Topical corticosteroids in infants: prescribing pattern and prescribing errors in Bahrain.

Objective: A nationwide, primary care-based prescription audit in infants to determine the prescribing pattern and prescribing errors of topical corticosteroid preparations in Bahrain.

Method: Prescriptions dispensed for infants were collected for two successive weeks from 20 primary-care health centres.

Results: Among 2282 out of 102,084 prescriptions (2.2%) dispensed for infants, 296 (13.0%) had corticosteroids for topical application to the skin, eye and ear. Plain corticosteroids comprised 6.7%, whereas corticosteroids with antiinfectives accounted for 6.3% of topical corticosteroid preparations. Based on potency the proportions of corticosteroids prescribed were: mild (6.7%), moderately potent (2.6%) and potent (3.7%). The frequency of dosing and length of therapy were not stated in 21.6% and 43.6% of prescriptions, respectively. Base cream as a dilutional vehicle was prescribed in 11.2% (11/98) and 32.4% (12/37) prescriptions containing hydrocortisone acetate 1% cream and betamethasone valerate 0.1%, respectively. In few instances two corticosteroids were concomitantly prescribed.

Conclusion: Prescribing moderate-to-potent topical preparations in approximately half of the infants, co-prescription of multiple corticosteroid preparations, omission of important components of prescription, and resorting to the controversial vehicle diluting technique suggest that topical corticosteroid therapy is sub-optimal. In infants, topical corticosteroids should be rationally prescribed. Establishing the treatment guidelines, pharmacovigilance programme and revision of the primary care essential drug list are needed in Bahrain.