Journal List > Allergy Asthma Respir Dis > v.6(5) > 1102179

Kim, Choi, Lee, Nam, and Jung: Analysis of pediatric adverse drug reactions reported to regional pharmacovigilance center of a single university hospital

Abstract

Purpose

Adverse drug reactions (ADRs) are a recurring problem among pediatric patients, and the incidence is increasing. How-ever, there have been only a few studies on the clinical presentation of pediatric ADRs in Korea. This study investigated the clinical presentation of ADRs and the causative drugs in pediatric patients from a single university hospital.

Methods

We retrospectively collected the data on pediatric ADRs as reported to the Regional Pharmacovigilance Center in Dong-A University Hospital between March 2013 and July 2016. We analyzed clinical presentations associated with the events. To determi-nate causality, we evaluated each ADR according to the Naranjo probability scale, the World Health Organization-Uppsala Monitoring Centre (WHO-UMC) criteria and the Korean ADR algorithm.

Results

A total of 365 ADR cases were reported. Sixty-eight patients (26.5%) responded to 2 or more drugs. Antibiotics (43.3%) were the most common causative drugs, of whom the third generation cephalosphorins caused most ADRs. The most common clinical presentations were gastrointestinal manifestations (36.6%). A total of 312 ADRs were reported in 257 patients based on both the Naranjo probability scale and the Korean ADR algorithm. In addition, 323 ADRs were reported in 257 patients based on the WHO-UMC criteria.

Conclusion

Various drugs are related to ADRs in pediatric patients. Further efforts to improve ADR-reporting systems and to increase awareness of ADRs in pediatric patients are needed.

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Fig. 1.
Causality assessment of adverse drug reactions by Naranjo's scale, WHO-UMC, and Korean algorithm, respectively. WHO-UMC, World Health Organization-Uppsla Monitoring Centre.
aard-6-263f1.tif
Table 1.
Demographic data of the study subjects
Variable No. of reports (%)
No. of reports  
 Present symptoms 331 (90.7)
 Past symptoms 34 (9.3)
No. of suspected drug  
 1 189 (73.5)
 ≥2 68 (26.5)
Sex  
 Male 162 (63)
 Female 95 (37)
Route of report  
 Ward 308 (84.4)
 Outpatient Department 33 (9.0)
 Emergency Department 24 (6.6)
Reporter  
 Nurse 299 (81.9)
 Doctor 62 (17.0)
 Pharmacist 4 (1.1)
Route of administration  
 Intravenous 271 (74.3)
 Oral 83 (22.7)
 Intradermal 7 (1.9)
 Inhalers 3 (0.8)
 Sublingual 1 (0.3)
Table 2.
Frequency of drug to cause the adverse reactions by age distribution
Age (yr) No. of reports (%)
0–1 5 (1.4)
 Antibiotics 3
 Anticholinergics 2
2–6 47 (12.9)
 Antibiotics 30
 NSAIDs 4
 Sedatives 2
7–12 90 (24.7)
 Antibiotics 44
 NSAIDs 9
 Radiocontrast media 4
13–18 223 (61.1)
 Antibiotics 81
 Narcotics 39
 NSAIDs 36

NSAIDs, nonsteroidal anti-inflammatory drugs.

Table 3.
Frequency of drug to cause the adverse reactions
Variable No. of reports (%)
Antibiotics 158 (43.3)
 1st generation cephalosporins 29
 2nd generation cephalosporins 13
 3rd generation cephalosporins 49
 Penicillin 13
 Vancomycin 12
 Clindamycin 8
 Others 34
NSAIDs 49 (13.4)
Narcotics 39 (10.7)
Anesthetics 15 (4.1)
Vitamins and amino acids 12 (3.3)
Radiocontrast media 11 (3.0)
Anticonvulsants and psychotropic drugs 9 (2.5)
Antiinfectives 9 (2.5)
Antiulcerants 8 (2.2)
Steroids and immunosuppressive drug 7 (1.9)
Respiratory medicines 6 (1.6)
Antineoplastic agent 5 (1.4)
Anticholingergic drugs 5 (1.4)
Sedatives 5 (1.4)
Muscle relaxant 4 (1.1)
Gastrointestinal regulator 4 (1.1)
Vaccines 2 (0.5)
Others 17 (4.7)
Total 365 (100)

NSAIDs, nonsteroidal anti-inflammatory drugs.

Table 4.
Clinical manifestation and severity of adverse drug reaction
Variable No. of reports (%)
Clinical manifestations  
 Gastrointestinal (nausea, vomiting, diarrhea, abdominal pain) 155 (36.6)
 Skin (urticaria, itching, skin eruption, angioedema) 128 (30.3)
 Neurologic (dizziness, anxiety, headache, behavioral disorder) 54 (12.8)
 Cardiovascular (hypotension, palpitation, arrhythmia, shock) 25 (5.9)
 Respiratory (dyspnea, chest tightness, coughing, wheezing) 10 (2.4)
 Anaphylaxis 7 (1.7)
 Hematology (thrombocytopenia, pancytopenia, neutropenia) 6 (1.4)
 Others 38 (9.0)
Severity  
 Mild 264 (76.8)
 Moderate 81 (22.2)
 Severe 4 (1.0)
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