Summary
Adverse reactions occur in only 2 to 5% of children for whom drugs are prescribed. Most of those which do occur are mild and transient in nature. Practitioners who treat children should be familiar with the adverse effects of every drug they use and be certain that every drug prescribed is strictly necessary.
Antimicrobials and antipyretic/analgesics are the drugs most commonly prescribed for childen. Serious adverse reactions such as aplastic anaemia (with chloramphenicol) are fortunately rare. Erythromycin prescribed for intercurrent infection may precipitate signs of toxicity in children receiving carbamazepine or theophylline. Anticonvulsants impair cognitive function and thereby affect school performance. Phenothiazines and metoclopramide prescribed as antiemetics may cause spectacular dystonic posturings, although this adverse reaction is rapidly reversed with intravenous biperiden.
The duration of drug therapy in paediatric practice should be limited to the minimum time compatible with full recovery. The management of adverse reactions in childhood hinges on early recognition and prompt withholding of the offending drug. Urgent resuscitation is essential when anaphylactic collapse occurs, but in most instances of adverse reaction symptomatic treatment of discomfort is all that is necessary. It is important that parents of a child who has suffered an adverse reaction be aware of this and know the name of the drug responsible. Practitioners who encounter an unreported adverse reaction have an obligation to notify the appropriate drug monitoring authority.
Similar content being viewed by others
References
Asmar BI, Maqbool S, Dajani AS. Haematological abnormalities after oral trimethoprim-sulfamethoxazole therapy in children. American Journal of Diseases of Childhood 135: 1100–1103, 1981
Bonati M, Marchetti F, Zullini MT, Pistotti V, Tognoni G. Adverse drug reactions in neonatal intensive care units. Adverse Reactions and Acute Poisoning Reviews 9: 103–118, 1990
Brown AE, Quesada O, Armstrong D. Minimal nephrotoxicity with cephalosporin aminoglycoside combinations in patients with neoplastic disease. Antimicrobial Agents and Chemotherapy 21: 592–594, 1982
Browne TR. Clonazepam: a review of a new anticonvulsant drug. Archives of Neurology 33: 326–332, 1976
Camfield CS, Chaplin S, Doyle AB. Side-effects of phenobarbital in toddlers: behavioural and cognitive aspects. Journal of Paediatrics 95: 361–365, 1979
Campbell M, Grega DM, Green WH, Bennet WG. Neuroleptic-induced dyskinesias in children. Clinical Neuropharmacology 6: 207–222, 1983
Cirko-Begovic A, Vrhovac B, Bakran I. Intensive monitoring of adverse drug reactions in infants and preschool children. European Journal of Clinical Pharmacology 36: 63–65, 1989
Cohen CD, Sayed AR, Kirsch RE. Hepatic complications of an-tituberculosis therapy revisited. South African Medical Journal 63: 960–963, 1983
Daum RS, Cohen DL, Smith AL. Fatal aplastic anaemia following apparent ‘dose-related’ chloramphenicol toxicity. Journal of Pediatrics 94: 403–406, 1979
Descotes J, Andre P, Evreux JC. Pharmacokinetic drug interactions with macrolide antibiotics. Journal of Antimicrobial Chemotherapy 15: 659–664, 1985
Dreifuss FE, Santilli N. Valproate acid hepatic fatalities: analysis of United States cases. Neurology 36 (Suppl. 1): 175, 1986
Editorial. Skin reactions to ampicillin. British Medical Journal 1: 195, 1972
Editorial. Tetracycline syrups and children’s teeth. Drug and Therapeutics Bulletin 22: 55-56, 1984
Editorial. Reye’s syndrome and aspirin: epidemiological associations and inborn errors of metabolism. Lancet 2: 429, 1987
Feder HM. Comparative tolerability of ampicillin, amoxicillin and trimethoprim-sulfamethoxazole suspensions in children with otitis media. Antimicrobial Agents and Chemotherapy 21: 426–427, 1982
Feingold BF. Introduction to clinical allergy, pp. 172–173. Charles C. Thomas, Springfield, 1973
Ferngren H. Diazepam treatment for acute convulsions in children. Epilepsia 15: 27–37, 1974
Furukawa CT, Du Hamel TR, Weimer L, Shapiro GG, Pierson WE, et al. Cognitive and behavioural findings in children taking theophylline. Journal of Allergy and Clinical Immunology 81: 83–88, 1988
Girling DJ. The hepatic toxicity of antituberculosis regimens containing isoniazid, rifampicin and pyrazinamide. Tubercle 59: 13–32, 1978
Holmes GL. Diagnosis and management of seizures in children, p. 90, WB Saunders Company, Philadelphia, 1987a
Holmes GL. Pharmacology of anti-epileptic drugs. In Diagnosis and Management of seizures in children, pp. 93–97, W.B. Saunders Co., Philadelphia, 1987b
Jick SS, Jick H, Habakangas JAS, Dinan BJ. Cotrimoxazole toxicity in children. Lancet 2: 631, 1984
Kapur RN, Girgis S, Little TM. Diphenyl hydantoin induced gingival hyperplasia: its relationship to dose and serum level. Developmental Medicine and Child Neurology 15: 483–487, 1973
Karnik AM, Feneck FF, Al-Shanali MA. A case of ocular toxicity to ethambutol — an idiosyncratic reaction. Postgraduate Medical Journal 61: 811–813, 1985
Kramer MS, Hutchinson TA, Flegel KM, Naimark L, Contardi R, et al. Adverse drug reactions in general pediatric outpatients. Journal of Pediatrics 106: 305–310, 1985
Lanzkowsky P. Pediatric haematology-oncology: a treatise for the clinician, 1st ed., pp. 166–172, McGraw-Hill, New York, 1980
Lepow ML. Aplastic anaemia following chloramphenicol therapy still happens. Pediatrics 77: 932–933, 1986
Lischner H, Seligman SJ, Krammer A, Parmelee AH. An outbreak of neonatal deaths among term infants associated with administration of chloramphenicol. Journal of Paediatrics 59: 29–34, 1961
Loiseau P. Sodium valproate, platelet dysfunction and bleeding. Epilepsia 22: 141–146, 1981
Lowe TL, Cohen DJ, Detior J, Kremenitzer MW, Shaywitz BA. Stimulant medications precipitate Tourette’s syndrome. Journal of the American Medical Association 247: 1729–1731, 1982
Mandell WF, Neu HC. Parasitic infections: therapeutic considerations. Medical Clinics of North America 72: 673–674, 1988
Mandell GL, Sande MA. Antimicrobial agents: drugs used in the chemotherapy of tuberculosis and leprosy. In Goodman et al. (Eds) The pharmacological basis of therapeutics, 7th ed, p. 1201, Macmillan Publishing Co, New York, 1985
Marcovitch H. Loperamide in ‘toddler diarrhoea’. Lancet 1:1413, 1980
Martin A, Hirt HR. Clinical experience with clonazepam (Rivotril) in the treatment of epilepsies in infancy and childhood. Neuropediatrie 4: 245–266, 1973
Menkes JH. Textbook of child neurology, 3rd ed., p.643, Lea and Febiger, Philadelphia 1985
Mitchell AA, Lacouture PG, Sheehan JE, Kauffman RE, Shapiro S. Adverse drug reactions in children leading to hospital admission. Pediatrics 82: 24–29, 1973
Motala C, Hill ID, Mann MD, Bowie MD. Effect of loperamide on stool output and duration of acute infectious diarrhoea in infants. Journal of Paediatrics 117: 467–471, 1990
Mowat AP. Dystonic reactions to drugs. Developmental Medicine and Child Neurology 15: 654–655, 1973
Nelson LA, Schwartz JI. Theophylline-induced age-related CNS stimulation. Pediatric Asthma, Allergy and Immunology 1: 175–183, 1987
Para A, Santos D, Cervantes C, Sojo I, Carranco A, et al. Plasma gonadotropins and gonadal steroids in children treated with cyclophosphamide. Journal of Paediatrics 92: 117–124, 1978
Parker PH, Helinek GL, Ghishan FK, Greene HL. Recurrent pancreatitis induced by valproic acid. Gastroenterology 80: 826–828, 1981
Rao SCC, Edwards CA, Austen CJ, Bruce C, Read NW. Impaired colonie fermentation of carbohydrate after ampicillin. Gastroenterology 94: 928–932, 1988
Roche AF, Lipman RS, Overall JE, Hung W. The effects of stimulant medication on the growth of hyperkinetic children. Pediatrics 63: 847–850, 1979
Rosenstein G, Freeman M, Standard AL, Weston N. Warning: the use of lomotil in children. Pediatrics 51: 132–134, 1973
Rosenthal S, Kaufman S. Vincristine neurotoxicity. Annals of Internal Medicine 80: 733–737, 1974
Saltissi D, Pusey CD, Rainford DJ. Recurrent acute renal failure due to antibiotic induced interstitial nephritis. British Medical Journal 1: 1182, 1979
Shenfield GM, Brogden RN, Ward A. Pharmacology of broncho-dilators. In Clark, et al. (Eds) Bronchodilator therapy: the basis of asthma and chronic obstructive airways disease management, pp. 29–31, Adis Press Ltd, Auckland, 1984
Shirkey HC. Table of drugs in pediatric therapy, 6th ed. pp. 1154–1156, 1980
Sinaniotis CA, Spyrides P, Vlachos P, Papadatos C. Acute halo-peridol poisoning in children. Journal of Paediatrics 93: 1038–1039, 1978
Spiteri MA, Janes DG. Adverse ocular reactions to drugs. Postgraduate Medical Journal 59: 343–349, 1983
Tinkelman DG. Theophylline — use and misuse in pediatric asthma. Hospital Practice 23: 179–184, 1988
Thompson PJ, Trimble MR. Anticonvulsant drugs and cognitive functions. Epilepsia 23: 531–544, 1982
van Dellen JR, McKeown CP. Praziquantel (pyrazinoisoquino-lone) in active cerebral cysticercosis. Neurosurgery 22: 92–96, 1988
Zarowitz BJM, Szefler SJ, Lasezky GM. Effect of erythromycin base on theophylline kinetics. Clinical Pharmacology and Therapeutics 29: 601–605, 1981
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Leary, P.M. Adverse Reactions in Children. Drug-Safety 6, 171–182 (1991). https://doi.org/10.2165/00002018-199106030-00003
Published:
Issue Date:
DOI: https://doi.org/10.2165/00002018-199106030-00003