Still too much codeine prescribed for kids

In spite of national and worldwide recommendations, codeine prescriptions for children presenting to an emergency department (ED) with cough or an upper respiratory infection (URI) have not declined, according to a cross-sectional analysis funded by the National Institutes of Health.

Using the nationally representative National Hospital Ambulatory Medical Care Survey, researchers from the University of California, San Francisco, and Canada found that although overall codeine prescriptions written in EDs for kids declined slightly-from 3.7% to 2.9%- over the period 2001 to 2010, codeine prescriptions for children presenting with cough or URI have remained fairly constant. As a result, between 558,805 and 876,729 codeine prescriptions are still written yearly for children.

Children aged 8 to 12 years were 1.42 times as likely to receive codeine as children aged 3 to 7 years. No statistically significant change in prescriptions occurred over the 10-year period in the 8- to 12-year-old age group, although a slight decline occurred in the 3- to 7-year-olds, who are at greatest risk of toxicity. Those living outside the Northeast were about twice as likely to receive codeine as those living in the Northeast. Black children were less likely to receive codeine than white children, as were those with Medicaid versus private insurance.

Guidelines issued by the American Academy of Pediatrics and other national and international organizations recommend against the use of codeine in children because of metabolism irregularities. About 1 in every 3 children metabolizes the drug poorly, which can lead to inadequate symptom relief. Even worse, some children metabolize the drug too quickly, which can turn a standard dose into one that is fatally toxic.

As alternatives to codeine, the researchers suggest acetaminophen-hydrocodone, ibuprofen for treatment of injury pain, and dark-honey–containing products for cough suppression. They conclude “that cough and URI prescribing may be an important focus for interventions to change provider behavior.”

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