Expert Consensus on a List of Inappropriate Prescribing after Prescription Review in Pediatric Units in Abidjan, Côte d’Ivoire

Figures & data

Figure 1 Diagram of development of qualitative list of IP from prescription review.

Table 1 Qualitative list of IP corresponding to drug-related problems

		n (%)
Inappropriate prescriptions	Noncompliance with recommendations or contraindication	22 (41)	46 (85)
	Drug–drug interactions	11 (20)
	Inappropriate administration	5 (9)
	Medication not indicated	4 (7)
	Underdosing	2 (4)
	Overdosing	2 (4)
Omission of prescriptions	Untreated indication	8 (15)
Total		54 (100)

Figure 2 Chronological sequence of the Delphi surveys.

Table 2 Professional characteristics of experts participating in the Delphi surveys

Hospital, n (%)	Teaching Hospital of Cocody	9 (39)
	Teaching Hospital of Treichville	4 (17)
	Teaching Hospital of Angré	3 (13)
	Teaching Hospital of Bouaké	2 (9)
	Hospital « mère-enfant » of Bingerville	2 (9)
	Military Hospital of Abidjan	2 (9)
	Teaching Hospital of Yopougon	1 (4)
	Total	23 (100)
Speciality, n (%)	Pediatrician	22 (96)
	Clinical pharmacist	1 (4)
	Total	23 (100)
Practitioner categories, n (%)	Clinical practitioner	12 (52)
	Academic and clinical practitioner	11 (48)
	Total	23 (100)
Professional seniority (years)	Mean ± SD	13.4±6.9
	Range	4–35

Table 3 Agreement on IP during the Delphi surveys

	First round (n=23)		Second round (n=20)		Status
	Median (range)	Agreement (n1/n2)	Median (range)	Agreement (n1/n2)
Inappropriate prescription
1. Administration during the same day of oral iron and injectable iron for treatment of anemia	5 (4–5)	100% (21/21)	5 (4–5)	100% (20/20)	Retained
2. Oral iron intake <5 days after administration of injectable iron for treatment of anemia	4 (2–5)	95% (21/22)	5 (4–5)	100% (19/19)	Retained
3. Coadministration of oral iron and topical gastrointestinal drugs (aluminum hydroxide) during anemia treatment	5 (4–5)	100% (20/20)	5 (4–5)	100% (19/19)	Retained
4. Prescription of oral salbutamol for asthma treatment	4 (1–5)	81% (17/21)	4 (1–5)	85% (17/20)	Retained
5. Prescription of salbutamol for treatment of first case of acute bronchiolitis in infants <12 months of age	4 (2–5)	73% (16/22)	4,5 (2–5)	80% (16/20)	Not Retained
6. Prescription of corticosteroids to treat a first case of acute bronchiolitis in infants <12 months of age	5 (2–5)	91% (21/23)	5 (4–5)	100% (20/20)	Retained
7. Prescription of suppositories containing terpene bases (niaouli extract) to treat bronchitis in children aged <30 months	5 (4–5)	100% (21/21)	5 (4–5)	100% (18/18)	Retained
8. Prescription of suppositories containing terpene bases (niaouli extract) for bronchitis treatment >3 days in children aged >30 months without a history of febrile convulsion or epilepsy	5 (2–5)	89% (16/18)	5 (4–5)	100% (17/17)	Retained
9. Prescription of trimebutine for treatment of colic in children <2 years of age	4 (3–5)	82% (18/22)	5 (4–5)	100% (20/20)	Retained
10. Coadministration of valproic acid and phenobarbital for convulsive fits without regular clinical or biological monitoring for the detection of hyperamonemia	5 (2–5)	86% (18/21)	5 (4–5)	100% (20/20)	Retained with rewording
11. Prescription of nifuroxazide to treat acute diarrhea in children and teenagers <18 years of age	5 (3–5)	95% (21/22)	5 (4–5)	100% (19/19)	Retained
12. Joint prescription of tramadol and morphine for the management of pain during tumor syndrome	5 (4–5)	100% (18/18)	5 (4–5)	100% (19/19)	Retained
13. Prescription of paracetamol + ibuprofen as first-line treatment for fever in children	5 (4–5)	100% (23/23)	5 (4–5)	100% (20/20)	Retained
14. Prescription of metamizole as first-line treatment for fever in children in absence of any contraindication to paracetamol	5 (4–5)	100% (23/23)	5 (4–5)	100% (20/20)	Retained with rewording
15. Prescription of gentamicin for daily administration in two injections during bacterial infections in children	5 (4–5)	100% (23/23)	5 (4–5)	100% (20/20)	Retained
16. Prescription of amikacin at a daily dose <15 mg/kg for infection treatment	5 (4–5)	100% (21/21)	5 (4–5)	100% (20/20)	Retained
17. Coprescription of gentamicin and vancomycin without increased clinical or biological monitoring for early detection of nephrotoxicity and ototoxicity during bacterial infections	5 (2–5)	95% (19/20)	5 (4–5)	100% (19/19)	Retained with rewording
18. Prescription of oral amoxicillin–clavulanic acid without specifying administration methods related to food intake during infections	4 (2–5)	78% (18/23)	4 (2–5)	85% (17/20)	Retained
19. Prescription of cyproheptadine as first-line treatment for insomnia in children	5 (4–5)	100% (21/21)	5 (4–5)	100% (20/20)	Retained
20. Systematic prescription of paracetamol as treatment for fever in children with severe acute malnutrition	5 (2–5)	96% (22/23)	5 (4–5)	100% (20/20)	Retained with rewording
21. Prescription of injectable artesunate at a dose <3 mg/kg per injection as treatment for severe malaria in children weighing <20 kg	5 (2–5)	96% (22/23)	5 (2–5)	95% (19/20)	Retained
22. Prescription of quinine as first-line treatment for severe malaria	5 (2–5)	96% (22/23)	5 (2–5)	95% (19/20)	Retained
23. Prescription of phenobarbital as first-line treatment for seizures in severe malaria	5 (3–5)	95% (21/22)	5 (2–5)	95% (19/20)	Retained
24. Prescription of phenobarbital at a daily dose of 20 mg/kg for treatment of repeated convulsions in severe malaria	4 (2–5)	82% (18/22)	4 (2–5)	80% (16/20)	Not Retained
25. Joint prescription of artemether–lumefantrine and domperidone during malaria treatment	5 (2–5)	94% (17/18)	5 (3–5)	95% (18/19)	Retained
26. Joint prescription of artemether–lumefantrine and mequitazine in malaria treatment	4 (4–5)	100% (17/17)	4 (3–5)	95% (18/19)	Retained
27. Joint prescription of artemether–lumefantrine and azithromycin without clinical or electrocardiographic monitoring during malaria treatment	4 (2–5)	83% (15/18)	4 (3–5)	89% (17/19)	Retained with rewording
28. Prescription of artemether–lumefantrine without specifying administration methods related to food intake for the treatment of malaria	4 (2–5)	73% (16/22)	4 (2–5)	90% (18/20)	Retained
29. Prescription of dihydroartemisinin–piperaquine without specifying administration methods related to food intake in malaria treatment	4 (2–5)	89% (17/19)	4 (2–5)	94% (17/18)	Retained
30. Prescription of sedating H1 antihistamine (chlorpheniramine, diphenydramine, mequitazine) for treatment of allergic rhinitis in children <2 years of age	5 (2–5)	83% (19/23)	5 (3–5)	95% (19/20)	Retained
31. Prescription of systemic vasoconstrictors (phenylephrine) for treatment of congestive states during rhinitis, in children under 15 years of age.	4 (2–5)	82% (18/22)	4 (4–5)	100% (20/20)	Retained
32. Prescription of nasal vasoconstrictors (oxymetazoline, xylometazoline) for treatment of congestive states during rhinitis in children aged <15 years	5 (2–5)	78% (18/23)	5 (2–5)	90% (18/20)	Retained
33. Prescription of nasal antibiotic solution (framycetin) as treatment for rhinitis	5 (1–5)	82% (18/22)	5 (4–5)	100% (19/19)	Retained
34. Joint prescription of paracetamol alone and medicines with a combination of active ingredients including paracetamol for the treatment of rhinitis	5 (3–5)	96% (22/23)	5 (2–5)	95% (19/20)	Retained
35. Joint prescription of mequitazine and chlorpheniramine for treatment of allergic rhinitis in children	5 (1–5)	90% (19/21)	5 (4–5)	100% (19/19)	Retained
36. Systematic prescription of antibiotics (amoxicillin–clavulanic acid, cefuroxime, josamycin) for treatment of nasopharyngitis or acute angina in children <3 years of age.	5 (2–5)	73% (16/22)	5 (3–5)	85% (17/20)	Retained with rewording
37. Prescription of NSAID (ibuprofen, ketoprofen) as first-line treatment for angina in children	5 (2–5)	86% (18/21)	5 (4–5)	100% (20/20)	Retained with rewording
38. Prescription of benzyl benzoate for daily application without renewal during treatment of scabies	5 (4–5)	100% (22/22)	5 (4–5)	100% (20/20)	Retained
39. Prescription of benzyl benzoate during treatment of scabies without specifying that the skin-contact time to be observed for children <2 years of age should be ≤12 hours	5 (2–5)	90% (19/21)	5 (4–5)	100% (19/19)	Retained
40. Prescription of proton-pump inhibitor (esomeprazole) for prevention of ulcers related to corticosteroid therapy during nephrotic syndrome in children	5 (2–5)	90% (18/20)	5 (4–5)	100% (20/20)	Retained
41. Prescription of injectable metronidazole at a dosage of 500 mg every 12 hours for treatment of tetanus	4 (2–5)	73% (11/15)	4 (2–5)	88% (15/17)	Retained with rewording
42. Joint prescription of diazepam and phenobarbital for treatment of trismus in tetanus	5 (2–5)	96% (22/23)	5 (4–5)	100% (20/20)	Retained
43. Prescription of sedative H1 antihistamine (chlorpheniramine, diphenydramine) for treatment of uncomplicated dry cough in children <2 years of age	5 (1–5)	90% (19/21)	5 (4–5)	100% (20/20)	Retained
44. Prescription of H2 antihistamine (ranitidine) as first-line of treatment for confirmed peptic ulcer disease	4 (2–5)	81% (17/21)	4,5 (3–5)	95% (19/20)	Retained with rewording
45. Prescription of sedative H1 antihistamine (mequitazine) for treatment of urticaria in children <2 years of age	4 (3–5)	95% (20/21)	5 (4–5)	100% (20/20)	Retained
46. Prescription of domperidone for treatment of vomiting in children <12 years of age	4 (2–5)	71% (15/21)	4 (2–5)	90% (18/20)	Retained
Omission of prescription
47. Failure to prescribe inhaled cortocosteroid for background therapy for treatment of asthma in patients in short-acting bronchodilatators (salbutamol)	4 (2–5)	91% (21/23)	5 (4–5)	100% (20/20)	Retained with rewording
48. Failure to prescribe oral rehydration salts for treatment of acute diarrhea in children <5 years of age not suffering from severe acute malnutrition	5 (4–5)	100% (23/23)	5 (4–5)	100% (20/20)	Retained
49. Failure to prescribe oral zinc for treatment of acute diarrhea in children not receiving therapeutic zinc-containing foods	5 (2–5)	78% (18/23)	5 (2–5)	95% (19/20)	Retained with rewording
50. Failure to prescribe preventive measures against constipation (dietetic measures and/or osmotic laxative) to patients being treated with morphine	5 (2–5)	84% (16/19)	5 (2–5)	95% (18/19)	Retained with rewording
51. Failure to prescribe folic acid as treatment for moderate anemia (Hb ≥4 g/dL) in children with severe acute malnutrition	5 (2–5)	83% (19/23)	5 (2–5)	95% (19/20)	Retained
52. Failure to prescribe an anthelmintic at the beginning of corticosteroid therapy during nephrotic syndrome in children	5 (1–5)	87% (20/23)	5 (4–5)	100% (20/20)	Retained
53. Failure to prescribe calcium and vitamin D supplementation during corticosteroid therapy in children suffering from nephrotic syndrome, insufficient dietary calcium intake, and/or vitamin D deficiency	5 (2–5)	80% (16/20)	5 (3–5)	95% (18/19)	Retained with rewording
54. Failure to prescribe tetanus vaccine during management of a patient with tetanus.	5 (1–5)	75% (15/20)	5 (2–5)	95% (18/19)	Retained

Notes: n1, number of experts rating 4 or 5; n2, number of experts not rating zero.