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Pharmacoepidemiology of Common Colds and Upper Respiratory Tract

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Pharmacoepidemiology of Common Colds and Upper Respiratory Tract Eckel et al. BMC Pharmacology and Toxicology 2014, 15:44 http://www.biomedcentral.com/2050-6511/15/44 RESEARCH ARTICLE Open Access Pharmacoepidemiology of common colds and upper respiratory tract infections in children and adolescents in Germany Nathalie Eckel1, Giselle Sarganas2, Ingrid-Katharina Wolf2 and Hildtraud Knopf2* Abstract Background: Medicines to treat common colds (CC) and upper respiratory tract infections (URTI) are widely used among children, but there are only few data about treatments actually applied for these diseases. In the present study we analyze the prevalence and correlations of self-medicated and prescribed drug use for the treatment of CCs and URTIs among children and adolescents in Germany. Methods: Medicine use during the week preceding the interview was recorded among 17,450 children (0–17 years) who participated in the drug interview of the 2003–2006 German Health Interview and Examination Survey for Children and Adolescents (KiGGS). The definition of CCs and URTIs in the present study included the WHO-ICD-10 codes J00, J01.0, J01.9, J02.0, J02.9, J03.0, J03.9, J04.0, J06.8, J06.9, J11.1, J11.8, R05 and R07.0. Using the complex sample method, the prevalence and associated socio-demographic factors of self-medication, prescribed medicines and antibiotics were defined. Results: 13.8% of the participating girls and boys use drugs to treat a CC or an URTI. About 50% of this group use prescribed medications. Among the users of prescribed medication, 11.5% use antibiotics for the treatment of these diseases. Looking at all prescribed medicines we find associations with younger age, immigration background, and lower social status. Antibiotic use in particular is associated with female sex, higher age, residency in the former East Germany and immigration background. Conclusions: The use of medicines to treat CCs or URTIs is widespread among children and adolescents in Germany. Thus, longitudinal studies should investigate the risks associated with this drug use. Differences in socio-demographic variables regarding exposure to antibiotic use indicate that there could be an implausible prescribing behavior among physicians in Germany. Keywords: Common cold, Upper respiratory tract infection, Cough & cold medicines, Pharmacotherapy, Antibiotics, Children, KiGGS Background children aged 3 to 6 years - almost 94% [1]. According to Common colds (CCs) and other upper respiratory tract the literature, an average child undergoes a minimum of 4 infections (URTIs) are usually self-limiting conditions to8URTIsperyear[2-4].Duetomissingorlowimmunity with a high prevalence worldwide. Earlier analyses of the in the first years of life, children are particularly vulnerable German Health Interview and Examination Survey for to viral infections [5]. Children and Adolescents (KiGGS) indicate that the 1- Medicines against CCs and its symptoms are widely year-average-prevalence of CCs among children and adoles- marketed, e.g. cough medicines, nasal decongestants, cents amounts to 88.5%, with the highest prevalence among throat medicines, but also vitamins and herbal or homeopathic medicines. Data of the statutory health in- surance document that 9 of the 20 most often prescribed * Correspondence: [email protected] 2Robert Koch-Institute, Department of Epidemiology and Health Monitoring, drugs for children and adolescents belong to cough&- General-Pape-Str. 62-66 12101, Berlin, Germany cold medicines (CCMs) [6]. Additionally, many of these Full list of author information is available at the end of the article © 2014 Eckel et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Eckel et al. BMC Pharmacology and Toxicology 2014, 15:44 Page 2 of 7 http://www.biomedcentral.com/2050-6511/15/44 drugs are acquired over-the-counter (OTC) [7]. Analyz- between 0 and 17 years were drawn randomly from the ing children’s and adolescents’ use of medications to corresponding local population registries. In total, treat CCs and URTIs throws light on the prevalence and 17,641 participants were included in the survey which related factors of drug use and is an essential step for equated to a response rate of 66.6%. Nonresponse understanding issues concerning their safety. Data from analysis showed only little differences in socio-demographic health insurances and sales figures are not able to com- and health-related variables between responders and non- pletely provide this transparency as they do not neces- responders. The survey was approved by the Ethics sarily correspond to the actual medication usage. In the Committee of the Virchow Hospital, Humboldt University USA, serious adverse events and even some deaths are Berlin and federal data-protection officials. The children’s associated with the use of OTC CCMs [8,9]. About 7% parents/guardians and/or children aged 14 years or older of all pediatric prescriptions for the respiratory tract sys- were informed about all aspects of the survey and they tem are not officially licensed for use in children, which submitted a written consent [17]. means that they have never been tested rigorously for Standardized, age-specified self-administered question- pediatric safety and efficacy [10]. Earlier analyses of naires filled out by parents/guardians and children aged KiGGS suggest that about 30% of the medicines are used 11 years or older were used to collect socio-demographic off-label in terms of under-dosing, over-dosing, untested data, family background and health-related issues. The chil- indication, or age [11]. dren’s age was categorized in 5 age groups: 0–2, 3–6, 7–10, Antibiotics are usually not indicated for viral infec- 11–13, and 14–17 years. Children with immigration tions such as uncomplicated URTIs or CCs. Antibiotics background were defined as those who had no German na- do not lead to an improvement of CC and URTI symp- tionality themselves or whose parents had no German na- toms, but they yield potential side effects [12,13]. Never- tionality. In order to calculate the socio-economic status theless, their use is common: Data from the statutory according to Winkler, the parents’ education, professional health insurance show that an URTI is the main reason classification and household net income were inquired [16]. for an antibiotic prescription. The data also indicate that Medicine use was investigated in a standardized computer- antibiotic use is highest among children aged 0 to 4 years assisted face-to-face-interview by a physician. Information [14]. High and unnecessary antibiotic consumption is on medicine use was collected by asking the parents and not only a problem for the individual but for the whole the children themselves. The participants were asked to population, as this is one of the main reasons for anti- bring all of the original packages of medicines used in the biotic resistances [15]. last 7 days to the interview. Drug use was assessed by the However, national representative data regarding the following question: “Has your child taken any medicines in pharmacoepidemiology of CCs and URTIs in the child the last 7 days? Please also mention any ointments, linea- population of Germany are lacking. By analyzing data ments, contraceptive pills, vitamin and mineral supple- of the KiGGS survey we attempt to fill this knowledge ments, medicinal teas, herbal medicines and homeopathic gap. We describe prevalence rates, investigate socio- medicines.” For all of the used drugs further information demographic characteristics and analyze factors associ- was collected, such as the form of administration, frequency ated with the use of CC and URTI medicines. The of intake, origin (‘prescribed by a doctor,’ ‘prescribed by a analyses are differentiated into the use of overall non-medical practitioner,’ ‘bought over the counter,’ ‘ob- CCMs, prescribed CCMs, self-medicated CCMs, and tained from other sources’), duration of use, improvement antibiotic use. of the condition(s) treated, and degree of tolerability. In addition, up to two conditions for which the medication Methods was taken were registered. The reported medicines were KiGGS, a nationwide representative Health Interview classified according to the Anatomical Therapeutic Chem- and Examination Survey for children and adolescents, ical (ATC) codes and the conditions treated according to was conducted by the Robert Koch Institute between the WHO International Classification of Diseases-10 codes May 2003 and May 2006. The target population com- (WHO ICD-10 codes) [18]. To evaluate the medication prised all non-institutionalized residents of Germany be- used for CCs or URTIs we included the following condi- tween 0 and 17 years of age. Therefore, children and tions (WHO-ICD-10 codes in brackets): CC (J00), acute adolescents with a foreign nationality were also included. sinusitis (J01.0, J01.9), acute pharyngitis (J02.0, J02.9), acute A detailed description of the methods of KiGGS have tonsillitis (J03.0, J03.9), acute laryngitis (J04.0), acute re- been published elsewhere [16]. Briefly, two-stage sam- spiratory tract infections (J06.8, J06.9), influenza (J11.1, pling procedures were applied. In the first stage 167 mu- J11.8), cough (R05) and sore throat (R07.0). nicipalities were drawn. This sample was representative All statistical analyses were performed using SPSS statis- for municipality sizes and structures in Germany. In the tical software 18.0. The analyses were performed with a second stage, samples of children and adolescents aged weighting factor to adjust for deviations in demographic Eckel et al. BMC Pharmacology and Toxicology 2014, 15:44 Page 3 of 7 http://www.biomedcentral.com/2050-6511/15/44 characteristics (age, sex, residence in West or former East status.
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