Unlicensed and off-label medication use in a general pediatrics ambulatoryhospital unit in Israel

Background: Many medications used for children have not undergone evaluatio n to assure acceptable standards for optimal dose, safety and efficacy. As a result, the majority of children admitted to hospital wards receive medic ations outside the terms of their license (off-label) or medications that a re not specifically licensed for use in children (unlicensed). The extent o f unlicensed and off-label medication use in ambulatory children is unknown . Objective: To determine the extent of unlicensed and off-label medication u se in a general pediatrics ambulatory hospital unit in Israel. Patients and Methods: We conducted a retrospective analysis of the medical records of 132 outpatient children treated in the General Pediatrics Ambula tory Unit of the Soroka Medical Center, Beer Sheva, in November-December 19 98. Results: The children's ages ranged from 1 month to 18 years (mean +/- SD 5 0 +/- 58 months). Of the 222 prescriptions given to these children, one-thi rd were unlicensed (8%) or unlabeled (26%). Different dose and age were the most common categories of off-label medication use. All 18 cases of unlice nsed use were due to modification of licensed drugs (tablets were crushed t o prepare suspensions). Altogether, 42% of children received medicines that were off-label and/or unlicensed. Conclusions: More off-label than unlicensed medications were used. Further investigations are required to establish the extent of unproved drug use in both hospitalized and ambulatory pediatric patients in Israel. Recommendat ions recently issued by the Ministry of Health's National Council for Child Health and Pediatrics constitute a first step in the Israeli contribution to the international effort demanding testing of medications for children.