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Shukla S, Sharma P, Gupta P, Pandey S, Agrawal R, Rathour D, Kumar Kewat D, Singh R, Kumar Thakur S, Paliwal R, Sulakhiya K. Current Scenario and Future Prospects of Adverse Drug Reactions (ADRs) Monitoring and Reporting Mechanisms in the Rural Areas of India. Curr Drug Saf 2024; 19:172-190. [PMID: 37132145 DOI: 10.2174/1574886318666230428144120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 03/13/2023] [Accepted: 03/20/2023] [Indexed: 05/04/2023]
Abstract
BACKGROUND Pharmacovigilance (PV) deals with the detection, collection, assessment, understanding, and prevention of adverse effects associated with drugs. The objective of PV is to ensure the safety of the medicines and patients by monitoring and reporting all adverse drug reactions (ADRs) associated with prescribed medicine usage. Findings have indicated that about 0.2- 24% of hospitalization cases are due to ADRs, of which 3.7% of patients have lethal ADRs. The reasons include the number of prescribed drugs, an increased number of new medicines in the market, an inadequate PV system for ADR monitoring, and a need for more awareness and knowledge about ADR reporting. Severe ADRs lead to enhanced hospital stays, increased treatment costs, risk of death, and many medical and economic consequences. Therefore, ADR reporting at its first instance is essential to avoid further harmful effects of the prescribed drugs. In India, the rate of ADR reporting is less than 1%, whereas worldwide, it is 5% due to a need for more awareness about PV and ADR monitoring among healthcare providers and patients. The main objective of this review is to highlight the current scenario and possible futuristic ways of ADR reporting methods in rural areas of India. We have searched the literature using PubMed, Google scholar, Indian citation index to retrieve the resources related to ADR monitoring and reporting in India's urban and rural areas. Spontaneous reporting is the most commonly used PV method to report ADRs in India's urban and rural areas. Evidence revealed that no effective ADR reporting mechanisms developed in rural areas causing underreporting of ADR, thus increasing the threat to the rural population. Hence, PV and ADR reporting awareness among healthcare professionals and patients, telecommunication, telemedicine, use of social media and electronic medical records, and artificial intelligence are the potential approaches for prevention, monitoring, and reporting of ADRs in rural areas.
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Affiliation(s)
- Shalini Shukla
- Department of Pharmacy, Neuropharmacology Research Laboratory, Indira Gandhi National Tribal University (IGNTU), Amarkantak, Madhya Pradesh, India
| | - Priyanka Sharma
- Department of Pharmacy, Neuropharmacology Research Laboratory, Indira Gandhi National Tribal University (IGNTU), Amarkantak, Madhya Pradesh, India
| | - Priya Gupta
- Department of Pharmacy, Neuropharmacology Research Laboratory, Indira Gandhi National Tribal University (IGNTU), Amarkantak, Madhya Pradesh, India
| | - Shikha Pandey
- Department of Pharmacy, Neuropharmacology Research Laboratory, Indira Gandhi National Tribal University (IGNTU), Amarkantak, Madhya Pradesh, India
| | - Reshu Agrawal
- Department of Pharmacy, Neuropharmacology Research Laboratory, Indira Gandhi National Tribal University (IGNTU), Amarkantak, Madhya Pradesh, India
| | - Deepak Rathour
- Department of Pharmacy, Neuropharmacology Research Laboratory, Indira Gandhi National Tribal University (IGNTU), Amarkantak, Madhya Pradesh, India
| | - Dharmendra Kumar Kewat
- Department of Pharmacy, Neuropharmacology Research Laboratory, Indira Gandhi National Tribal University (IGNTU), Amarkantak, Madhya Pradesh, India
| | - Ramu Singh
- Department of Pharmacy, Neuropharmacology Research Laboratory, Indira Gandhi National Tribal University (IGNTU), Amarkantak, Madhya Pradesh, India
| | | | - Rishi Paliwal
- Department of Pharmacy, Nanomedicine and Bioengineering Research Laboratory (NBRL), Indira Gandhi National Tribal University, Amarkantak, India
| | - Kunjbihari Sulakhiya
- Department of Pharmacy, Neuropharmacology Research Laboratory, Indira Gandhi National Tribal University (IGNTU), Amarkantak, Madhya Pradesh, India
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Bigi C, Tuccori M, Bocci G. Healthcare professionals and pharmacovigilance of pediatric adverse drug reactions: a 5-year analysis of Adverse Events Reporting System Database of the Food and Drug Administration. Minerva Pediatr (Torino) 2022; 74:272-280. [PMID: 28211644 DOI: 10.23736/s2724-5276.17.04733-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of this study was to analyze the Adverse Events Reporting System (AERS) Database of the Food and Drug Administration (FDA), investigating the characteristics of pediatric adverse drug reactions (ADRs) and describing the effective participation of healthcare professionals in the reporting activity. METHODS Reports of ADRs were obtained from the FDA website. Only ADRs in pediatric subjects (divided by age, by country and by professional category) were included into the analysis. The drugs suspected as primary cause of the ADRs in pediatric subjects and their principal anatomic group according to the Anatomical Therapeutic Chemical Classification system were considered. To classify the ADRs, the Medical Dictionary for Regularity Activities terminology was adopted. RESULTS Between 2008 and 2012, FDA collected 113,077 ADRs in pediatric patients. Of the total pediatric ADR reports, those performed by medical doctors were 32%, followed by consumers (26%) and healthcare professionals (25%). Most of the ADR reports were related to the adolescent group (39%). Healthcare professionals resulted the category with the highest rate of ADR reports in neonates and infants. Drugs acting on nervous system and antineoplastic/immunomodulating agents were the most involved the pediatric ADR reports. Pyrexia, convulsion, vomiting and accidental overdose were the reactions more reported both from healthcare professionals and medical doctors. CONCLUSIONS The present study describes the pediatric ADR reports of the FDA database through healthcare professional's perspective, describing the various aspects of pediatric pharmacovigilance.
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Affiliation(s)
- Caterina Bigi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.,Barking, Havering and Redbridge University Hospital, NHS Trust, London, UK
| | - Marco Tuccori
- Unit of Adverse Drug Reactions Monitoring, University Hospital of Pisa, Pisa, Italy
| | - Guido Bocci
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy -
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Feyissa Mechessa D, Dessalegn D, Melaku T. Drug-related problem and its predictors among pediatric patients with infectious diseases admitted to Jimma University Medical Center, Southwest Ethiopia: Prospective observational study. SAGE Open Med 2020; 8:2050312120970734. [PMID: 33240498 PMCID: PMC7675898 DOI: 10.1177/2050312120970734] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 10/13/2020] [Indexed: 11/17/2022] Open
Abstract
Background Drug-related problem is any event involving drug therapy that may interfere in a patient's desired clinical outcome. It has been pointed out that hospitalized pediatric patients are particularly prone to drug-related problems. Thus, this study aimed to assess drug-related problems and its predictors among pediatric patients diagnosed with infectious diseases admitted to Jimma University Medical Center, Southwest Ethiopia. Methodology A prospective observational study was conducted among pediatric patients with infectious diseases admitted to the Jimma University Medical Center. Drug-related problems were classified based on Cipolle, Morley, and Strand's drug-related problems classification method. The patient's specific data were collected using a structured questionnaire. Data were entered into Epi data version 4.0.2 and then exported to statistical software package version 21.0 for analysis. To identify predictors of drug-related problems occurrence, multiple stepwise backward logistic regression analysis was done. Statistical significance was considered at a p-value < 0.05. Results Of the total 304 participants, 226 (74.3%) of them had at least one drug-related problem during their hospital stay. A total of 356 drug-related problems were identified among 226 patients. Anti-infective medication was the major class of drug involved in drug-related problems. Noncompliance (28.65%) and dose too low (27.53%) were the most common type of drug-related problems identified. Presence of disease comorbidity (adjusted odds ratio = 3.39, 95% confidence interval = 1.89-6.08), polypharmacy (adjusted odds ratio = 3.16, 95% confidence interval = 1.61-6.20), and more than 6 days stay in hospital (adjusted odds ratio = 3.37, 95% confidence interval = 1.71-6.64) were independent predictors for the occurrence of drug-related problems.. Conclusion Drug-related problems were high among pediatric patients with infectious disease in the study setting. The presence of comorbidity, polypharmacy, and prolonged hospital stay were predictors of drug-related problems in this finding. Therefore, to prevent these problems, the collaboration of clinical pharmacists, pediatricians, and other health care professionals is needed during the provision of pharmaceutical care.
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Affiliation(s)
- Desalegn Feyissa Mechessa
- Department of Pharmacy, College of Medicine and Health Science, Mizan-Tepi University, Mizan-Aman, Ethiopia
| | - Dula Dessalegn
- Department of Clinical Pharmacy, School of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Tsegaye Melaku
- Department of Clinical Pharmacy, School of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
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Formica D, Sultana J, Cutroneo PM, Lucchesi S, Angelica R, Crisafulli S, Ingrasciotta Y, Salvo F, Spina E, Trifirò G. The economic burden of preventable adverse drug reactions: a systematic review of observational studies. Expert Opin Drug Saf 2018; 17:681-695. [PMID: 29952667 DOI: 10.1080/14740338.2018.1491547] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 06/18/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Adverse drug reactions (ADRs) are an important cause of morbidity and mortality worldwide. They are associated with healthcare costs due to hospital admissions or prolonged length of stay, as well as additional interventions. The aim of this study was to conduct a systematic review of observational studies to evaluate the economic impact of preventable ADRs. AREAS COVERED Published observational research investigating the cost of preventable ADRs in Western countries (limited to the USA and European countries). EXPERT OPINION Several reviews have been carried out in the field of the ADR epidemiology but fewer reviews have investigated the economic impact of ADRs, and at the time of writing, none has focused on preventable ADRs. The reason why future research should focus on the costs of preventable ADRs is that both the costs and the negative clinical outcomes are preventable, and as such, are a key point of public health policy action. Nevertheless, the present review highlights an important and sobering limitation of published research on the cost of preventable ADRs, of which the major limitation is the heterogeneity in methods and in reporting which limit what can be known through the summarizing work of a systematic review.
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Affiliation(s)
- D Formica
- a Unit of Clinical Pharmacology , AOU Policlinico "G. Martino" , Messina , Sicily , Italy
| | - J Sultana
- b Department of Biomedical and Dental Sciences and Morphofunctional Imaging , University of Messina , Messina , Sicily , Italy
| | - P M Cutroneo
- a Unit of Clinical Pharmacology , AOU Policlinico "G. Martino" , Messina , Sicily , Italy
| | - S Lucchesi
- c Department of Chemical, Biological, Pharmaceutical and Environmental Sciences , University of Messina , Messina , Sicily , Italy
| | - R Angelica
- b Department of Biomedical and Dental Sciences and Morphofunctional Imaging , University of Messina , Messina , Sicily , Italy
| | - S Crisafulli
- b Department of Biomedical and Dental Sciences and Morphofunctional Imaging , University of Messina , Messina , Sicily , Italy
| | - Y Ingrasciotta
- b Department of Biomedical and Dental Sciences and Morphofunctional Imaging , University of Messina , Messina , Sicily , Italy
| | - F Salvo
- d University of Bordeaux, Inserm, Bordeaux Population Health Research Centre, Pharmacoepidemiology Team , Bordeaux , France
- e CHU de Bordeaux, Pôle de Santé Publique , Service de Pharmacologie Médicale , Bordeaux , France
| | - E Spina
- a Unit of Clinical Pharmacology , AOU Policlinico "G. Martino" , Messina , Sicily , Italy
- f Department of Clinical and Experimental Medicine , University of Messina , Messina , Sicily , Italy
| | - G Trifirò
- a Unit of Clinical Pharmacology , AOU Policlinico "G. Martino" , Messina , Sicily , Italy
- b Department of Biomedical and Dental Sciences and Morphofunctional Imaging , University of Messina , Messina , Sicily , Italy
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Abstract
Objectives: To analyze clinical spectrum, seriousness, outcome, causality, severity and preventability of ADRs in geriatrics and pediatric patients. Materials and Methods: All ADRs reported in geriatrics (≥ 65 years) and pediatrics (≤ 12 years) indoor as well outdoor patients from January, 2010 to April, 2016 at ADR monitoring centre, Department of Pharmacology, B. J. Medical College and Civil Hospital were identified. A retrospective analysis was carried out for clinical presentation, causality (as per WHO-UMC scale and Naranjo's algorithm), severity (Hatwig and Seigel scale) and preventability (Schaumock and Thornton criteria). Results: Out of 3690 ADRs, 160 were in geriatric patients (4.33%) while 231 in pediatric patients (6.26%). The most commonly affected body system was gastrointestinal (53, 33.13%) followed by neurological disorders (26, 16.25%) in geriatric patients. While in pediatric patients, the most commonly affected body system was skin and appendages (73, 31.60 %) followed by gastrointestinal disorders (58, 25.11%). The most common causal drugs in geriatric patients was cardiovascular (38, 23.75%) followed by antimicrobials (28, 13.25%). While in pediatric patients, the most common causal drug group was antimicrobials (85, 33.46%) followed by blood products (36, 14.12%). Total 17 ADRs reported following vaccination, 7 (41.17%) were injection site abscess and 11 (64.70%) were due to pentavalent vaccine. Polypharmacy was common in geriatrics (31, 19.37%). Causality assessment for majority of ADRs in geriatrics (83, 52.5%) and pediatrics (171, 67.32%) were probable. Conclusion: ADRs are common in geriatric and pediatric patients usually within four weeks of oral therapy. Active surveillance of drug safety monitoring in these vulnerable population is recommended.
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Affiliation(s)
- Saloni Amin
- Department of Pharmacology, B. J. Medical College, Ahmedabad, Gujarat, India
| | - Samidh Shah
- Department of Pharmacology, B. J. Medical College, Ahmedabad, Gujarat, India
| | - Mira Desai
- Department of Pharmacology, B. J. Medical College, Ahmedabad, Gujarat, India
| | - Asha Shah
- Department of Medicine, B. J. Medical College, Ahmedabad, Gujarat, India
| | - K M Maheriya
- Department of Paediatrics, B. J. Medical College, Ahmedabad, Gujarat, India
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Harry M, Lebel D, Comtois A, Bussières JF. Détection et codification des effets indésirables médicamenteux dans un centre hospitalier universitaire mère-enfant. Arch Pediatr 2017; 24:1179-1187. [DOI: 10.1016/j.arcped.2017.09.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 08/03/2017] [Accepted: 09/17/2017] [Indexed: 10/18/2022]
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Ithnin M, Mohd Rani MD, Abd Latif Z, Kani P, Syaiful A, Nor Aripin KN, Tengku Mohd TAM. Mobile App Design, Development, and Publication for Adverse Drug Reaction Assessments of Causality, Severity, and Preventability. JMIR Mhealth Uhealth 2017; 5:e78. [PMID: 28559222 PMCID: PMC5470006 DOI: 10.2196/mhealth.6261] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 01/27/2017] [Accepted: 03/15/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Adverse drug reactions (ADRs) cause significant morbidity and mortality. Improved assessment of ADRs to identify the causal relationship, the severity, and the preventability will aid ADRs prevention or reduce patient burden. OBJECTIVE The aim of this study was to develop mobile apps in assisting clinical decision in ADR assessments of causality, severity, and preventability using validated tools. The usability of the apps was assessed. METHODS We designed mobile apps using validated assessment tools for ADRs. They are the Liverpool ADRs Causality Assessment Tool, Hartwig's Severity Assessment Scale, and the Modified Schumock and Thronton Preventability Scale. The apps were named "Adverse Drug ReactionCausality," "Adverse Drug ReactionSeverity," and "Adverse Drug RxnPreventability." A survey was conducted using the System Usability Scale (SUS) to assess the usability of the developed apps among health care professionals. RESULTS These apps are available for download through Google Play Store for free since January 2015. From the survey, the mean SUS score was 70.9 based on 26 responses from the pediatric ward of Hospital Ampang, Malaysia. CONCLUSIONS The developed apps received an overall acceptable usability among health care professionals. The usage of these apps will improve detection, assessment, and avoidance of future ADRs. They will also contribute to future research on ADRs, thus increasing drug safety.
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Kim B, Kim SZ, Lee J, Jung AH, Jung SH, Hahn HJ, Kang HR, Suh DI. Clinical profiles of adverse drug reactions spontaneously reported at a single Korean hospital dedicated to children with complex chronic conditions. PLoS One 2017; 12:e0172425. [PMID: 28199420 PMCID: PMC5310859 DOI: 10.1371/journal.pone.0172425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Accepted: 02/03/2017] [Indexed: 12/02/2022] Open
Abstract
Children with complex chronic conditions (CCC) are presumed to be vulnerable to adverse drug reactions (ADRs). The clinical profiles of ADRs in CCC are not well known. Herein, we aim to describe the ADR profiles in CCC with regard to typical presentations and vulnerable groups. We accessed the ADR yearly reports at a tertiary children's hospital whose practice is mainly dedicated to CCC and descriptively analyzed their clinical profiles according to the presence of a complex chronic condition, ADR severity, and age groups. A total of 1841 cases were analyzed, among which 1258 (68.3%) were mild, 493 (26.8%) moderate, and 90 (4.9%) cases were severe. A total of 1581 (85.9%) cases of complex chronic condition were reported. The proportion of CCC in each severity group increased as the ADR becomes more severe. In CCC, ADRs were most frequently reported by nurses in the adolescent group and in cases where the symptoms involved the gastrointestinal system. The class of antineoplastic and immunomodulating drugs was the most commonly suspected of causing an ADR, followed by one of the antibiotics. When we focus on the trend across the age groups, the ratio of severe-to-total ADRs decreased with older age. Among severe cases, the ratio of off-label prescription-related cases was the highest in the infant/toddler group and decreased as the groups aged. In conclusion, ADRs of CCCs admitted to a tertiary children's hospital have a unique profile. These groups are vulnerable to ADRs and thus they should be monitored closely, especially when they are infants or toddlers, so that severe ADRs can be identified and treated immediately.
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Affiliation(s)
- Bomi Kim
- Department of Pharmacy, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sunwha Zara Kim
- Student in training, Bachelor of Medicine and Bachelor of Surgery (MBBS), Shanghai Medical College of Fudan University, Shanghai, China
| | - Jin Lee
- Department of Pharmacy, Seoul National University Hospital, Seoul, Republic of Korea
- Regional Drug Safety Monitoring Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ae Hee Jung
- Department of Pharmacy, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sun-Hoi Jung
- Department of Pharmacy, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyeon-Joo Hahn
- Department of Pharmacy, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hye Ryun Kang
- Regional Drug Safety Monitoring Center, Seoul National University Hospital, Seoul, Republic of Korea
- Division of Allergy, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Dong In Suh
- Regional Drug Safety Monitoring Center, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Pediatrics, Seoul National University Hospital, Seoul, Republic of Korea
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Baek HJ, Cho YS, Kim KS, Lee J, Kang HR, Suh DI. Multidisciplinary approach to improve spontaneous ADR reporting in the pediatric outpatient setting: a single-institute experience in Korea. Springerplus 2016; 5:1435. [PMID: 27652011 PMCID: PMC5005223 DOI: 10.1186/s40064-016-3151-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 08/24/2016] [Indexed: 01/06/2023]
Abstract
In order to improve the reporting of adverse drug reactions (ADRs) as part of the routine practice at the pediatric outpatient department (OPD), we modified our ADR reporting strategy into one that facilitates the reporting process by means of a multi-disciplinary approach. In this study, we retrospectively reviewed ADR records during the period from March to September 2014 when we changed our reporting process as a part of institutional quality assurance (QA) activity. Yearly differences in the number and composition of ADRs were compared, and the descriptive analyses were done for cases reported from OPD during the QA activity in terms of the suspected drugs, type, causality, and severity of ADRs. There were 1211 pediatric ADR reports including 520 cases with underlying hemato-oncologic diseases during the period of 2014. Among the 691 non-oncologic cases, 76 were reported from the OPD, which was a significant increase (347 %) from the 17 cases reported during the previous year. Further analyses of these 76 cases revealed that the caregivers (47.4 %) initiated about half of the reports, the most frequently affected organ was the skin (32.9 %), and the most frequent suspected drugs were anticonvulsants (14.5 %). In contrast to the in-ward system, moderate cases were more frequent (51.3 %) than mild ones. In conclusion, this study provides a profile of pediatric ADRs in the OPD, which were largely under-reported during the usual clinical practice. A multi-disciplinary approach would improve spontaneous ADR reporting at the pediatric OPD.
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Affiliation(s)
- Hyun Jeong Baek
- Department of Pharmacy, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
| | - Yoon Sook Cho
- Department of Pharmacy, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
| | - Kwi Suk Kim
- Department of Pharmacy, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
| | - Jin Lee
- Legional Drug Safety Monitoring Center, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
| | - Hye Ryun Kang
- Legional Drug Safety Monitoring Center, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea ; Division of Allergy, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
| | - Dong In Suh
- Legional Drug Safety Monitoring Center, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea ; Department of Pediatrics, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
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