Despite the appropriate phenytoin concentration in the capsules, the patient presented with phenytoin toxicity. This toxicity likely resulted from the drug interaction between phenytoin and valproic acid that leads to phenytoin displacement from plasmatic proteins and inhibits phenytoin metabolism, thereby increasing the concentration of free drug in the serum.

Objectives:The objectives of this study were to analyze adverse drug events (ADEs) related to admissions to a pediatric emergency unit and to identify the associated risk factors.Methods: This was a prospective study. Demographic data and details of medications were collected for each patient admitted. Case studies were performed by clinical pharmacists and the clinical team to discuss whether the admission was due to an ADE and to characterize the ADE. Multivariate logistic regression was used for statistical analysis.Results: In total, 1708 pediatric patients were included in this study. Adverse drug events were the cause of hospital admission in 12.3% of the studied population. The majority of patients presenting with an ADE were in the age group of 0 to 5 years (61.6%), had a mean ± SD age of 4.9 ± 3.9 years, were female (51.2%), were Caucasian (72.0%), and had infectious disorders (49.3%). High frequencies of medication errors (68.8%), use of drugs to treat respiratory disorders (27.7%), and ADEs of mild severity (75.3%) were reported. The risk of being admitted to the pediatric emergency unit for any ADE increased in cases of neurological (odds ratio [OR], 4.63; 95% confidence interval [CI], 2.38-8.99), dermatological (OR, 3.16; 95% CI, 1.93-5.18), and respiratory (OR, 3.02; 95% CI, 1.89-4.83) disorders. Conclusions:A high frequency of ADE-related admissions to the pediatric emergency unit was observed. The risk of being admitted to the pediatric emergency unit for any ADE increased in cases of neurological, dermatological, and respiratory disorders. Clinical pharmacists play an important role in the identification of ADEs and the education of child caregivers and health care providers concerning pediatric medication.

Background Paediatric patients are one of the most vulnerable patient populations. There are many unlicensed medicines and the so-called ‘off-label’ uses for which they are prescribed may increase the risk of drug-related problems (DRPs) such as lack of efficacy and adverse drug reactions (ADRs). Purpose The objective of this study is determine the incidence of DRPs for patients admitted to the hospital's paediatric emergency unit, and provide information about drug use, with the intention of improving the rational use of medicines. Materials and methods A prospective observational study took place in July to September 2011. Pharmacists interviewed the people who were responsible for children up to 15 years old, without race restrictions, from both sexes, to obtain information about medicines the children had been taking. The results were evaluated and the DRPs were related to the admission to the hospital emergency paediatric unit of the State University Hospital of Campinas (UNICAMP). The DRPs obtained were classified as ineffective treatment, ADRs, inappropriate use, compliance, poisoning, drug interactions and technical defects. Results The authors interviewed 348 patients or those responsible for them and the proportion of hospital admissions due to DRPs was 14.7% (51 patients). Among the DRPs identified, 23 (45.1%) were due to ineffective treatment, 11 (21.6%) due to ADRs, 9 (17.6%) to inappropriate use, 4 (7.8%) to non-compliance, 2 (3.9%) to intoxication, 1 (2%) to a technical defect and 1 (2%) to a drug interaction. The respiratory and gastrointestinal systems were the most commonly affected organs, and antipyretics/analgesics were the drugs most commonly associated with ADRs. Conclusions This data may be used to construct the epidemiology profile of paediatric patients, showing that there is a high incidence of DRPs that cause hospitalisation. More study is necessary in both pharmacoepidemiology and pharmacovigilance in the paediatrics area to understand the DRPs involved and improve the use medicines in children.

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