COMMENTARY

5 Best of 2017: Pediatrics Viewpoints

William T. Basco, Jr., MD

Disclosures

December 28, 2017

In This Article

Outpatient Pediatric Adverse Drug Events

This study[6] sought to describe the patterns and drugs involved in outpatient adverse drug events (ADEs) by examining 2013-2014 data from the National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance Project, which collates ADEs from a stratified national sample of hospital emergency departments (EDs). The mechanism of ADE, such as dosing or scheduling error, route error, incorrect drug administration, ingestion, or allergic reaction, was recorded for each event.

Among all children, the most frequent ADE (37%) was a supratherapeutic effect from taking an appropriate dose or an excess dose; allergic reactions (28%) were next in frequency, and "other" ADEs (26%) were third. Unsupervised ingestion of a drug (5%) was substantially less common.

One fourth of the ED visits for ADEs resulted in a hospitalization. Among children aged 19 years or younger, antibiotics were among the most frequent drugs associated with ADEs, led by amoxicillin at 21.5% of ADEs. The second most common category associated with ADEs was psychoactive drugs. Two substances each accounted for about 1% of childhood ADEs: methylphenidate and risperidone. Vaccines accounted for 19.5% of ADEs for children aged 5 years or younger and 3.7% of ADEs for those aged 6-19 years. Opioid analgesics accounted for 0.6% of ADEs for children aged 5 years or younger and 3% for those aged 6-19 years.

Viewpoint

So many of the "take-home messages" of this study are pertinent to daily practice. Antibiotics are the most common drugs prescribed to children, and as a class, they contributed to the greatest proportion of ADEs in this study, offering another reason to prescribe antibiotics judiciously. For children younger than 6 years, vaccines accounted for 1 of every 5 ADEs, so we should not lose sight of complications associated with these commonly administered agents. The high relative contribution of antipsychotics to ADE rates emphasizes the need to closely monitor children for whom these drugs are prescribed. Finally, inadvertent ingestion of drugs accounted for almost 5% of ADEs among all children, pointing out the need to remind parents about safe drug storage.

Pediatric Viewpoints

A Musing Pediatrician

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