor (PPI) use continues to be explored,” comment Dr Chai and colleagues.

"Drug utilisation data suggesting off-label use of products in children highlight areas for further research," add the authors, who used two large prescription databases - IMS Vector One National and Total Patient Tracker - for their study. 

'It is important to continue to monitor patterns of drug utilisation in the paediatric population as part of the risk/benefit evaluation of therapies for children," they conclude.