Trends in prescriptions of paracetamol for childrenBMJ 1995; 311 doi: https://doi.org/10.1136/bmj.311.7001.362 (Published 05 August 1995) Cite this as: BMJ 1995;311:362
- Department of Dental Medicine and Surgery, University Dental Hospital of Manchester, Manchester M15 6FH
- Correspondence to: Dr Mackie.
- Accepted 5 August 1995
In 1979 the BMJ focused attention on the harmful effects of medicines sweetened with sugar on children's teeth.1 From 1984 the British National Formulary has included a warning, “although liquid preparations are particularly suitable for children, many contain sugar which encourages tooth decay. Sugar-free preparations should be used whenever possible.” In 1986 the British National Formulary marked preparations which did not contain sucrose, glucose, or fructose as “sugar free.” Pharmaceutical companies have responded to professional and market forces and are producing sugar free medicines.2 However, availability does not necessarily mean that the medicines will be widely used and recommended.
The most commonly prescribed paediatric medicine is paracetamol. Sugar containing and sugar free generic and brand named versions which have identical therapeutic actions have been available for years. We investigated trends in prescribing by general practitioners in four health districts.
Permissions was obtained from the North West Regional Health Authority to view combined district prescribing analysis and cost data for the districts of Oldham, Rochdale, Bury, and Bolton for April to June 1991, 1992, and 1993. The total volume of paracetamol prescribed was determined and the proportions that were sugar free and generic calculated. The χ2 test was used to determine the differences in proportions between 1991 and 1993.
The table shows the proportions of sugar free and generic paracetamol prescribed in the four districts. In all four districts there was an increase in the proportion of sugar free prescriptions between 1991 and 1993 (P<0.001). In Oldham and Bolton the increase was over 10%. In 1991 overall, 29% of paediatric medicines were sugar free (95% confidence interval 17% to 41%). This had risen to 37% (31% to 44%) by 1993. Over the four districts generic prescriptions accounted for 19% (5% to 34%) in 1991 and 24% (16% to 33%) in 1993; fewer than 4% of these were sugar free.
Paracetamol is an excellent example of a medicine that is commonly prescribed, over 70% of prescriptions being for branded products. Of the 37% of sugar free prescriptions in 1993, most were brand name products. Efforts have been made to encourage generic prescribing, and though a generic sugar free version is available, it is rarely prescribed. This suggests that as generic prescribing becomes more prevalent the use of sugar free paracetamol may decline unless specifically encouraged.
A study of doctors' prescribing habits for children suggested that the main reason for not prescribing sugar free was that doctors had simply not thought about the issue and automatically prescribed whatever they were accustomed to using.3 Others thought that it was not important in relation to all the other sugar intakes children have.
Decayed teeth may seem a minor problem, but a great deal of misery and pain can accompany tooth decay and many young children still require general anaesthesia for extractions. Fluoride in water and toothpaste helps but controlling the diet is also important, as the frequency of sugar consumption overwhelms the protective benefit of fluoride.
The more frequent the sugar intake, the more likelihood there is of decay developing. Young children are often given medicines just before bedtime or during the night. This is particularly damaging to teeth because saliva flow is reduced, buffering of the acids produced by sugar will be compromised, and demineralisation of tooth enamel will be greater, expediting decay.
A simple change to a sugar free medicine would have the same therapeutic effect and yet not pose a risk to children's dental health.
We thank the regional pharmaceutical and dental officers for their help.
Funding This project was funded by the North West Regional Health Authority.