Práticas da adaptação de medicamentos orais sólidos para administração por sondas enterais em crianças com condições crônicas complexas: um estudo farmacoepidemiológico

Abstract

The administration of medications via enteral feeding tubes represents a challenge for physicians, nurses, pharmacists, and caregivers, especially given the shortage of liquid formulations, which leads to the adaptation of solid pharmaceutical forms. In this context, this study aimed to characterize the prescription profile of medications with adaptation of the solid pharmaceutical form and the factors associated with dose adjustment for administration through enteral tubes in children with complex chronic conditions. This is a pharmacoepidemiological, observational, descriptive study conducted through retrospective analysis of medical prescriptions from January 2023 to December 2024. The research was conducted in a pediatric hospital of the Unified Health System and teaching hospital, located in Fortaleza/CE. The sample consisted of 109 patients, including infants, children, and adolescents. Categorical variables were described using percentage counts, and numerical variables were described using standard deviation, mean, and median. The three groups were analytically evaluated for normality using the nonparametric Kruskal-Wallis test, followed by post-hoc paired analyses using Dunn's test. Statistical significance was defined as p < 0.05 for all tests. All statistical analyses were performed using Prism© 2026 GraphPad Software. The study was approved by the Research Ethics Committees of the Federal University of Ceará and Albert Sabin Children's Hospital. Our results showed a variation in age group, with a predominance of males (59%) and children (47%). The The most prevalent diagnoses were neurological and/or neuromuscular conditions (63.0%). All patients depended on an alternative route for drug administration, 55% had gastrostomy, and 45% used a nasoenteric tube. Tracheostomy was present in 48% of patients. Polypharmacy was observed in all groups analyzed, with a higher average in adolescents (6 medications). Simple tablets were the most frequent pharmaceutical form dispensed and administered (79.0%). There was a high recommendation for splitting oral disintegration tablets (93.91%) and coated tablets (51.25%). The need to split tablets and adjust doses due to this practice was greater for infants p<0.0001 and children p 0.0076. We found that there is a statistically significant association between the need to modify the pharmaceutical form and the age group of patients, and we can also verify that there are no clear guidelines regulating this practice, although recommendations for this practice are frequent. Thus, it is strongly recommended that pharmacists educate healthcare professionals and caregivers about when the adaptation of solid pharmaceutical forms becomes an acceptable and safe practice.