Do GPs always prescribe medications that are appropriate for children?

[imaginaryfriend]

Dd's got a dreadful skin problem which may or may not be eczema. She's had a sackful of creams and antibiotics over the last six months and is waiting to go into hospital for a skin biopsy by general anaesthetic.

That's a potted history. While waiting for the biopsy the GP has just now prescribed her Metronidazole cream to use on her face. But I noticed on the instruction booklet that came with it, it says in large letters 'do not use on children'.

Should I stop using it imemdiately or trust the GP?

Hmm they dont always get it right, but it may be because children have thinner skin than adults, if she has it bad then it may be necessary.

IME a high percentage of GPs don't know their arses from their elbows and in many cases mums know best.

your GP prescribed it having seen your DD and knowing her age presumably ... if you are concerned can you call your GP on Monday or speak to NHS Direct

It was slightly convoluted, the prescribing process, because my GP was prescribing on the recommendations of the dermatologist at Guy's Hospital that she's been seeing. GP phoned the dermatologist for advice and spoke to the on-call guy who told her to give dd this cream.

tbh, I think there are some medicines that haven't been tried on enough children to establish they are 100% safe - however, that doesn't mean that they aren't or shouldn't be prescribed iyswim. But I think you should have been told about it if that's the case.

It was kind of an emergency - dd had reacted badly to the oral antibiotics but clearly needed something antibiotic to help.

yes, was going to say - often consultants prescribe drugs like that. Because they get to see the small percentage of children who aren't responding to the 'normal' creams, they are more experienced at prescribing 'other' drugs. I think you should have been consulted about it though.

HI fox. As you see it's still going on - dd's face got so bad this week and her eyes and eyelids became infected too. The GP didn't know what to do so phoned the dermatologist, couldn't get the one dd sees so had to ask the on-call guy who's never actually seen dd.

Gawd, I hate the hospital / medical system in London. It's way too busy, there's no personal care at all.

Yes, obviously, it's dd's little face that they're messing with so I do need to know if they're 'experimenting' with something don't I?

yes, I think so. It may be no big deal to them (prescribing it) but they need to keep you in the loop, definitely.

Oh if, I'm so so sorry things are so bad. When are they going to do the biopsy?

if you google "metronidazole cream children" you come up with lots of references, so it looks like it is used in children pretty regularly.

If it has been suggested by a drematologist, I would say it's OK.

nipping off for a bit now, will check in later.

I would phone a pharmacist

they have the reference books to check and can put your mind at rest, or otherwise

Lots of medicines aren't licensed in children just because they haven't been tested on them in the drug trials that products must go through. That doesn't mean it isn't safe though. Tbh I don't think that I've prescribed metronidazole cream for a child but I can look in the British National Formulary for Children tonight at work and check for you if you want though I would really think that if a dermatologist prescribed it knowing your dd's age then it will be fine.

I should think it will be OK.

It will be unlicensed (used off-label I think is the term) for use in children. Many drugs prescribed by hospital consultants are unlicensed for children.

That's a good idea, Franny.

Thanks Ladidadi I'd appreciate it if it's not a nuisance. You know, you say that, but when we last saw the dermatologist and he prescribed oral antibiotics he prescribed her an adult dose and it was only the dilligence of the pharmacist at the hospital that noticed and phoned through to check with dermatology and they adjusted the dose.

The reason for this is that it is near impossible to set up a clinical trial for a drug, on children. Quite understandably.

However we do need to use drugs on children. Doctors will often have a great deal of information on the use of a specific drug on kids, that they have amassed over a long period of time. This sort of 'off licence' use is not uncommon.

The doctor knows that he or she will be held responsible for any untoward effects and this makes the majority of them very careful. If the GP wsa prescribing on the recomendation of a consultant dermatologist you can be fairly confient that this is something that has been donw in the past.

dd has had unlicensed drugs all her life. They're the only reason she's still here.

Hope your GP/consultant can put your mind at rest imaginary friend.

Ok, thanks everyone, I think I'll stop worrying now!

Looked it up in BNF for children and it's fine, lots of different topical metronidazole preparations are listed .

Thank you. I've been googling it too and it seems to be quite widely used. I just panicked when I saw that note in the prescription packet. Her skin's been such a mess and is so infected at the moment that the thought of irritating it further is too much.