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Adverse Events in Pediatric Patients Receiving Long-Term Outpatient Antimicrobials
Scott C Olson1, Sherilyn Smith2, Scott J Weissman3
1Department of Pediatrics Division of Infectious Diseases, University of Washington, Seattle.
Insights
Pediatric patients on long-term outpatient antimicrobial therapy frequently experience adverse events (AEs). Close monitoring is essential for these children to detect and manage potential medication side effects.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Pharmacology
- Patient Safety
Background:
- Prolonged outpatient antimicrobial courses are common in pediatric care.
- Data on the frequency of adverse events (AEs) in this population are limited.
Purpose of the Study:
- To determine the frequency and types of adverse events (AEs) in pediatric patients receiving prolonged courses of outpatient antimicrobials.
Main Methods:
- Retrospective cohort study at a tertiary children's hospital.
- Included patients receiving ≥14 days of oral or intravenous antibiotics, antivirals, or antifungals.
- Excluded prophylactic treatments and HIV therapy.
Main Results:
- 335 pediatric patients met inclusion criteria; 31.9% experienced 151 distinct AEs.
- Diarrhea was the most common AE (29.1% of all AEs).
- Serious AEs occurred in 12.5% of subjects, including allergic reactions and neutropenia.
Conclusions:
- Pediatric patients on prolonged outpatient antimicrobial therapy frequently experience adverse events.
- Close monitoring and vigilance for AEs are crucial for this patient group.
Background:
Although long treatment courses of outpatient antimicrobials are often used in pediatric patients, few data exist regarding the frequency of adverse events (AEs) associated with these medications.
Methods:
We performed a retrospective cohort study of all patients seen in the Infectious Diseases clinic at a tertiary referral children's hospital from August 1, 2009 to August 1, 2011. We included patients who received ≥14 days of oral or intravenous antibiotic, antiviral, or antifungal medications. Patients receiving only prophylactic medications or human immunodeficiency virus treatment were excluded.
Results:
Three hundred thirty-five subjects met inclusion criteria, with a median age of 7.4 years at start of therapy. The cohort was predominantly male (60%), white (54%), and previously healthy (59%). A majority (88.4%) of subjects were treated for bacterial infections. β-Lactam agents were the most commonly used antimicrobial class (210 subjects; 62.7%), followed by clindamycin (86; 25.7%), rifampin (76; 22.7%), and vancomycin (62; 18.5%). Overall, 107 (31.9%) subjects experienced 151 distinct AEs. The most common individual AE noted was diarrhea (44; 29.1% of all AEs). Serious AEs developed in 42 (12.5%) subjects, including allergic reactions (15; 11.3% of all AEs), venous catheter-related complications (14; 13.0% of those with catheters), neutropenia (9; 3.0%), renal insufficiency (7; 2.5%), and hepatotoxicity (3; 1.1%). Rates of AEs were similar between those on oral and intravenous antimicrobials.
Conclusions:
In our study population, patients on prolonged oral or intravenous outpatient antimicrobials experienced AEs frequently. These findings support the need for close monitoring of pediatric patients on prolonged antimicrobial therapy and vigilance for unwanted effects of these medications.
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