Resumen de Extemporaneous compounding for children with coronary heart diseases in Jamaica
T. Harris Tieca, S. Adebayo Amusa, B. Deon, Olugbuyi O., Scott Charmaine
Background: Coronary heart disease (CHD) has an incidence of approximately 8 per 1,000 live births globally. Treatment of pediatric CHD is largely dependent on underlying cause and the child's age. Drug therapy is commonly employed for managing children with cardiac failure and other heart related conditions. Overall, few drugs are approved for use in pediatric patients, guided by evidence-based trials conducted in adult population. Studies in Europe, North America and Canada indicate that about 80% of prescriptions for managing pediatric heart conditions are used as unlicensed or as off-label products. Such studies in the Caribbean populations are lacking in the literature. This study was therefore designed to investigate the methods by which children with heart failure are being managed in Jamaica, West Indies. Method: A real-time prescription screening and retrospective survey of compounding record of medications compounded and dispensed for children age 0 to 12 years was done during a period of 12 months at the Bustamante Hospital for Children, Jamaica. A validate data sheet was used to collect demographic (child's age, gender), diagnostic and pharmacotherapeutics data on patients after securing informed consents from their parents. In addition, historical data were extracted from an onsite compounding logbook. Pharmacotherapeutics information include drug prescribed, dose size and dosing frequency, dosage form and its age-appropriateness of medication prescribed. For lack of age-appropriate medications, compounding or modification performed, volume compounded and dispensed extracted. Data were analyzed using SPSS Version 19 and MS Excel. Results: a total of 3,747 prescriptions were surveyed with 10,797 items prescribed. Of the items prescribed heart specific medicines represented 5.23% (565). The mean age of children was 62.55 months (SD = 31.02) with 53.33% of them being male patients. Among the top twenty drugs prescribed for children, only three (3) were for cardiovascular indication i.e. Captopril (1.33%), furosemide (3.49%) and spironolactone (3.35%). Approximately 76.11% of these prescriptions was either compounded or manipulated to provide child-appropriate dosage forms. Conclusion: Extemporaneous compounding is still being used to provide age-appropriate dosage forms for pediatric patients with heart disease in Jamaica. Therefore, there is ongoing need for validation of compounding practices with regard to the quality of the practice and the quality of the finished preparations
