Paediatric off label prescribing in primary care is common and widespread throughout the UK, affecting up to 26% of children aged 0-16 years of age and is due primarily to the prescription of licensed medicines out with their dosage recommendations [1].

Although the problem of unlicensed and off label paediatric prescribing is well recognised by both individual researchers, official organisations, and the pharmaceutical industry, little is known about the level of knowledge, attitudes and experiences of primary care physicians towards paediatric off label prescribing.

A 13 point questionnaire, comprised of a combination of tick box, ranked 5 point scale, and free text responses were sent to 80 randomly selected Scottish primary care practices. Topics covered included prior knowledge of off label prescribing and licensing recommendations, knowledge of and perceived problems with off label prescribing, prescribing information sources used, and proposed methods for reducing off label prescribing. Three hundred and forty-six questionnaires were sent out and 202 (58%) returned completed. Over 70% of GPs admitted to being at least familiar with the concept of off label prescribing, and approximately 40% to knowingly prescribing medicines in this way. The most important sources of paediatric prescribing information were the BNF (81%), personal experience (71%) and previous prescription notes (45%). GPs reported their most common reason for off label prescribing to be prescribing for a younger age than recommended, frequently on the advice of a hospital paediatrician. However published evidence from these primary care practises suggests that dose is the most important and age one of the least important reasons for off label prescribing. When asked to comment upon specific examples of those medicines and reasons/situations which commonly give rise to off label prescribing, approximately 80% of GPs expressed appropriate concern and awareness of the medicines and causes for such off label prescribing. Although 31% of GPs claimed a special interest in paediatrics there were no differences between their and their colleagues responses. Over 97% of GPs ranked the development of appropriate formulations for children and more consistent and clearer dosage information more highly than fostering clinical trials as a means to reducing the levels of off label prescribing.

Despite high levels of off label prescribing in primary care practice in the UK, the majority of GPs admitted to being familiar with the concept of off label prescribing, although less than half are aware that this practice is widespread. Despite published evidence to the contrary few admitted prescribing medicines outside the dosage recommendations. A disparity between perceived and actual reasons for off label prescribing in primary care was noted, possibly due to a reliance on personal experience, colleague experience or previous patient prescription notes as a guide to future prescribing.