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OBJECTIVE: Antibiotic drugs are frequently used for viral infections in children. It is probable that health beliefs and parental concern have great influence on the use of drugs in children. This study, performed in The Netherlands, investigates whether the use of antibiotics in children is associated with the use of medicines by parents. DESIGN: Observational cohort study, using a prescription database. METHODS: We selected 6,731 children from the prescription database IADB.nl, who did not receive antibiotics until their fifth birthday, and 1,479 children who received at least one antibiotic prescription in every year. The parents for each group of children were identified and we compared the use of antibiotics and other medicines between the two groups of parents. RESULTS: Parents of children who received antibiotics recurrently were found to use more antibiotics themselves than parents of children who did not receive antibiotics. Moreover, this group showed a higher percentage of chronic medication use: 11.3% versus 6.2% (mothers) and 13.1% versus 9.5% (fathers). Mothers more often used antacids, non-steroidal anti-inflammatory drugs (NSAIDs), analgesics, anxiolytics, hypnotics, antidepressants, asthma drugs and antihistamines. Fathers used more antacids, cardiovascular drugs, NSAIDs and asthma drugs. CONCLUSIONS: The parents of children who receive antibiotic drugs regularly use more medicines than the parents of children who use no antibiotic drugs. Parents' medicine use may influence that of children and is a factor physicians and pharmacists should take into account.

OBJECTIVE: Antibiotic drugs are frequently used for viral infections in children. It is probable that health beliefs and parental concern have great influence on the use of drugs in children. This study, performed in The Netherlands, investigates whether the use of antibiotics in children is associated with the use of medicines by parents. DESIGN: Observational cohort study, using a prescription database. METHODS: We selected 6,731 children from the prescription database IADB.nl, who did not receive antibiotics until their fifth birthday, and 1,479 children who received at least one antibiotic prescription in every year. The parents for each group of children were identified and we compared the use of antibiotics and other medicines between the two groups of parents. RESULTS: Parents of children who received antibiotics recurrently were found to use more antibiotics themselves than parents of children who did not receive antibiotics. Moreover, this group showed a higher percentage of chronic medication use: 11.3% versus 6.2% (mothers) and 13.1% versus 9.5% (fathers). Mothers more often used antacids, non-steroidal anti-inflammatory drugs (NSAIDs), analgesics, anxiolytics, hypnotics, antidepressants, asthma drugs and antihistamines. Fathers used more antacids, cardiovascular drugs, NSAIDs and asthma drugs. CONCLUSIONS: The parents of children who receive antibiotic drugs regularly use more medicines than the parents of children who use no antibiotic drugs. Parents' medicine use may influence that of children and is a factor physicians and pharmacists should take into account.

Objective: To describe the frequency, nature, determinants and clinical relevance of prescription modifications in a Dutch community pharmacy. Design: A descriptive, retrospective study of the documented prescription modifications during dispensing in 2007. Methods: The frequency and nature of prescription modifications and their patient, drug and prescriber related determinants were assessed. To examine the clinical value of pharmacists' interventions, each prescription modification was rated from A to D (A is clinically irrelevant, D is clinically relevant with possible fatal consequences for the patient). Results: In 2007, on average, one intervention was documented per workday. Almost 50% of all interventions concerned dose corrections. Prescriptions for incidental medications, children (0-20 year) and patients with less than four other medications, had a higher chance of modification. A higher chance of prescription modifications was found in anti-infective agents for systemic use, in treatments for the central nervous system and the sensory organs. Verification and attentiveness to the prescriptions of these risk groups can reduce (serious) clinical consequences. Of all prescription modifications 86% were clinically relevant (groups B, C and D) and every ten days at least one harmful clinical incident was prevented by prescription modifications. Conclusions: Modifications of prescriptions by pharmacists vary in nature from clinically irrelevant to potentially fatal. Analysis of documented interventions in one community pharmacy allows identification of patients who are at risk and need more attention from prescribing physicians. It also shows that pharmacists' interventions have a positive impact on patients' health.

Objective: To describe the frequency, nature, determinants and clinical relevance of prescription modifications in a Dutch community pharmacy. Design: A descriptive, retrospective study of the documented prescription modifications during dispensing in 2007. Methods: The frequency and nature of prescription modifications and their patient, drug and prescriber related determinants were assessed. To examine the clinical value of pharmacists' interventions, each prescription modification was rated from A to D (A is clinically irrelevant, D is clinically relevant with possible fatal consequences for the patient). Results: In 2007, on average, one intervention was documented per workday. Almost 50% of all interventions concerned dose corrections. Prescriptions for incidental medications, children (0-20 year) and patients with less than four other medications, had a higher chance of modification. A higher chance of prescription modifications was found in anti-infective agents for systemic use, in treatments for the central nervous system and the sensory organs. Verification and attentiveness to the prescriptions of these risk groups can reduce (serious) clinical consequences. Of all prescription modifications 86% were clinically relevant (groups B, C and D) and every ten days at least one harmful clinical incident was prevented by prescription modifications. Conclusions: Modifications of prescriptions by pharmacists vary in nature from clinically irrelevant to potentially fatal. Analysis of documented interventions in one community pharmacy allows identification of patients who are at risk and need more attention from prescribing physicians. It also shows that pharmacists' interventions have a positive impact on patients' health.

OBJECTIVE: Antibiotic drugs are frequently used for viral infections in children. It is probable that health beliefs and parental concern have great influence on the use of drugs in children. This study, performed in The Netherlands, investigates whether the use of antibiotics in children is associated with the use of medicines by parents. DESIGN: Observational cohort study, using a prescription database. METHODS: We selected 6,731 children from the prescription database IADB.nl, who did not receive antibiotics until their fifth birthday, and 1,479 children who received at least one antibiotic prescription in every year. The parents for each group of children were identified and we compared the use of antibiotics and other medicines between the two groups of parents. RESULTS: Parents of children who received antibiotics recurrently were found to use more antibiotics themselves than parents of children who did not receive antibiotics. Moreover, this group showed a higher percentage of chronic medication use: 11.3% versus 6.2% (mothers) and 13.1% versus 9.5% (fathers). Mothers more often used antacids, non-steroidal anti-inflammatory drugs (NSAIDs), analgesics, anxiolytics, hypnotics, antidepressants, asthma drugs and antihistamines. Fathers used more antacids, cardiovascular drugs, NSAIDs and asthma drugs. CONCLUSIONS: The parents of children who receive antibiotic drugs regularly use more medicines than the parents of children who use no antibiotic drugs. Parents' medicine use may influence that of children and is a factor physicians and pharmacists should take into account.

Recently, two importance articles about St. John's wort (Hypericum perforatum) appeared in the medical literature: a randomised clinical trial comparing St. John's wort with placebo and imipramine and a commentary about interactions between St. John's wort and registered medicines. These publications are discussed in the broader perspective of a benefit-risk assessment.

Recently, two importance articles about St. John's wort (Hypericum perforatum) appeared in the medical literature: a randomised clinical trial comparing St. John's wort with placebo and imipramine and a commentary about interactions between St. John's wort and registered medicines. These publications are discussed in the broader perspective of a benefit-risk assessment.

BACKGROUND: In chronic inpatients polypharmacy is common and sometimes the combinations of psychotropics are irrational from a theoretical point of view. AIMS Registration of polypharmacy and irrational combinations in clinical practice. METHODS: In this descriptive study of 127 longstay patients in a psychiatric hospital we registrated the frequency of polypharmacy, the number of irrational combinations of psycho tropics and the reasons to describe these combinations. We tried to find a relation with the type of housing (an indirect measure for the intensity of care) and to the DSM-IV diagnosis. RESULTS: We found the use of four or five psychotropics in 24% of the population, in these cases we found irrational combinations in 89%. This group mainly consisted of patients with (partial) therapy-resistant schizophrenia of the undifferentiated and disorganised subtype and with schizo-affective disorder. In the total group of users of four and five psychotropics we found relatively more premorbid personality disorders and mild mental retardation. The percentage of users of four and five psychotropics increased with the intensity of care. Irrational combinations were mainly the result of long-lasting treatment of complex symptomatology. Following literature, a list of possible treatments in case of therapy resistance and conduct disorders is given. The authors give recommendations for further research on addition with a second high-potency antipsychotic drug in the case of therapy resistance for clozapine, and for fostering the quality of prescribing low-potency antipsychotic drugs and benzodiazepines for addition in the case of conduct disorders. CONCLUSIONS: Polypharmacy and irrational combinations occur frequently in chronic inpatients and seem inevitable.

BACKGROUND: In chronic inpatients polypharmacy is common and sometimes the combinations of psychotropics are irrational from a theoretical point of view. AIMS Registration of polypharmacy and irrational combinations in clinical practice. METHODS: In this descriptive study of 127 longstay patients in a psychiatric hospital we registrated the frequency of polypharmacy, the number of irrational combinations of psycho tropics and the reasons to describe these combinations. We tried to find a relation with the type of housing (an indirect measure for the intensity of care) and to the DSM-IV diagnosis. RESULTS: We found the use of four or five psychotropics in 24% of the population, in these cases we found irrational combinations in 89%. This group mainly consisted of patients with (partial) therapy-resistant schizophrenia of the undifferentiated and disorganised subtype and with schizo-affective disorder. In the total group of users of four and five psychotropics we found relatively more premorbid personality disorders and mild mental retardation. The percentage of users of four and five psychotropics increased with the intensity of care. Irrational combinations were mainly the result of long-lasting treatment of complex symptomatology. Following literature, a list of possible treatments in case of therapy resistance and conduct disorders is given. The authors give recommendations for further research on addition with a second high-potency antipsychotic drug in the case of therapy resistance for clozapine, and for fostering the quality of prescribing low-potency antipsychotic drugs and benzodiazepines for addition in the case of conduct disorders. CONCLUSIONS: Polypharmacy and irrational combinations occur frequently in chronic inpatients and seem inevitable.

Objective: To describe the frequency, nature, determinants and clinical relevance of prescription modifications in a Dutch community pharmacy. Design: A descriptive, retrospective study of the documented prescription modifications during dispensing in 2007. Methods: The frequency and nature of prescription modifications and their patient, drug and prescriber related determinants were assessed. To examine the clinical value of pharmacists' interventions, each prescription modification was rated from A to D (A is clinically irrelevant, D is clinically relevant with possible fatal consequences for the patient). Results: In 2007, on average, one intervention was documented per workday. Almost 50% of all interventions concerned dose corrections. Prescriptions for incidental medications, children (0-20 year) and patients with less than four other medications, had a higher chance of modification. A higher chance of prescription modifications was found in anti-infective agents for systemic use, in treatments for the central nervous system and the sensory organs. Verification and attentiveness to the prescriptions of these risk groups can reduce (serious) clinical consequences. Of all prescription modifications 86% were clinically relevant (groups B, C and D) and every ten days at least one harmful clinical incident was prevented by prescription modifications. Conclusions: Modifications of prescriptions by pharmacists vary in nature from clinically irrelevant to potentially fatal. Analysis of documented interventions in one community pharmacy allows identification of patients who are at risk and need more attention from prescribing physicians. It also shows that pharmacists' interventions have a positive impact on patients' health.

Recently, two importance articles about St. John's wort (Hypericum perforatum) appeared in the medical literature: a randomised clinical trial comparing St. John's wort with placebo and imipramine and a commentary about interactions between St. John's wort and registered medicines. These publications are discussed in the broader perspective of a benefit-risk assessment.

The benzodiazepines take an important place in the treatment of anxiety and sleep-disorders. The pharmacokinetic, pharmacodynamic and therapeutic properties of these drugs are shortly dealt with, whereafter the development of tolerance and dependence is considered in more detail. The clinical manifestations and their causes are explained, as well as possible procedures to restrict their occurrence.

The benzodiazepines take an important place in the treatment of anxiety and sleep-disorders. The pharmacokinetic, pharmacodynamic and therapeutic properties of these drugs are shortly dealt with, whereafter the development of tolerance and dependence is considered in more detail. The clinical manifestations and their causes are explained, as well as possible procedures to restrict their occurrence.