Rational prescribing for children

In an evidence based desert, safe and appropriate treatment is difficult and too easily exploited

Many drugs used to treat children are unlicensed or off label.1 Three recent news stories highlight how children, like adults, are at risk from overprescribing and inappropriate prescribing. A systematic review conducted by the National Institute for Health and Clinical Excellence has shown fluoxetine (with or without cognitive behavioural therapy) to be the only selective serotonin reuptake inhibitor that is more effective than placebo in teenage patients with depression.2 Furthermore, the US Food and Drug Administration and the Medicines Healthcare Products Regulatory Agency have shown that most randomised controlled trials have reported higher rates of “possibly suicide-related event” and “suicide attempt event” among adolescents and children taking selective serotonin reuptake inhibitors than in those taking placebo.3 The systematic review on fluoxetine included children as young as 7 years old and found no conclusive evidence of increased suicidal behaviour or ideation in studies lasting seven to 12 weeks.2 It may be surprising or even confusing for the public, nevertheless, to find that the European Medicines Agency recently licensed fluoxetine for use in children as …