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Oral corticosteroids are often used to treat inflammatory conditions such as asthma, croup, and rheumatologic conditions. Both short-term and long-term use of these drugs can create problems, such as increased risk of infection, impaired growth and bone abnormalities, cataracts, and development of depression, anxiety, and aggressive behavior. Nevertheless, if Tennessee is any indication, use of oral steroids among Medicaid-insured children is common, concludes a study supported by the Agency for Healthcare Research and Quality (HS10384). Findings show that 7 percent of children insured by TennCare, Tennessee's managed health care program for Medicaid-eligible or uninsured people, had at least one oral corticosteroid prescription filled in 1998.
Providers should ensure that use of these potentially dangerous drugs is warranted for individual children. Children should be monitored closely for infections, slowing of growth, ophthalmologic problems, and psychiatric complications. Close monitoring is especially important for chronic users (four or more short courses of corticosteroids in 1 year) who have other chronic health conditions that place them at risk for complications, cautions Wayne A. Ray, Ph.D., of Vanderbilt University.
Dr. Ray and his colleagues studied prescriptions filled for oral corticosteroids in 1998 by 400,724 TennCare-insured children and files of medical encounters temporally related to the index prescription. The rate of corticosteroid use among children birth to 2 years of age was three to four times that of older children, and use was more common among white and rural children than it was among black and urban children. About 80 percent of new users had a possible indication for steroid use, with asthma being the most common indication. About one child in five (22 percent) had an unknown indication for corticosteroid use.
More details are in "Oral corticosteroid use among children in TennCare," by William O. Cooper, M.D., M.P.H., Judy A. Staffa, Ph.D., R.Ph., J. William Renfrew, M.S., and others, in the September/October 2002 Ambulatory Pediatrics 2(5), pp. 375-381.
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