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. 2019 Mar 20;9(3):e019186. doi: 10.1136/bmjopen-2017-019186

Table 1.

Pediatrics: Omission of Prescriptions and Inappropriate prescriptions (POPI)

Diverse illnesses
 A: pain and fever
  Inappropriate prescriptions Omissions
  AI-1. Prescription of two alternating antipyretics as a first-line treatment.
  AI-2. Prescription of a medication other than paracetamol as a first-line treatment (except in the case of migraine).
  AI-3. Rectal administration of paracetamol as a first-line treatment.
  AI-4. The combined use of two NSAIDs.*†
  AI-5. Oral solutions of ibuprofen administered in more than three doses per day using a graduated pipette of 10 mg/kg (other than Advil).†
  AI-6. Opiates to treat migraine attacks.*		 A0-1. Failure to give sugar solution to new-born babies and infants under 4 months old 2 min prior to venipuncture.
A0-2. Failure to give an osmotic laxative to patients being treated with morphine for a period of more than 48 hours.
 B: urinary infections
  Inappropriate prescriptions Omissions
  BI-1. Nitrofurantoin used as a prophylactic.*
  BI-2. Nitrofurantoin used as a curative agent in children under 6 years of age or indeed any other antibiotic if avoidable.*
  BI-3. Antibiotic prophylaxis following an initial infection without complications (except in the case of uropathy).*
  BI-4. Antibiotic prophylaxis in the case of asymptomatic bacterial infection (except in the case of uropathy).*		   
 C: vitamin supplements and antibiotic prophylaxis
  Inappropriate prescriptions Omissions
  CI-1. Fluoride supplements prior to 6 months of age. †* CO-1. Insufficient intake of vitamin D. Minimum vitamin D intake:

  • Breastfed baby=1000–1200 IU/day.

  • Infant <18 months of age (milk enriched with vitamin D)=600–800 IU/day.

  • Child aged between 18 months and 5 years, and adolescents aged between 10 years and 18 years: two quarterly loading doses of 80 000–100 000 IU/day in winter (adolescents can take this as one dose).

CO-2. Antibiotic prophylaxis with phenoxymethylpenicillin (Oracilline) starting from 2 months of age and lasting until 5 years of age for children with sickle-cell anaemia: 100 000 IU/kg/day (in two doses) for children weighing 10 kg or less and 50 000 IU/kg/day for children weighing over 10 kg (also in two doses).*
 D: mosquitos
  Inappropriate prescriptions Omissions
  DI-1. The use of skin repellents in infants less than 6 months old and picardin in children less than 24 months old.
  DI-2. Citronella (lemon grass) oil (essential oil).
  DI-3. Anti-insect bracelets to protect against mosquitos and ticks.
  DI-4. Ultrasonic pest control devices, vitamin B1, homeopathy, electric bug zappers and sticky tapes without insecticide.
 DO-1. DEET ‘30%’ (max) before 12 years old.
‘50%’ (max) after 12 years old.
DO-2. IR3535 ‘20%’ (max) before 24 months old.
‘35%’ (max) after 24 months old.
DO-3. Mosquito nets and clothes treated with pyrethroids.
Digestive Problems
 E: nausea, vomitting or gastro-oesophageal reflux
  Inappropriate prescriptions Omissions
  EI-1. Metoclopramide.*†
  EI-2. Domperidone.*†
  EI-3. Gastric antisecretory drugs to treat gastro-oesophageal reflux, dyspepsia, the crying of new-born babies (in the absence of any other signs or symptoms), as well as faintness in infants.*
  EI-4. The combined use of proton pump inhibitors and NSAIDs, for a short period of time, in patients without risk factors.*
  EI-5. Oral administration of an intravenous proton pump inhibitor (notably by nasogastric tube).*
  EI-6. The use of type H2 antihistamines for long periods of treatment.* †
  EI-7. Erythromycin as a prokinetic agent.*
  EI-8. The use of setrons (5-HT3 antagonists) for chemotherapy-associated nausea and vomiting.*		 EO-1. Oral rehydration solution in the event of vomiting.*
 F: diarrhoea
  Inappropriate prescriptions Omissions
  FI-1. Loperamide before 3 years of age.*†
  FI-2. Loperamide in the case of invasive diarrhoea.*
  FI-3. The use of diosmectite (Smecta) in combination with another medication.*†
  FI-4. The use of Saccharomyces boulardii (Ultralevure) in powder form, or in a capsule that has to be opened prior to ingestion, to treat patients with a central venous catheter or an immunodeficiency.*
  FI-5. Intestinal antiseptics.*†		 FO-1. Oral rehydration solution in the event of diarrhoea.*
ENT, pulmonary Problems
 G: cough
  Inappropriate prescriptions Omissions
  GI-1. Pholcodine.*†
  GI-2. Mucolytic drugs, mucokinetic drugs or helicidine before 2 years of age.*†
  GI-3. Alimemazine (Theralene), oxomemazine (Toplexil), promethazine (Phenergan) and other types.*†
  GI-4. Terpene-based suppositories.*†		 GO-1. Failure to propose a whooping cough booster vaccine for adults who are likely to become parents in the coming months or years (only applicable if the previous vaccination was more than 10 years ago). This booster vaccination should also be proposed to the family of expectant parents and those in contact with them (parents, grandparents, nannies/child minders).
 H: bronchiolitis in infants
  Inappropriate prescriptions Omissions
  HI-1. Beta2 agonists, corticosteroids to treat an infant’s first case of bronchiolitis.*
  HI-2. H1-antagonists, cough suppressants, mucolytic drugs or ribavirin to treat bronchiolitis.*
  HI-3. Antibiotics in the absence of signs indicating a bacterial infection (acute otitis media, fever and so on).*		 HO-1. 0.9% NaCl to relieve nasal congestion (not applicable if nasal congestion is already being treated with 3% NaCl delivered by a nebulizer).*
HO-2. Palivizumab in the following cases:
(1) Babies born both at less than 35 weeks of gestation and less than 6 months prior to the onset of a seasonal RSV epidemic.
(2) Children less than 2 years old who have received treatment for bronchopulmonary dysplasia in the past 6 months.
(3) Children less than 2 years old suffering from congenital heart disease with haemodynamic abnormalities.
 I: ENT infections
  Inappropriate prescriptions Omissions
  II-1. An antibiotic other than amoxicillin as a first-line treatment for acute otitis media, strep throat or sinusitis (provided that the patient is not allergic to amoxicillin). An effective dose of amoxicillin for an pneumococcal infection is 80–90 mg/kg/day and an effective dose for a streptococcal infection is 50 mg/kg/day.*
  II-2. Antibiotic treatment for a sore throat, without a positive rapid diagnostic test result, in children more than 3 years old.*
  II-3. Antibiotics for nasopharyngitis, congestive otitis, sore throat before 3 years of age or laryngitis; antibiotics as a first-line treatment for acute otitis media showing few symptoms after 2 years of age.*
  II-4. Antibiotics to treat otitis media with effusion (OME), except in the case of hearing loss or if OME lasts for more than 3 months.*
  II-5. Corticosteroids to treat acute suppurative otitis media, nasopharyngitis or strep throat.*
  II-6. Nasal or oral decongestant (oxymetazoline (Aturgyl), pseudoephedrine (Sudafed), naphazoline (Derinox), ephedrine (Rhinamide), tuaminoheptane (Rhinofluimicil) and phenylephrine (Humoxal)).*†
  II-7. H1-antagonists with sedative or atropine-like effects (pheniramine and chlorpheniramine) or camphor; inhalers, nasal sprays or suppositories containing menthol (or any terpene derivatives) before 30 months of age.*†
  II-8. Ethanolamine tenoate (Rhinotrophyl) and other nasal antiseptics.*†
  II-9. Ear drops in the case of acute otitis media.*		 IO-1. Doses in mg for drinkable (solutions of) amoxicillin or josamycin.*†
IO-2. Paracetamol combined with antibiotic treatment for ear infections to relieve pain.*
 J: asthma
  Inappropriate prescriptions Omissions
  JI-1. Ketotifen and other H1-antagonists, and sodium cromoglycate.*
  JI-2. Cough suppressants.*		 JO-1. Asthma inhaler appropriate for the child’s age.
JO-2. Preventative treatment (inhaled corticosteroids) in the case of persistent asthma.*
Dermatological problems
 K: acne vulgaris
  Inappropriate prescriptions Omissions
  KI-1. Minocycline.*†
  KI-2. Isotretinoin in combination with a member of the tetracycline family of antibiotics.*†
  KI-3. The combined use of an oral and a local antibiotic.*
  KI-4. Oral or local antibiotics as a monotherapy (not in combination with another drug).*
  KI-5. Cyproterone+ethinylestradiol (Diane 35) as a contraceptive to allow isotretinoin per os.*†
  KI-6. Androgenic progestins (levonorgestrel, norgestrel, norethisterone, lynestrenol, dienogest, contraceptive implants or vaginal rings).*		 KO-1. Contraception (provided with a logbook/diary) for menstruating girls taking isotretinoin.
KO-2. Topical treatment (benzoyl peroxide, retinoids or both) in combination with antibiotic therapy.*
 L: scabies
  Inappropriate prescriptions Omissions
LO-1. A second dose of ivermectin 2 weeks after the first.*
LO-2. Decontamination of household linen and clothes and treatment for other family members.
 M: lice
  Inappropriate prescriptions Omissions
  MI-1. The use of aerosols for infants, children with asthma or children showing asthma-like symptoms such as dyspnoea.   
 N: ringworm
  Inappropriate prescriptions Omissions
  NI-1. Treatment other than griseofulvin for Microsporum.* NO-1. Topical treatment combined with an orally administered treatment.*
NO-2. Griseofulvin taken during a meal containing a moderate amount of fat.*†
 O: impetigo
  Inappropriate prescriptions Omissions
  OI-1. The combination of locally applied and orally administered antibiotics.*
  OI-2. Fewer than two applications per day for topical antibiotics.*
  OI-3. Any antibiotic other than mupirocin as a first-line treatment (except in cases of hypersensitivity to mupirocin).*		   
 P: herpes simplex
  Inappropriate prescriptions Omissions
  PI-1. Topical agents containing corticosteroids.*
  PI-2. Topical agents containing acyclovir before 6 years of age.*†		 PO-1. Paracetamol during an outbreak of herpes.*
PO-2. Orally administered acyclovir to treat primary herpetic gingivostomatitis.*
 Q: atopic dermatitis
  Inappropriate prescriptions Omissions
  QI-1. A strong topic steroid (clobetasol propionate 0.05% Dermoval, betamethasone dipropionate Diprosone) applied to the face, armpits or groin and to the backside of babies or young children.*
  More than one application per day of a topical steroid, except in cases of severe lichenification.*
  QI-2. Local or systemic antihistamine during treatment of outbreaks.*
  QI-3. Topically applied 0.03% tacrolimus before 2 years of age.*†
  Topically applied 0.1% tacrolimus before 16 years of age.
  QI-4. Oral corticosteroids to treat outbreaks.*		   
Neuropsychiatric, epilepsy disorders
 R: epilepsy
  Inappropriate prescriptions Omissions
  RI-1. Carbamazepine, gabapentin, oxcarbazepine, phenytoin, pregabalin, tiagabine or vigabatrin in the case of myoclonic epilepsy.*
  RI-2. Carbamazepine, gabapentin, oxcarbazepine, phenytoin, pregabalin, tiagabine or vigabatrin in the case of epilepsy with absence seizures (especially for childhood absence epilepsy or juvenile absence epilepsy).*
  RI-3. Levetiracetam, oxcarbamazepine in millilitre or in milligram without systematically writing XX mg per Y mL.*†		   
 S: depression
  Inappropriate prescriptions Omissions
  SI-1. An SSRI antidepressant other than fluoxetine as a first-line treatment (in the case of pharmacotherapy).*
  SI-2. Tricyclic antidepressants to treat depression.*		   
 T: nocturnal enuresis
  Inappropriate prescriptions Omissions
  TI-1. Desmopressin administered by a nasal spray.*†
  Desmopressin in the case of daytime symptoms.
  TI-2. An anticholinergic agent used as a monotherapy in the absence of daytime symptoms.*
  TI-3. Tricyclic agents in combination with anticholinergic agents.*†
  TI-4. Tricyclic agents as a first-line treatment.*		   
 U: anorexia
  Inappropriate prescriptions Omissions
  UI-1. Cyproheptadine (Periactin) and clonidine.*†   
 V: attention deficit disorder with or without hyperactivity
  Inappropriate prescriptions Omissions
  VI-1. Pharmacological treatment before age 6 years (before school), except in severe cases.*
  VI-2. Antipsychotic drugs to treat attention deficit disorder without hyperactivity.*
  VI-3. Slow release methylphenidate as two doses per day, rather than only one dose.*†		 VO-1. Recording a growth chart (height and weight) if the patient is taking methylphenidate.*

*Criteria analysed in emergency department.

†Criteria analysed in community pharmacy.

ENT: ear, nose and throat.