Pediatric Use of Off-Label Medicines and Nonevidence-Based Supplements for COVID-19: Findings From the 2015 Pelotas Birth Cohort Study (Brazil).

PURPOSE: Pediatric off-label medicine use increased during the COVID-19 pandemic, exposing children to nonevidence-based treatments. We described the use of nonevidence-based COVID-19 medicines and supplements among children from the 2015 Pelotas Birth Cohort, according to sociodemographic and health-related characteristics.

METHODS

Data from the 6-7-year follow-up were analyzed. Mothers/caregivers reported children's use of nonevidence-based medicines (azithromycin, chloroquine/hydroxychloroquine, ivermectin, nitazoxanide) and supplements (vitamin C, vitamin D, and zinc) along with sociodemographic and health-related characteristics. Two scores were analyzed: (1) child's COVID-19 burden score (considering negative experiences such as death or separation from a close person due to COVID-19, and risk factors such as living with older adults or having asthma, bronchitis, or obesity) and (2) preventive behavior score (limited outdoor exposure during COVID-19 and vaccine uptake against COVID-19). Hierarchical logistic regression analyses were used to identify factors associated with nonevidence-based medicine and supplement use.

RESULTS

Among 3098 children interviewed after COVID-19 vaccines became available in the municipality, 13.9% (95% CI 12.7-15.2) used nonevidence-based medicines and supplements for COVID-19. Overall, the use of nonevidence-based medicines and supplements increased with higher COVID-19 burden scores and decreased with higher preventive behavior scores. Unvaccinated children had 2.57-fold higher odds of using off-label medicines than vaccinated children.

CONCLUSIONS

These findings highlight behavioral responses during a health emergency and suggest that public health policies should strengthen evidence-based risk communication and discourage inappropriate medicine use during future health emergencies.