Polypharmacy in critically Ill children: A prospective cross-sectional study from a Tertiary PICU in Pakistan.

Abstract

Objective: To determine the frequency and patterns of polypharmacy from the PICU of a tertiary care children’s hospital in Karachi, Pakistan. Study Design: Prospective Cross-sectional Observational study. Setting: PICU at Korangi Children Hospital, Karachi, Pakistan. Period: Three months: March–May 2025. Methods: All admitted children aged 1 month to 15 years were included. Patients with PICU stay of less than 48 hours were excluded. Data on clinico-demographic characteristics and prescribed medications were collected. Polypharmacy was defined as ≥5 medications, while hyper-polypharmacy was defined as ≥10. Descriptive statistics were used to summarize demographics, prescribing patterns, and the frequency of polypharmacy. Results: Among 499 patients included in the analysis, polypharmacy was observed in 46.9% of patients, while 26.3% had hyper-polypharmacy. The median number of medications per patient per day was 7 (interquartile range 4-10). Anti-infective agents were the most prescribed class of drugs; ceftriaxone (41%) and meropenem (15%) were the most frequently used. Other commonly prescribed drug classes included sedatives, vasoactive agents, and corticosteroids. Most medications were administered intravenously. Conclusion: Polypharmacy is highly prevalent among critically ill pediatric patients in this setting. These findings highlight the need for rational prescribing practices, pharmacovigilance, and the integration of clinical pharmacists into PICU care to optimize medication safety.