Exemplar comments received from the Delphi panel on rejected indicators
| Rejected following round 1 Indicator Rationale | Comments |
|---|---|
| Domperidone should not be prescribed to children under 1 year, and for children over 1 year, it should not be prescribed for more than 7 days. Efficacy in GORD and gastroenteritis is uncertain in this age group. Extrapyramidal side effects occur in young children. Can be used for short-term treatment of nausea and vomiting, maximum duration of use should not normally exceed 1 week. | ‘domperidone is not evidence based for little ones’ ‘would not prescribe…because of risk of extrapyramidal side effects’ ‘have used this longer term in many cases with no adverse effects But am aware of recent questions’ ‘efficacy of this drug is unproven, any drug which may mask symptoms or disease progression should never be prescribed for apparent gastroenteritis’ |
| Very potent or potent topical corticosteroids should not be prescribed to children under 1 year Topical corticosteroids can cause adrenal suppression and Cushing's syndrome. | ‘occasional use necessary- if a child can't sleep won't grow…’ ‘very rare situations this might be appropriate’ ‘agree unless prescribed by a consultant’ ‘if child has severe eczema they may be needed for a short period of time’ ‘possibly under dermatology guidance for rare severe eczema’ |
| Rejected following round 2 Indicator Rationale | Comments |
| Other than in children with asthma, systemic corticosteroids should not be prescribed to children aged 5–15 years. Systemic corticosteroids can cause serious side effects including adrenal suppression, immunosuppression and mood disturbances. In the general paediatric population, there are few indications for systemic corticosteroids apart from asthma and croup. Croup commonly affects children under 5 years | ‘Agree unless there is a clinical indication such as flare of juvenile rheumatoid arthritis’ ‘Exceptions being serious diseases where specialists might prescribe. e.g, glomerulonephritis’ ‘there are relatively rare indications for systemic steroids in children- they would always be initiated by a specialist’ |
| Long-acting β agonists (LABAs) should not be prescribed to children under 5 years. Use of LABAs is associated with increased risk of asthma exacerbations, hospitalisations and asthma-related deaths in children and adults. It is not known if combination use with inhaled corticosteroids reduces this risk. | ‘Not recommended by the British thoracic guidelines in under 5′s’ ‘Lack of fear of their pernicious side effects plus a lack of understanding of the definition of asthma is to blame’ ‘The Cochrane review summary that is attached says that LABA does not significantly decrease exacerbations or hospitalisations as opposed to your statement of increasing the risk based on the SMART trial’ ‘I have seen evidence of poor response to short acting bronchodilators in those on long acting bronchodilators’ |
GORD, Gastro-oesophageal reflux disease; LABA, long-acting β agonists; SMART, Salmeterol Multicenter Asthma Research.