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

Abstract

ABSTRACT 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.