Patient selection: hospitalized child
Risk factors for an adverse drug reaction:
(1) >= 5 low-risk drugs
(2) >= 3 high-risk drugs
(3) older age (12 to 18 years of age)
High-risk drugs include:
(1) analgesics
(2) anti-epileptics
(3) systemic corticosteroids
(4) immunosuppressive agents
(5) systemic antibiotics
(6) systemic antifungal agents (antimycotics)
(7) drugs for obstructive airways disease
High-risk drugs in adults that may be given to children:
(1) chemotherapeutic agents
(2) anticoagulants
where:
• Drugs for obstructive airways diseases is not given in the list of high-risk drugs but on page 808 it is reported as being a common cause of ADR.
• There also should be some provision for a combination of low and high-risk drugs. It appears that high-risk drugs are weighted 5/3 or 1.66 times a low-risk drug. An adjusted score might be (1.66 * (high risk drugs)) + (low risk drugs).
• Other factors to consider are drugs being given at high doses, renal failure, etc.
To reduce the risk of an adverse drug reaction then the number of drugs being given must be decreased, especially if high-risk ones.
