Anti-epileptic drug toxicity in children

Anti-epileptic drugs (AEDs) have had a major impact on children, improving their quality of life and significantly reducing both morbidity and mortality. They are, however, associated with significant toxicity. Behavioural problems and somnolence are the most frequent adverse drug reactions for many AEDs. Unfortunately, the comparative risk of drug toxicity for different AEDs has been inadequately studied. Drug toxicity is poorly reported in randomised controlled trials. Prospective cohort studies are the best way to study drug toxicity. There have been a few prospective cohort studies of children with epilepsy, but the numbers of children have been small. Systemic reviews of the toxicity of individual AEDs have been helpful in identifying the risk of drug toxicity. Parents of children with epilepsy and the children and young people who are due to receive AED treatment have the right to know the likelihood of them experiencing drug toxicity. Unfortunately, the evidence base on which health professionals can provide such information is limited

Paediatric clinical pharmacology in the UK

Paediatric clinical pharmacology is the scientific study of medicines in children and is a relatively new subspecialty in paediatrics in the UK. Training encompasses both the study of the effectiveness of drugs in children (clinical trials) and aspects of drug toxicity (pharmacovigilance). Ethical issues in relation to clinical trials and also studies of the pharmacokinetics and drug metabolism in children are crucial. Paediatric patients require formulations that young children in particular are able to take. The scientific evidence generated from clinical trials, pharmacokinetic studies and studies of drug toxicity all need to be applied in order to ensure that medicines are used rationally in children

Armed conflict and child health

Armed conflict has a major impact on child health throughout the world. One in six children worldwide lives in an area of armed conflict and civilians are more likely to die than soldiers as a result of the conflict. In stark contrast to the effect on children, the international arms trade results in huge profi ts for the large corporations involved in producing arms, weapons and munitions. Armed confl ict is not inevitable but is an important health issue that should be prevented

Medication errors in infants at home

The study by Solanki and colleagues involved interviewing 166 parents/grandparents at home regarding the medications that had been prescribed at discharge to their infants, by the hospital staff [1]. As part of the study, the parents were also asked to demonstrate how much medicine they would give. With this methodology, Solanki et al. estimated that two out of three of the infants in their study would have experienced medication errors at home. This is an alarmingly high proportion of medication errors. Fortunately, none of the infants experienced significant harm. The authors have suggested that this high rate may be due to lack of parental education and inadequate pre-discharge counselling. The study was performed in Pondicherry in India. It would be wrong, however, to dismiss the relevance of their findings when considering the possibility of medication errors among neonates discharged from centres from high income countries, such as the U.K

Double checking the administration of medicines: what is the evidence? A systematic review

Objective To evaluate the evidence for double checking the administration of medicines. Design A systematic search of six electronic databases—Embase, Medline, British Nursing Index and Archive, CINAHL, National electronic library for Medicines (NeLM) and PsycINFO—for all articles describing double checking of medication and dose calculation, for either dispensing or administration in both adults and children up to and including October 2010. Results Sixteen articles met the inclusion criteria. There were only three quantitative studies. Only one of these was a randomised controlled clinical trial in a clinical setting. This study showed a statistically significant reduction in the medication error rate from 2.98 (95% CI 2.45 to 3.51) to 2.12 (95% CI 1.69 to 2.55) per 1000 medications administered with double checking. One study reported a reduction in dispensing errors, by a hospital pharmacy, from 9.8 to 6 per year following the introduction of double checking. The majority of the studies were qualitative and involved interviews, focus groups and questionnaires. Conclusion There is insufficient evidence to either support or refute the practice of double checking the administration of medicines. Clinical trials are needed to establish whether double checking medicines are effective in reducing medication errors