ABSTRACT:

Infants and pediatric patients are at high risk of adverse drug events due to irrational prescribing, polypharmacy, and medication errors. Poor nutritional status further affects growth, immunity, and treatment outcomes. The increasing use of drugs and nutraceuticals in pediatrics raises serious concerns regarding polypharmacy, drug interactions, and nutritional health. Therefore, prescription pattern studies are needed to promote rational medication use and improve the nutritional status and overall health of pediatric patients. The study aimed to assess drug and nutraceutical prescribing practices, identify potential drug-drug interactions, and determine their determinants among pediatric outpatients. A prospective observational study was conducted at a private outpatient clinic over 6 months. The study population comprised 213 pediatric patients aged 0 to 12 years. Data collection included reviewing treatment records and drug therapy. Data were collected and analyzed, and potential drug interactions were checked using the Medscape drug interaction checker. Analysis of prescriptions revealed an average of 5.37 medications per encounter. Notably, 99.1% of drugs were prescribed by brand name. Antipyretics or analgesics were prescribed most frequently (17.7%), followed by antibiotics (12.1%). A total of 78.5% of drugs were from the essential drug list. Upper respiratory tract infections were the most common diagnosis. Polypharmacy prevalence was 69.5%, with most patients receiving five or more drugs. Potential drug-drug interactions were present in 29.5% of prescriptions, with cetirizine and azithromycin being the most common drug pair involved in moderate interactions. Multivariate logistic regression identified polypharmacy as a strong predictor for drug interactions, while age and gender were not significant. Among 213 patients, 59 received nutraceuticals (31 males [52.5%], 28 females [47.5%]), with Vitamin D3 being the most prescribed nutraceutical, and no prescriptions for proteins. This study revealed a high prevalence of polypharmacy and potential drug-drug interactions among pediatric outpatients, highlighting the need for rational prescribing and careful medication monitoring. Collaborative efforts between pharmacists and pediatricians, along with regular prescription audits, are essential for promoting safe use of medications and nutraceuticals and improving the overall health and nutritional status of pediatric patients.
Keywords: WHO prescribes indicators, polypharmacy, nutraceuticals, drug-drug interactions, prescribing patterns

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