Khan Zakir, Karataş Yusuf, Kıroğlu Olcay
Department of Pharmacology, Institute of Health Sciences, Faculty of Medicine, Cukurova University, Adana, Turkey.
Pharmacovigilance Specialist, Balcali Hospital, Faculty of Medicines, Cukurova University, Adana, Turkey.
Front Pharmacol. 2021 Nov 12;12:786182. doi: 10.3389/fphar.2021.786182. eCollection 2021.
Drug safety in paediatric patients is a serious public health concern around the world. The paediatric patients are more prone to adverse drug reactions (ADRs) than adults. Moreover, there is a scarcity of information about ADRs in paediatric patients. This study was conducted to determine the frequency, causality, severity, preventability of paediatric patients' ADRs reported in a tertiary care hospital in Adana, Turkey. A retrospective study was conducted on all spontaneously reported ADRs between January 01, 2020, to July 30, 2021, in paediatric patients. The ADRs reports were evaluated in terms of gender, age, ADR characteristics, suspected drugs and reporting source. All included ADRs reports were characterized according to the Naranjo Algorithm/World Health Organization (WHO) causality scales, Hartwig/Siegel and Common Terminology Criteria for Adverse Events (CTCAE) severity scales, the modified Schoumock and Thornton preventability scale and hospital pharmacovigilance center criteria for seriousness. Therapeutic groups were also coded using the WHO-Anatomical Therapeutic and Chemical (ATC) classification. During the study period, 8,912 paediatric patients who were admitted had 16 ADRs with 1.7 ADRs/1,000 admissions. The majority of ADRs were found in infants (31.2%) and children (56.2%) as compared to adolescents (12.5%). ADRs were observed more in females (81.2%) than males. Skin (62.5%) was the most affected organ due to the ADRs, and maculopapular rash and erythema multiforme were the most commonly reported symptoms. Most ADRs were probable/likely (93.7%), severe (50%), preventable or probably preventable (43.7%) and serious (37.5%). Antibiotics (93.7%) were found to be the most common cause of ADRs in paediatric patients. The majority of ADRs were associated with vancomycin (68.7%). Most of the ADRs were reported by a medical doctor in this study. This small sample size study highlights significant problems of ADRs in paediatric patients, mainly caused by antibiotics and with a majority of ADRs manifest as skin reactions. Furthermore, a high proportion of the identified ADRs were found to be preventable. More focused efforts are needed at the national level to avoid preventable ADRs in hospitals. Monitoring and management of ADRs and future studies would be beneficial for better patient care and safety.
儿科患者的药物安全是全球严重的公共卫生问题。儿科患者比成人更容易发生药物不良反应(ADR)。此外,关于儿科患者药物不良反应的信息匮乏。本研究旨在确定土耳其阿达纳一家三级医院报告的儿科患者药物不良反应的发生率、因果关系、严重程度和可预防性。对2020年1月1日至2021年7月30日期间儿科患者所有自发报告的药物不良反应进行了回顾性研究。对药物不良反应报告进行了性别、年龄、不良反应特征、可疑药物和报告来源方面的评估。所有纳入的药物不良反应报告均根据纳朗霍算法/世界卫生组织(WHO)因果关系量表、哈特维希/西格尔量表和不良事件通用术语标准(CTCAE)严重程度量表、改良的舒莫克和桑顿可预防性量表以及医院药物警戒中心严重性标准进行特征描述。治疗组也使用WHO解剖学治疗学及化学分类法(ATC)进行编码。在研究期间,8912名入院的儿科患者发生了16例药物不良反应,发生率为1.7例/1000次入院。与青少年(12.5%)相比,大多数药物不良反应发生在婴儿(31.2%)和儿童(56.2%)中。女性(81.2%)的药物不良反应发生率高于男性。皮肤(62.5%)是受药物不良反应影响最严重的器官,斑丘疹和多形红斑是最常报告的症状。大多数药物不良反应可能/很可能发生(93.7%)、严重(50%)、可预防或很可能可预防(43.7%)且严重(37.5%)。抗生素(93.7%)被发现是儿科患者药物不良反应最常见的原因。大多数药物不良反应与万古霉素有关(68.7%)。在本研究中,大多数药物不良反应是由医生报告的。这项小样本研究突出了儿科患者药物不良反应的重大问题,主要由抗生素引起,且大多数药物不良反应表现为皮肤反应。此外,发现很大一部分已识别的药物不良反应是可预防的。国家层面需要做出更有针对性的努力,以避免医院中可预防的药物不良反应。药物不良反应的监测和管理以及未来的研究将有助于更好地保障患者护理和安全。