Prescription practice of antihistamines for acute upper respiratory tract infections in pediatric patients in a local emergency department in Hong Kong

doi:10.5847/wjem.j.1920-8642.2017.01.009

Abstract

Abstract:

BACKGROUND: Currently there is very limited data in the literature assessing the prevalence of antihistamine prescription, and there is no local prevalence data about the prescription of antihistamine agents among primary practitioner and emergency physicians. The objectives are 1) to report the prevalence of antihistamine prescription for children less than 6 years old with acute upper respiratory infection and 2) to explore the associated factors for the prescription practice.

METHODS: This is a cross-sectional study. All consecutive cases of paediatric patients aged 6 or below who presented to the emergency department during a study period of one week from April 1 to July 4, 2009 with diagnosis of acute upper respiratory infection were included. Totally 162 patients were included.

RESULTS: Among the 162 cases, 141 (87%) patients were prescribed one antihistamine of any group. Sixty (37%) patients were prescribed two or more antihistamines. In multivariate logistic regression model, age was found to be significantly (P<0.001) associated with multiple antihistamine prescription (OR=1.042, 95%CI=1.02 to 1.06). Years of graduation of attending physician for more than 5 years was also a strong predictor of multiple antihistamine prescription (OR=4.654, 95%CI=2.20 to 9.84, P<0.001).

CONCLUSION: In the local emergency department, patients' age and the years of graduation from medical school of the attending physician were predictors of multiple antihistamine prescription for acute upper respiratory infections for children aged less than 6.

Key words: Upper respiratory infections, Respiratory tract infections, Common cold, Drug prescription, Drug utilization, Prescription practice, Antihistamine, Histamine antagonist, Children

Chun Tat Lui. Prescription practice of antihistamines for acute upper respiratory tract infections in pediatric patients in a local emergency department in Hong Kong[J]. World Journal of Emergency Medicine, 2017, 8(1): 47-54.

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Predictive factors	Case (antihistamine prescribed) (n=60)	Controls (antihistamine not prescribed) (n=102)	P value (two-tailed)
Chronic diseases, n (%)			0.293
Yes	5 (8.3)	4 (3.9)
No	55 (91.6)	98 (96.1)
Reattendance, n (%)			0.613
Yes	2 (3.3)	3 (2.9)
No	58 (96.7)	99 (97.1)
Age (mean±SD) (months)	42.7±17.6	29.1±18.7	<0.001
Attending physician years of graduation ≥5 years, n (%)			<0.001
Yes	44 (73.3)	40 (39.2)
No	16 (26.7)	62 (60.8)
Attending physician was a fellow, n (%)			0.121
Yes	14 (23.3)	15 (14.7)
No	46 (76.7)	87 (85.3)

Predictive variables	Percent of antihistamine prescription	Number of antihistamine prescription	Odds ratio	95%CI	P value
Age (mean±SD) [months]			1.042	1.02-1.06	<0.001
Cases: 42.7±17.6
Controls: 29.1±18.7
Gender					0.161
Male	30.4	24/79	0.56	0.27- 1.18
Female	43.4	36/83	1
Chronic disease					0.099
Yes	55.6	5/9	3.63	0.75-17.5
No	35.9	55/153	1
Reattendance					0.365
Yes	40	2/5	0.445	0.06-3.57
No	36.9	58/157	1
Attending physician years of graduation from medical school ≥5 years					<0.001
Yes	52.3	44/84	4.654	2.20-9.84
No	20.5	16/78	1
Attending physician was as fellow					0.711
Yes	48.3	14/29	0.848	0.31-2.33
No	34.6	46/133	1

Drug	Age group	Study	Conclusion
Brompheniramine + phenylephrine vs. placebo	Less than 6 years old	Hutton et al^[15]	No significant difference
Brompheniramine + phenylpropanolamine vs. placebo	Less than 6 years old	Clemens et al^[16]	No significant difference
Chlorpheniramine vs. clematine vs placebo	Less than 6 years old	Sakchainanont et al^[17]	No significant difference
Diphenhydramine vs. dextromethorphan vs. placebo	2 to 16.5 years old (median 4.5 years old)	Paul et al^[18]	No significant difference
Diphenhydramine vs. dextromethorphan vs. placebo	2 to 16.5 years old (median 7.5 years old)	Yoder et al^[19]	No significant difference

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