[Drug-induced hepatotoxicity in children. Where we are and where we are going]

Childhood is characterized by continuous growth and development during which the organs and systems gradually mature. Because drug pharmacokinetics and pharmacodynamics in children differ from those in adults, pediatric patients are highly susceptible to adverse drug reactions. Surprisingly, very few studies have been designed to study the efficacy and safety of drugs in this population and consequently dosage regimens are based on the assumption that children are small adults. We present a detailed review of these controversial aspects and propose the establishment of a multicenter, multidisciplinary network to monitor drug-induced liver disease in children. This project represents the integration of an epidemiological approach into routine clinical care. A protocol agreed by consensus for the collection of data on cases of hepatotoxicity with uniform and internationally accepted criteria for causality assessment and the classification of drug-induced liver injuries is proposed.