Adverse Drug Reactions Across the Age Continuum: Epidemiology, Diagnostic Challenges, Prevention, and Treatments

Abstract

Adverse drug reactions (ADRs) are common and important complications of drug therapy for children. The risk for ADRs changes over childhood, as do the nature and types of ADRs. Importantly, the risk and nature of ADRs in children are markedly different from those of adults, and adult data cannot be relied on to guide safe drug therapy in children. There are groups of children, notably those with complex and chronic diseases, who are at substantial risk for ADRs. The evaluation of an undesired effect during therapy is ideally accomplished by an organized approach that is a skill that clinicians who care for children—especially those children at high risk for ADRs must have. Additionally, clinicians as well as drug regulatory agencies and industry need to be both vigilant and astute as well as aware that ADRs in children are often different in nature and frequency from those in adults. The increasing use of pharmacogenomics to guide drug dosing and the increasing number of biological agents will provide new sets of challenges to clinicians over the next decade.

Serious adverse drug reactions at two children’s hospitals in South Africa

“…Although an association between serious ADR occurrence and sex was found in the majority of studies included in the 2012 paediatric systematic review [4], we did not find any such association in this survey. Regarding associations with age, the association between ADR occurrence and prematurity which is attributable to reduced drug metabolism and clearance is also well established [26]. Previous hospital-based surveys in the United Kingdom [18,27], United States [17], and in sub-Saharan Africa [20] have also, similar to our finding, described an association between ADR occurrence and later childhood.…”

Incidence, preventability, and causality of adverse drug reactions at a university hospital emergency department

“…ADRs are known to cause serious health problems and even deaths in every health care setting [1][2][3]. Frequencies of ADRs range widely between studies from 3.6 to 61% in hospitalized patients [4,5].…”

“…As these risks are well recognized, information regarding adverse effects in various subgroups or settings is found in many studies [1][2][3][11][12][13]. There is, however, no recent study about ADRs in tertiary care.…”

“…At a university hospital level, risks causing ADRs are usually well-known and avoidable risks should be quite few. Moreover, there is a lot of enthusiasm and expectations concerning the use of pharmacogenetic testing to help the clinicians to select the right drug and dose for each patient [3].Therefore, we evaluated which drugs were related to ADRs in our hospital at the emergency units covering internal medicine, surgery, neurology, and pulmonology during 6 months and what were the ADRs that they caused. Furthermore, we analyzed whether these risks could have been avoided and whether the use of pharmacogenetics would have helped in avoiding any of these cases.…”

Developmental Pharmacotherapy: The Interface Between Ontogeny and Drug Effect

“…Safety is of paramount importance in the development of clinically useful, broad‐platformed drug formulations when administered to patients of all ages and specifically to the pediatric patient. Rieder expertly reviews the classification, risk factors, burden, and ontogenic influences on adverse drug reactions in children and offers a thoughtful, methodical approach, the “five A's,” to consider when assessing the possibility/probability of an adverse event within the context of drug therapy. The nature of adverse drug reactions changes as the child grows and may manifest differently than in adults.…”