The KIDs List
A List Of Key Potentially Inappropriate Drugs in Pediatrics
Adverse drug reactions (ADRs) are defined by the American Society of Health-System Pharmacists (ASHP) as “ any unexpected, unintended, undesired, or excessive response to a drug that:
— Requires discontinuing the drug, changing drug therapy, modifying a dose, admission to the hospital, supportive treatment
— Prolongs length of hospital stay
— Complicates diagnosis
— Negatively affects prognosis
— Results in temporary or permanent harm, disability, or death
These drug reactions are caused by medication errors, allergic reactions, and overdoses. ADRs can be predictable, unknown or unintended; but all are preventable. Events can occur in any patient care setting (e.g. outpatient setting, inpatient setting). A number of drug reactions may not be harmful while others can have a negative impact on patient morbidity and mortality, and cost.
Higher rates of ADRs in the pediatric population may exist as a result of the lack of FDA labeling in various pediatric populations as well as age-related differences in drug distribution and effect. According to the FDA, most drugs prescribed for children have not been tested in children. Only about 20 percent of drugs approved by the FDA were labeled for pediatric use; therefore these drugs are given to children “off-label.” This poses a problem in the pediatric population because of their pharmacodynamic (PD), pharmacokinetic (PK), age and weight differences throughout the population.
ADRs can lead to adverse drug events (ADEs) — injury due to a drug. ADEs have the potential to harm pediatric patients at a higher rate than in adult patients and are 3 times more likely in hospitalized pediatric patients. According to the Centers for Disease Control and Prevention, about 200,000 children visit the emergency department each year due to adverse drug events.
The History
In 1991, a list of inappropriate drugs for use in elderly patients (65 years of age and older) was created. Health care professionals know this list as the “Beers Criteria.” The Beers Criteria allowed healthcare providers to practice a standard of care that has had positive impacts on prescribing and drug use in the elderly population.
It is now 2020, and the Beers Criteria has already been updated a number of times since it first appeared almost 30 years ago. This raises the question— “when will a “kids criteria” be available?” — A relatively similar list would benefit health care professionals that treat the pediatric population. A list of inappropriate drugs for use in pediatric patients would have positive impacts on medication safety by mitigating unintentional and preventable ADRs.
A List Just For Kids
The Pediatric Pharmacy Association (PPA) decided it was time to create a pediatric version of the Beers Criteria. A group of pediatric pharmacists were selected to compile a reference list of drugs that should not be used or used with caution in pediatric patients.
I am happy to announce that this year the PPA published the — Key Potentially Inappropriate Drugs in Pediatrics or the KIDs List. The news is already buzzing around twitter.
Conclusion
Higher rates of ADRs and ADEs are present in the pediatric population. Steps have been taken in the past to help mitigate inappropriate drug use by creating drug lists (e.g. the Beers Criteria). The KIDs List is a crucial step in establishing a standard of care in the pediatric population and improving medication safety. The list can serve as a reference tool to aid in:
— Identification of medications associated with a high-risk of ADRs.
— Decreasing costs.
— Improving the quality of care and patient outcomes.
— Identifying areas where further research may be warranted for the pediatric population.
References
- American Society of Health-System Pharmacists. ASHP Guidelines on Adverse Drug Reaction Monitoring and Reporting. Available at: https://www.ashp.org/-/media/assets/policy-guidelines/docs/guidelines/adverse-drug-reaction-monitoring-reporting.ashx. Accessed April 12, 2020.
- Food and Drug Administration. Drug Research and Children. Available at: https://www.fda.gov/drugs/drug-information-consumers/drug-research-and-children. Accessed April 12, 2020.
- Centers for Disease Control and Prevention. Adverse Drug Events in Children. Available at: https://www.cdc.gov/medicationsafety/parents_childrenadversedrugevents.html. Accessed April 12, 2020.
- Meyers RS, Thackray J, Matson KL, et al. Key Potentially Inappropriate Drugs in Pediatrics: The KIDs List. J Pediatr Pharmacol Ther. 2020; 25(3): 175–191. DOI: 10.5863/1551–6776–25.3.175.
- American Geriatric Society. For Older People, Medications Are Common; Updated AGS Beers Criteria® Aims To Make Sure They’re Appropriate, Too. Available at: https://www.americangeriatrics.org/media-center/news/older-people-medications-are-common-updated-ags-beers-criteriar-aims-make-sure. Accessed April 13, 2020.
