ArticlePediatrics2019
Trends in Off-Label Drug Use in Ambulatory Settings: 2006-2015.
Article in Pediatrics, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 49 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
49 citing papers in PubMed.
- Post-Approval Pediatric Use of Drugs Granted Waivers from Pediatric Testing.Clinical pharmacology and therapeutics · 2026Article
- Application of the Target Trial Emulation Framework to Studies in the Pediatric Population.The Journal of pediatrics · 2026Article
- Statewide trends in access to medications for opioid use disorder (moud) among adolescents with opioid use disorders in Indiana.Drug and alcohol dependence reports · 2026Article
- Identifying Pediatric Drug Safety Knowledge Gaps: An Integrated Approach Leveraging Real-World Data, a Biomedical Knowledge Base, and Postmarketing Surveillance Data.Pharmacotherapy · 2025Article
- Utilization of Child-Appropriate Medicines: Use of Pediatric Use Marketing Authorisation (PUMA) Products in Croatia.Journal of clinical medicine · 2025Article
- The importance of patient engagement when promoting age-inclusive research.Research involvement and engagement · 2025Article
- Pediatric Pharmacy Association 2025 KIDs List of Key Potentially Inappropriate Drugs in Pediatrics.The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG · 2025Article
- Prescription drug use in Danish children and adolescents 2005-2023.European journal of epidemiology · 2025Article
- Article
- Special considerations for the child with obesity: An Obesity Medicine Association (OMA) clinical practice statement (CPS) 2024.Obesity pillars · 2024Article
- Personalized Dosing of Medicines for Children: A Primer on Pediatric Pharmacometrics for Clinicians.Paediatric drugs · 2024Review
- Younger Children with Respiratory Tract Infections Are More Exposed to Off-Label Treatments: An Exploratory Retrospective Study in a Pediatric Emergency Setting.Children (Basel, Switzerland) · 2024Article
- Puberty Suppression for Pediatric Gender Dysphoria and the Child's Right to an Open Future.Archives of sexual behavior · 2024Article
- Real-world data for the availability of pediatric medicines in Chinese hospitals: a multi-center survey and analysis.Frontiers in pharmacology · 2024Article
- Optimizing therapeutic decision-making for off-label medicines use: A scoping review and consensus recommendations for improving practice and researchPharmacoepidemiology and drug safety · 2023Article
- Acid-suppressive medication and incidence of chronic childhood immune-mediated diseases: A scoping review.Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology · 2023Article
- Gabapentin is Associated With Decreased Postoperative Opioid Use and Length of Stay After Appendectomy in Children With Perforated Appendicitis: A Propensity Score-Matched Analysis.Journal of pediatric surgery · 2023Article
- Advancing pediatric medication safety using real-world data: Current problems and potential solutions.Journal of hospital medicine · 2023Article
- Characterization of Pediatric Reports in the US Food and Drug Administration Adverse Event Reporting System from 2010-2020: A Cross-Sectional Study.Therapeutic innovation & regulatory science · 2023Article
- Paediatric obesity: Documentation, screening, and pharmacotherapy in a national cohort.Pediatric obesity · 2023Article
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6 authors.
Funding
Abstract
backgroundOff-label drug use in children is common and potentially harmful. In most previous off-label use research, authors studied hospitalized children, specific drug classes, or non-US settings. We characterized frequencies, trends, and reasons for off-label systemic drug orders for children in ambulatory US settings.
methodsUsing nationally representative surveys of office-based physicians (National Ambulatory Medical Care Surveys, 2006-2015), we studied off-label orders of systemic drugs for children age <18 based on US Food and Drug Administration-approved labeling for age, weight, and indication. We characterized the top classes and diagnoses with off-label orders and analyzed factors and trends of off-label orders using logistic regression.
resultsPhysicians ordered ≥1 off-label systemic drug at 18.5% (95% confidence interval: 17.7%-19.3%) of visits, usually (74.6%) because of unapproved conditions. Off-label ordering was most common proportionally in neonates (83%) and in absolute terms among adolescents (322 orders out of 1000 visits). Off-label ordering was associated with female sex, subspecialists, polypharmacy, and chronic conditions. Rates and reasons for off-label orders varied considerably by age. Relative and absolute rates of off-label orders rose over time. Among common classes, off-label orders for antihistamines and several psychotropics increased over time, whereas off-label orders for several classes of antibiotics were stable or declined.
conclusionsUS office-based physicians have ordered systemic drugs off label for children at increasing rates, most often for unapproved conditions, despite recent efforts to increase evidence and drug approvals for children. These findings can help inform education, research, and policies around effective, safe use of medications in children.
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