단일 상급 종합병원에서 소아 입원환자의 주사제 사용현황 분석을 통한 저함량 단위 주사제의 필요성 제언

Abstract

Background : Currently, most clinical trials are conducted on adults. Also, dose formulations are developed based on adult standard doses, resulting in problems with pediatric administration. Firstly, the excess drugs become medical waste. Secondly, patients may be overcharged even when they only use a small portion of the drugs. Lastly, medical errors may arise while preparing and administering pediatric doses with comparatively large dose formulations. Therefore, this study aimed to analyze the status of injectable drug use in pediatric inpatients and estimate the discarded drug amounts and the proportion of the actual dose used, thus evaluating the marketability of lower dose formulations. Methods : The data of injectable drugs prescribed from June 1, 2018, to May 31, 2019, were collected and retrospectively analyzed using the Order Communication System program. Results : The average daily injectable drug prescriptions for children were 1,738.1, and 40.1% of them were for less than the dose formulations. The number of injections discarded daily was 435.7, accounting for 1,692,217 Korean won. The injectable drugs frequently prescribed in small proportions were dexamethasone 5 mg/ampoule (A), ranitidine 50 mg/A, cimetidine 200 mg/A, and furosemide 20 mg/A. Among the top 20 products, only seven had lower dose formulations available in Korea, of which three were unavailable due to low demand, never produced though granted permission, and one was due to non reimbursement by insurance. Moneywise, the biggest loss was from caspofungin 50 mg/vial (V), whose daily drug disposal accounted for 256,352 Korean won, followed by smoflipid 20%® 100 ml/bottle, ganciclovir 500 mg/V, and teicoplanin 200 mg/V. Conclusion : This study showed that utilizing injectable drugs with adult dose formulations for children could result in biohazardous medical waste and economic losses. However, there are only a few alternatives currently available. Therefore, the government, instead of individual medical institutions or pharmaceutical companies, should authorize the investigation and development of lower dose formulations for children.