Hidden dangers and high costs: Children's medication must not "run a yellow light"

Medication errors are very dangerous for children, and their incidence is about three times that of adults. According to a statistical data from the World Health Organization, tens of millions of children under the age of 5 die each year worldwide, of which 2/3 die from improper medication. my country has a large population base, and pediatric diseases account for 20% of all visits. It is also a hard-hit area for hidden dangers in safe medication. The incidence of adverse drug reactions in children is about 12.9%, and that in newborns is as high as 24.4%. The proportion of irrational medication is 12-32%. As early as 20 years ago, the famous "American Medical Journal" concluded that "up to 19% of medication errors are preventable." With the continuous development of hospital pharmacy and the increasing awareness of people's safety, this data continues to improve, indicating that scientific intervention in children's medication can effectively prevent the occurrence of danger.

Teng Hailong, director of the pharmacy department and chief pharmacist of Mudanjiang Cardiovascular Hospital in Heilongjiang Province, told reporters that children are in the growth and development period, and the development of various organs in the body is not yet mature. The reaction to drugs is different from that of adults, and the rationality of their medication and the method of taking medication are also different. Therefore, the status and importance of pharmacists in children's medication are becoming increasingly prominent. Teng Hailong introduced that there are many varieties of drugs on the market. Many drug advertisements and instructions exaggerate the therapeutic effects, and the side effects are not written clearly, which often leads to irrational medication, and even adverse reactions after medication are common. How to correctly guide children to use medication, avoid pitfalls, let children bear the minimum risk of medication, and obtain the greatest therapeutic effect, in order to achieve the requirements of safe, effective, economical and appropriate rational medication. Director Teng Hailong believes that this topic deserves lasting attention.

In response to the common clinical issues of rational medication for children, Chief Pharmacist Teng Hailong summarized the following points for attention and urged parents to pay attention to them:

First, use antibiotics with caution

Reducing the number of times antibiotics are used is very helpful in improving children's immunity. Teng Hailong pointed out that as the most common cause of infection, it is often crucial to distinguish between bacterial or viral infections. Severe bacterial infections must be treated with antibiotics as prescribed by the doctor, otherwise the bacterial infection may worsen and develop into serious consequences such as sepsis and meningitis. It should be noted that it is rare for bacteria and viruses to be infected at the same time, and the vast majority of children do not need to use "antibiotics + antivirals" at the same time. If antibiotic treatment is indeed necessary, it must be ensured that the time is sufficient, at least 5-7 days (such as azithromycin has a special half-life and can be used for 3-5 days, but because this type of drug is cardiotoxic, especially children with underlying heart diseases should avoid using it), to completely kill the bacteria and avoid the emergence of drug-resistant bacteria.

Director Teng warned that the more advanced and expensive the antibiotics are, the better they are. If you suspect a bacterial infection, you can cooperate with the doctor to conduct blood, urine or bacterial sensitivity tests to clarify the cause of the disease. For different bacterial infections, choose relatively strong antibiotics. Similarly, no matter how similar the child's symptoms are, do not reuse previously used antibiotics without the doctor's advice. The risk of prescribing medicine to children on your own is: destroying good bacteria, even bacteria that are useful to the immune system, and letting those drug-resistant bacteria take advantage of the opportunity to cause chaos and invade. Especially in pediatrics, antibiotics are not recommended for preventing infections because doing so does not achieve any therapeutic effect.

Second, antiviral drugs should not be abused

Teng Hailong pointed out that there is no specific antiviral drug for the common cold, so there is no need to use antiviral drugs to treat the common cold. Excessive use of antiviral drugs can significantly increase the probability of related adverse reactions. Some compound cold preparations contain adamantane, which only has an inhibitory effect on influenza A virus, but has no "influence" on rhinovirus and coronavirus that cause the common cold. Many parents do not understand the ingredients of compound cold medicines, and often give their children more than two compound cold preparations at the same time, which will lead to repeated use and overdose of ingredients such as pseudoephedrine, antitussive drugs (such as dextromethorphan, etc.), antihistamines (such as chlorpheniramine, cetirizine, ketotifen, etc.), which will not only fail to shorten the course of the disease, but will easily increase adverse drug reactions, which is an important hidden danger to children's drug safety. Director Teng said that for the treatment of colds with many symptoms, it is best to choose drugs containing a single ingredient, which is beneficial for reducing drug side effects.

Third, it is necessary to choose the antipyretic medicine correctly

Teng Hailong warned that first of all, whether to use antipyretics requires the judgment of professional doctors, and blindly taking medicine on your own is not conducive to the control of the disease. Acetaminophen (paracetamol) is the most commonly used antipyretic for children, generally administered orally or rectally; ibuprofen preparations (such as Anrique), like acetaminophen, have few side effects and are the first-line medication for children's fever. Two points need to be pointed out. Only one of the two can be selected. Alternating between the two drugs mentioned above, there is currently no clinical data on the effectiveness and safety of combined medication, and pharmacists do not recommend it. In addition, most cold medicines contain antipyretic ingredients. If there is no guidance from a doctor or pharmacist, the "cold medicine + antipyretic" plan should not be used at will to avoid the serious consequences of drug-induced liver injury.

Fourth, look at "enema treatment" rationally

Enema treatment is very popular in some areas. Parents believe that enema is less painful and safer for children than intravenous infusion. Doctors say that enema is simple to operate, convenient, practical and effective. Pharmaceutical research has confirmed that if the suppository is inserted about 2 cm from the anus, 50-75% of the total amount of drugs administered can avoid the "first-pass effect" of the drug. Director Teng explained that the first-pass effect, also known as the "first-pass effect" or "first-pass effect", refers to the effect that after certain drugs are inactivated and metabolized by the intestinal mucosa and liver after oral administration, the amount of drugs entering the systemic circulation is reduced and the efficacy is reduced. Some drugs have almost no metabolic effects, while others are widely metabolized and eliminated in the gastrointestinal wall or liver, resulting in a first-pass effect. The phenomenon that drug effects differ due to different routes of administration is of great significance in therapeutics. For example, rectal administration, injection, subcutaneous or sublingual administration can avoid the first-pass effect.

According to relevant literature reports, the depth of anal tube insertion during enema for young children often ranges from 3-4 cm to 15-25 cm. Director Teng believes that the main purpose of rectal drug administration is to avoid the first-pass effect of the liver. This enema method cannot reduce the damage to the nerves, blood, heart, liver, kidneys, etc. that may be caused by the drug due to the too deep drug administration position. Although it avoids drug stimulation to the stomach and small intestine, it may cause potential damage to the rectum and colon. There are safety risks and should be chosen with caution.

Fifth, take the medicine for diarrhea correctly

Pharmacist Teng emphasized that whether to use medication or not does not depend on the stool characteristics and bowel movement frequency of the child, but on the need to determine the cause of diarrhea. If it is caused by bacterial infection, antibacterial drugs should be used first; if adsorption drugs (montmorillonite) and microecological preparations (quadruple live bacteria, etc.) need to be used together, it is recommended to take montmorillonite powder first to adsorb bacteria, viruses and toxins in the gastrointestinal tract, and after thoroughly "cleaning" the intestines, use microecological preparations to correct the disorder of the flora and restore normal intestinal flora. The interval between the two medications is at least 2 hours. If the above three types of drugs are used together, antibacterial drugs should be used first, then montmorillonite powder, and finally microecological preparations. The order and interval of medication determine the clinical effect, and it must not be arbitrary.

Sixth, pay attention to the mutual interference between milk and some drugs

Teng Hailong said that most antibacterial drugs should not be taken with milk. For example, most quinolones (not recommended for children) are not easily absorbed, and the antibacterial effect is seriously "discounted", resulting in reduced efficacy or even complete ineffectiveness (but amoxicillin, cefadroxil, amoxicillin-clavulanate potassium, cefaclor, clarithromycin, roxithromycin, and minocycline can be taken with milk). At the same time, the protein in milk easily forms clots with commonly used calcium and zinc preparations such as calcium lactate, calcium gluconate, and zinc gluconate, which not only destroys absorption, but also weakens the peak blood drug concentration and increases the burden on the gastrointestinal tract. Not only that, the phosphorus in milk can easily cause iron to precipitate, which is not conducive to iron absorption and interferes with efficacy.

Finally, Chief Pharmacist Teng Hailong reminded parents that drug treatment for pediatric diseases is an extremely professional discipline, because appropriate dosage information and medication guidelines are always on the road to gradual improvement. Parents must follow the guidance of doctors and pharmacists and must not blindly take medicines to avoid delaying treatment opportunities and causing adverse consequences. In addition, it is necessary to choose the most suitable drug dosage form and it is not advisable to take adult drugs casually. On the one hand, the drug dosage is difficult to convert, and on the other hand, it is easy to cause adverse reactions.

Brief introduction of Chief Pharmacist Teng Hailong

Graduated from the Department of Clinical Pharmacy of China Medical University, he is currently the director of the Pharmacy Department, chief pharmacist, and practicing pharmacist of Mudanjiang Cardiovascular Hospital (the only Class III Class A cardiovascular hospital in Heilongjiang Province). He was formerly a pharmacy reviewer of the medical quality management of the former Heilongjiang Provincial Health Department, a pharmacy reviewer of the Mudanjiang Medical Quality Expert Group, a visiting professor of Heilongjiang Commercial Vocational College, Heilongjiang Forestry Vocational College, and Mudanjiang University. He has published one national 13th Five-Year Plan textbook and one pharmaceutical monograph, and won one second prize for new medical technology in Heilongjiang Province. He has published 6 national and provincial papers and is an expert in antimicrobial therapy and pharmaceutical management in Mudanjiang.