IDENTIFICATION AND REPORTING OF ADVERSE DRUG REACTIONS IN THE PHARMACOVIGILANCE CENTER OF A TERTIARY CARE HOSPITAL

HIV/AIDS remains a global health challenge, with significant prevalence in sub-Saharan Africa. Highly active antiretroviral therapy (HAART) is the mainstay treatment for HIV, and the number of people living with HIV (PLWHIV) on HAART has considerably increased worldwide. The use of HAART has led to improved patient outcomes; however, it is associated with adverse drug reactions (ADRs) and drug-drug interactions (DDIs), which pose serious concerns in the management of patients with HIV. The aim of the study was to determine the prevalence and factors associated with ADRs among patients on HAART. This was a hospital-based cross-sectional study carried out among 312 HIV patients on HAART attending HIV clinics at Mbarara Regional Hospital. Data was collected using an interviewer-administered, semi-structured questionnaire and a review of patient charts. ADRs were assessed for causality and categorized using Naranjo ADR assessment scale into probable, possible and definite, for severity using the modified Hartwig and Siegel criteria into mild, moderate and Severe, and for preventability using Schumock and Thornton criteria into definite, probable and non-preventable. Lexicomp® Drug Interaction Checker software was used to identify and rate clinically significant drug-drug interactions. The prevalence of ADRs and potential DDI was analyzed using descriptive statistics while logistic regression analysis was used to establish the association of variables. 312 patients were interviewed and their records reviewed. The prevalence of ADRs during this study was 76.0%. On assessment, 78.3% of the ADRs were mild and 76.6% of ADRs were definitely preventable. CD4 count below 200 cells/mm3 (AOR = 1.00, 95% CI: 1.00-1.02; p value = 0.04), primary education level (AOR = 3.27, 95% CI: 1.34-7.95; p value = 0.009), and secondary education level (AOR = 3.64, 95% CI: 1.39-9.52; p value = 0.009) were identified as independent risk factors. Patients who experienced a significant DDI were 5.66 times more likely to experience an ADR (p value = 0.02, 95% CI: 1.32-24.18). There is a high prevalence of adverse drug reactions among patients with HIV on HAART. Low CD4 count and lower education levels are risk factors for ADRs in this population; therefore, tailored interventions to these subgroups should be implemented for early ADR identification and management. Significant drug-drug interactions are highly associated with the occurrence of ADRs among HIV patients on HAART, which calls for intensified pharmacovigilance and pharmaceutical care in this population.

A growing body of evidence suggests that adverse drug reactions (ADRs) are a major cause of morbidity and mortality in the healthcare system. Fifteen to twenty-five percent of patients with epilepsy discontinued antiseizure drugs (ASDs) within 6 months of therapy owing to intolerable adverse drug reactions. In Ethiopia, the prevalence of antiseizure adverse drug reactions and associated factors was not extensively conducted in advanced settings like Jimma Medical Centers. Hence, the objective of this study is to assess patterns of adverse drug reactions and associated factors among ambulatory epileptic patients at tertiary hospitals in Ethiopia. A hospital-based prospective observational study was spanned for 1 year. Two hundred ninety patients were consecutively recruited into the study from all epileptic patients attending the ambulatory clinic. Relevant data were collected through patient interviews and medical chart reviews. The causality assessment was done by using the Naranjo Probability Scale. Epi-Data manager version 4.6.0.4 was used for data entry and statistical analysis was performed by Statistical Package for Social Science version 25.0 (SPSS). Stepwise backward logistic regression analysis was done to identify factors that increase the risk of antiseizure adverse drug reactions. The mean (± SD) age of the participants were 29.91(± 11.26) years. The overall prevalence of ADR was 33.8% (95% CI 29.2–39.9%). A total of 110 adverse drug reactions were identified among 98 patients with an average of 1.12 per patient. ADRs were frequently reported with phenobarbital (52.04%) and phenytoin (34.70%). The commonly identified adverse drug reactions were epigastric pain (27.55%) and central nervous system drowsiness (23.46%). Comorbidity (AOR = 5.91, 95% CI (2.14–16.32), seizure-free period of fewer than 2 years (AOR = 1.94, 95% CI (1.18–3.19), and polytherapy (AOR = 1.35, 95% CI (1.80–2.26) were significantly associated with adverse drug reactions. This trial had a comparatively high percentage of adverse medication reactions. Adverse medication reactions were more common in patients with polytherapy, comorbidities, and seizure-free durations less than two years. Therefore, medical practitioners should advise patients who exhibit these traits on how to reduce or avoid bad drug responses or provide comfort in the event of small incidents.

Objective: To compare and contrast adverse drug reaction (ADR) reporting between 2 psychiatric hospitals, as well as preventability and possible reasons that one hospital had more preventable occurrences than the other. Methods: A 3-year retrospective analysis was conducted comparing ADRs previously reported in a study from Maryland Psychiatric Hospital that were classified as probable and definite according to the modified Naranjo probability scale versus probable and definite ADR reports from the Colorado Mental Health Institute at Pueblo (CMHIP). The same study period (July 1, 2006–June 30, 2009) was used for the retrospective analysis of ADRs at both institutions. We compared the most frequently reported classes of medications and examined the number of reactions, types of reactions, and preventability. Results: Psychiatric medications were responsible for 98/145 (67.6%) ADRs at CMHIP, while 47 (32.4%) ADRs were caused by nonpsychiatric medications. At Maryland Psychiatric Hospital, 48.4% of ADRs were caused by psychiatric medications and 51.6% were caused by nonpsychiatric medications. Of the 145 ADRs reported at CMHIP, only 1 (0.7%) was classified as preventable, versus 19 (20.4%) preventable ADRs reported in Maryland Psychiatric Hospital. The classes of medications most frequently associated with ADRs at Maryland Psychiatric Hospital were cardiovascular agents, antiepileptic drugs, and second-generation antipsychotic medications; at CMHIP the medications most commonly associated with ADRs were second-generation antipsychotics, conventional antipsychotics, and mood stabilizers. Proposed reasons for differences in numbers, types, and preventability of ADRs between the institutions are that different reporting mechanisms and pharmacy medication monitoring programs, in conjunction with quality assurance programs, were used at the 2 institutions. Conclusions: Differences between 2 comparable hospitals in the number and preventability of ADRs and the classes of medications reportedly responsible for them may be due to different reporting mechanisms and monitoring programs. Pharmacy intervention programs may lead to prevention of ADRs.

BackgroundAccurate identification and routine preventive practices are crucial steps in lessening the incidence of medications and patients related adverse drug reactions (ADRs).MethodsThree years retrospective study was conducted among chronic kidney disease (CKD) patients at multi-wards in a tertiary healthcare center. Data collected included demographic characteristics, physical examination results, comorbid conditions, laboratory tests and medications taken. Only medication prescribed during the hospital stay were considered in this study.ResultsFrom this study only one ADR incident was definitely preventable and majority of other ADRs (88.3%) were possibly preventable. Type of renal replacement therapy (p = 0.023) and stages of renal function (p = 0.002) were significantly associated with survivability of the hospitalized CKD patients after ADRs. Highest percentage of mortality based on categories were 50–59 years (20.0%), male (16.3%), Indian ethnicity (23.7%), obese (15.0%), smoking (17.1%), consumes alcohol (17.4%), conservative management of renal disease (19.5%) and renal function of < 15 mL/min/1.73m2. Overall survivability using Kaplan-Meier analysis reported a significant difference of 18-day survival rate between patients undergoing hemodialysis and patients conservatively managing their renal disease. The 18 days survival rate of patients undergoing hemodialysis, peritoneal dialysis and conservative management were 94.9%, 91.7% and 75.1% respectively. Eighteen days survival rate of patients with renal functions of 30–59 mL/min/1.73m2, 15–29 mL/min/1.73m2 and < 15 mL/min/1.73m2 were 87.4%, 69.8% and 88.6% respectively. Similarly, Cox regression analysis revealed that renal replacement therapy was the only factor significantly contributed to ADRs related mortality. CKD patients whom conservatively managed renal disease or/and with renal function of < 15 mL/min/1.73m2 had 5.61 and 5.33 higher mortality risk respectively.ConclusionMajority of the reported ADRs were possibly preventable. Renal replacement therapy and/or renal function were significant risk factors for mortality due to ADRs among hospitalized CKD patients stages 3 to 5. Clinician engagement, intensive resources and regular updates aided with online monitoring technology are needed for enhancing care and prevention of ADRs among CKD patients.

In pediatric individuals, polypharmacy would increase the prevalence of adverse drug reactions (ADRs). However, there is no report on the ADR increase adjusted for the influence of concomitant disease types. We conducted a retrospective study in pediatric patients to determine whether polypharmacy is a risk factor for ADR development, after the adjustment. Patients aged 1–14 years on medication who visited Gifu Municipal Hospital (Gifu, Japan) were included. We evaluated patient characteristics, ADR causality, ADR classification and severity, and ADR-causing drugs. We examined the association between ADR prevalence and number of drugs used. We performed multiple logistic regression analyses to investigate risk factors for ADR development. Of 1330 patients, 3.5% sought medical attention for ADRs. ADR causality was most often assessed as “possible,” with gastrointestinal ADRs being the most common. Grade 1 ADRs were the most and antibiotics were the most common suspected ADR-inducing drug. The multiple logistic regression analysis showed that ≥ 2 or ≥ 4 drug use, neoplasms, mental and behavioral disorders, and circulatory system diseases significantly increased ADR prevalence. Polypharmacy increased the prevalence of ADR resulting in hospital visits in children, after adjusting for the influence of disease types. Therefore, proactive polypharmacy control measures are necessary for children.

Background: Older adults are vulnerable to adverse drug reactions (ADRs), particularly in low-income settings, yet data on ADR prevalence in Africa, including Ethiopia, remain limited. Objective: This study aimed to evaluate the incidence, severity, and preventability of ADRs among hospitalized older adults, as well as all-cause inpatient mortality. Methods: A cross-sectional observational study was conducted at Jimma Medical Center, located in Jimma town, Ethiopia, from 6 September 2021 to 26 December 2022. The study participants were older adults (n = 162) admitted to the medical wards. ADRs were assessed using the Naranjo ADR probability scale, severity was classified according to the modified Hartwig and Siegel criteria, and preventability was determined using the Schumock and Thornton criteria. Results: The median age of participants was 65 years (interquartile range: 60–70). During their hospital stay, 84 patients (51.9%) experienced at least one ADR. A total of 123 ADRs (76 ADRs per 100 admissions) were captured. Most ADRs (93.5%) were classified as mild to moderate in severity, and 84.5% (n = 105) were considered preventable. Endocrine and metabolic systems (48.8%) and diuretics (43.9%) were the most frequently affected organ systems and drug class linked to ADRs, respectively. Furosemide (41.5%) and aspirin (10.6%) were the most frequently implicated medications, commonly causing hypokalemia (35.3%) and dyspepsia (53.8%), respectively. The observed all-cause in-patient mortality rate was 6.8% (5 deaths per 1000 patient-days). The use of potentially inappropriate medications (PIMs) (aOR: 4.747, p = 0.003) and presence of digestive system disorders (aOR: 8.784, p = 0.038) were associated with an increased risk of ADRs, while a history of recent traditional medicine use (aOR: 0.285, p = 0.042) was linked to a lower risk. Conclusions: More than half of the hospitalized older adults experienced ADRs, most of which were mild to moderate in severity and considered preventable. Regular medication review for screening and minimizing PIM use in older adults may play a crucial role in lowering ADR occurrence. The borderline but statistically significant association between a history of traditional medicine use and lower occurrence of ADRs requires cautious interpretation and further investigation to explore possible explanations. Nearly seven deaths per hundred hospitalized patients were recorded.

To assess the nature, severity, predictability and preventability of adverse drug reactions (ADRs) and to identify risk factors for antiretroviral ADRs. Enrolled ambulatory patients were intensively monitored for ADRs. Spontaneously reported ADRs by clinicians were also included. Predictability was assessed based on history of previous exposure to the drug or literature incidence of ADRs. Preventability was assessed using Schumock and Thornton criteria and severity was assessed using modified Hartwig and Siegel scale. Bivariate analysis and subsequently multivariate logistic regression were used to identify the risk factors for ADRs. Data from spontaneous reporting was assessed using Bayesian neural network method for possible ADR signals. Monitoring by active surveillance indentified 159 (52.82%) ADRs from 400 patients. One hundred and forty-two (47.17%) reactions were spontaneously reported. Anaemia and vomiting were the most commonly observed ADRs. The ADRs were severe in 10.9% of cases. A total of 88% ADRs were definitely/probably preventable. Use of Zidovudine+Lamivudine with Nevirapine or Efavirenz, CD4 <200 cells/microl, female gender, tuberculosis and illiteracy were observed as risk factors for ADRs by bivariate analysis. Concurrent tuberculosis was the only influential risk factor for development of ADRs identified by multivariate logistic regression. Prevalence of ADRs in intensively monitored patients was found to be 39.7%. Tuberculosis in HIV patients is an influential risk factor for occurrence of ADRs. With the increasing access to antiretrovirals in India, ADRs to antiretrovirals require monitoring and reporting.

There is a paucity of information regarding adverse drug reactions (ADRs) in psychiatric patients. Information on common and preventable ADRs (pADRs) in psychiatric patients will allow for targeted improvement projects. To characterize reported ADRs and pharmacist interventions to prevent ADRs in an extended-care state psychiatric hospital. Four years of ADR reports were assessed for probability, reaction severity, pharmacological class of medication involved, preventability, change in therapy, and transfers to a medical facility. The pharmacist intervention database was queried for interventions classified as "prevention of ADR." The interventions were assessed for type of medication and recommendation acceptance. Medication classes responsible for ADRs included mood stabilizers (30%), typical antipsychotics (25%), atypical antipsychotics (25%), and antidepressants (8%). Nine percent resulted in transfer to a medical facility. Of all ADRs, 34.4% were pADRs; mood stabilizers (41%) and atypical antipsychotics (27%) were the most common pADRs. The most common causes of pADRs were supratherapeutic serum concentrations, drug-drug interactions, and history of reaction. There were 87 pharmacist interventions that were classified as "prevention of ADR," and the acceptance rate of pharmacists' recommendations was 96.5%. Mood stabilizers (20%), atypical antipsychotics (17%), and typical antipsychotics (11%) were commonly associated with prevented ADRs. Lithium accounted for 13.8% of prevented ADRs; these ADRs were most often due to a drug-drug interaction with a nonsteroidal anti-inflammatory drug. ADRs were most commonly associated with mood stabilizers and antipsychotics, and pADRs were common. There is an opportunity to provide education to medical staff on therapeutic drug monitoring and drug-drug interactions for these classes, particularly lithium.

Objective: The objective of the study is to monitor the adverse drug reactions (ADRs) due to anti-hypertensive drugs prescribed in a tertiary care hospital. Methods: The study was conducted in the outpatient department of General Medicine of a tertiary care hospital in Kerala. The demographic details and suspected ADRs were collected from the patients and evaluated, and causality assessment was done. Results: More women developed ADRs compared to men due to the anti-hypertensive drug. The occurrence of adverse reactions was seen to be more in older patients over 50 years of age compared to younger individuals. The occurrence of ADR was more in patients using a combination of drugs (74.3%) rather than monotherapy. Calcium channel blockers were associated with more number of adverse reactions (62.5%) with amlodipine showing the maximum ADRs (64.8). The commonly seen ADR was edema. When the causality assessment was done, most were probable/likely followed by possible. Conclusion: This study shows that calcium channel blockers were the therapeutic class of drugs that caused the most number of ADRs, especially pedal edema; there was a higher frequency of ADRs to various antihypertensive drugs. Females and those more than 50 years old had shown a higher proportion of ADRs though not statistically significant. Furthermore, those individuals who took more drugs to treat hypertension also showed more ADRs. This study of adverse reactions toward antihypertensive medications will help physicians to choose a better option to treat their patients which will eventually help in patient satisfaction and medication safety.

The present study was conducted to evaluate the pattern of occurrence of adverse drug reactions and drug-drug interaction in a pediatric oncology unit of a tertiary care hospital. A prospective, observational study was conducted in the Department of Pediatric Oncology, Sri Ramachandra Medical College and Hospital, India. Patients were monitored actively for the occurrences of any adverse drug reaction during the study period. Patient's demographic details, clinical, and treatment data were collected for drug-drug interaction analysis. The detected adverse drug reaction was assessed for causality, severity, and preventability. Drug-drug interaction identified was rated based on their level of urgency and the nature of actions necessary to respond to an interaction. Of 176 patients, 118 were detected for the occurrence of various adverse drug reaction. The majority of the cases were suffering with acute lymphocytic leukemia (67.9%). Vincristine was noted for a maximum number of adverse drug reaction in cytotoxic drugs. Rash is the most frequently occurred reaction. Assessment of causality showed that the majority of cases are "probable" (60.16%). In evaluating the severity of adverse drug reactions, 57.6% reactions were moderately severe and 74.5% of the reactions were preventable. Upon assessing the drug-drug interaction, 38.13% of the prescription needs to be monitored and 10 drug-drug interactions were under the risk category of "X." The majority of the adverse drug reaction was moderately severe in nature and those were preventable. Since pediatrics are vulnerable population, they must have a thorough surveillance system for adverse drug reaction and drug-drug interaction; thereby, a positive impact on the medication-use system and improved patient care can be achieved.

Adverse drug reactions account for the highest proportion among the causes of morbidity and mortality in clinical wards and are posing a considerable challenge. Hence, the objective of this study was to find out the prevalence of adverse drug reactions and the factors which contribute to their prevalence. A prospective patient record review was carried out at a tertiary care hospital in North India from August 2010-May 2011. A total of 1033 subjects admitted to hospital for any kind of treatment were included while patients admitted in the ward because of adverse drug reactions were excluded. The ward where we collected the data includes multispecialty and cardiovascular wards. The causality, severity, and preventability of adverse drug reactions were assessed using Naranjo, modified Hartwig, and Schumock and Thornton criteria, respectively. Kolmogorov-Smyrnov, chi -square and multiple logistic regression tests were used to determine adverse drug reactions ascribed to drugs. Out of 1033 patients whose records were assessed, 167(16.2%) experienced one or more adverse drug reactions. The metabolic systems, which accounted for 49(24.6%) were most frequently affected by adverse drug reactions, followed by gastrointestinal, 45(22.6%); hematological, 28(14.1%) and cutaneous, 21(10.6%) systems. The drug classes most frequently associated with the reactions were antibiotics 40(20.1%), diuretics 35(17.6%) and anticoagulants 30(15.1%). According to the selected preventability scale, 72(36.2%) adverse drug reactions were classified as probably or definitely preventable. About 165(83%) of the reactions were type A, which represents augmentation of the pharmacological action of a drug. Number of drugs, length of hospitalization and number of diagnosis were identified as significant predisposing factors for ADRs. The result of this study suggested that adverse drug reactions were significant causes of superimposed health problems that occur following hospitalization. The major risk factors associated with ADR include number of drugs, length of hospitalization and number of diagnosis. Based on the findings a rigorous study is recommended to determine the burden and identify the risk factors of adverse drug reactions to target interventions.

Poly pharmacy significantly raises the likelihood of adverse reac tions to drugs, risk of hospitalization and medical errors related to drugs. It depends on the number of drugs, the diseases, and patient related factors . Poly pharmacy is a risk factor for severe adverse drug reactions (ADRs) and is associated with an inc reased risk of mortality. The main aim of the study was to assess the poly pharmacy leading to adverse drug reaction. This is a prospective observational study conducted at Basaveshwara Medical College Hospital and Research Center (BMCH and RC), Chitradurg a , India for the period of 4 months in the department of Medicine. In this study 601 patients of both genders were included. The identified ADRs are reported to the phy sician and causality assessment of adverse drug reactions (ADR’s) was done by using the Naranjo’s scale and Modified Hartwig Seigle scale. About 601 patients screened among them 315 patients were males and 286 were females and average drugs per prescription were 6.17. There are 356 (59.23 %) patients with major poly pharmacy ( ≥ 6 drugs) and 2 45 (40.76 %) with minor poly pharmacy (3 - 5 drugs). During the study 32 ADRs were identified and reported to the Physicians; in this 28 ADRs were accepted. The prevalence of ADRs seen during the study was 5.32 % and in this 3.49 % (n = 21) were seen patien ts who had major poly pharmacy. Our study showed that females were more prone to develop ADRs compared to the males i.e., 53.12 % (n = 17) of ADRs were identified in female gender and 46.87 % (n = 15) in male gender. Out of 32 ADRs 21 (65.62 %) were identi fied in patients with major poly pharmacy and 11 (34.37 %) with minor poly pharmacy. There were more ADRs associated with major poly pharmacy and female gender. It is necessary to create the awareness to curb irrational prescription of poly pharmacy which helps in prevention of drug related problems like ADRs.

Introduction:Infections caused by multidrug-resistant Enterobacterales pose a significant global health challenge, thus necessitating novel therapeutic strategies.The increasing prevalence of carbapenem-resistant Enterobacterales has led to reliance on colistin and polymyxins as last-resort antibiotics.However, emerging colistin resistance and associated polymyxin toxicity have significantly limited their use.Aztreonam is effective against metallo--lactamase (MBL)-producing pathogens but requires protection from co-produced enzymes such as extended-spectrum -lactamases (ESBLs), AmpC cephalosporinases, and other carbapenemases.Avibactam, a non--lactam -lactamase inhibitor, inhibits ESBLs, Klebsiella pneumoniae carbapenemase (KPC), certain oxacillinase (OXA)-48-like enzymes, and AmpC cephalosporinases but is ineffective against metallo-lactamases.This study evaluated the in vitro synergy of ceftazidimeavibactam with aztreonam as a potential colistin-sparing strategy for carbapenem-resistant Enterobacterales infections.Methods: In a prospective cross-sectional study from July 2022 to June 2023, 97 carbapenem-resistant Gram-negative clinical isolates (prevalence: 97/8876 =1.09%) were obtained from 8876 samples tested for aerobic bacterial culture and antimicrobial susceptibility at a tertiary care hospital in Pune, India.For 69 Enterobacterales isolates resistant to ertapenem, imipenem, and meropenem, synergy between ceftazidime-avibactam and aztreonam was tested using disk diffusion and modified E-test/disk diffusion method, interpreted as per the guidelines of the Clinical and Laboratory Standards Institute (CLSI).Results: Enterobacterales comprised 69 (71.13%) of isolates, with 35 (50.73%) of these demonstrating synergy between ceftazidime-avibactam and aztreonam.Klebsiella pneumoniae (33/69; 47.83%) was the predominant species, followed by Escherichia coli (26/69; 37.68%) and Citrobacter species (10/69; 14.49%).Conclusion: In vitro synergy between ceftazidime-avibactam and aztreonam was observed in 50.73% of carbapenem-resistant Enterobacterales isolates, suggesting a possible colistin-sparing alternative for infections such as complicated urinary tract infections, intra-abdominal infections, and hospital-acquired pneumonia; however, further clinical studies are needed to validate its efficacy.

Introduction: World Health Organization (WHO) in 2014 recommended delayed cord clamping (DCC) in all babies who cry immediately after birth. Despite many benefits, there are concerns of increased rate of phototherapy in babies receiving DCC. This study was done to determine the increment in the rate of phototherapy required in infants managed with DCC vs infants managed with early cord clamping (ECC). Methods: A retrospective observational study was conducted in a tertiary care hospital in Pune, India. All the infants born between January 2018 and July 2018, for whom ECC was done, were compared with infants who were born between January 2019 and July 2019, after DCC policy was adopted. All the infants with birth weight ≥2 kg and gestation ≥35 weeks, who were with their mother, were included. Baseline characteristics were compared for both the groups. American Academy of Pediatrics guidelines for treatment of neonatal jaundice were used to determine the need for phototherapy. Number of infants in both the groups who required phototherapy were compared. Results: The ECC group had 565 infants while DCC group had 731 infants. There was no difference in the baseline characteristics of the 2 groups. Jaundice requiring phototherapy was noted in 31% of infants in the ECC group, compared to 45% in infants in the DCC group (relative risk: 1.47 [1.27-1.71] [ P &lt; .001]). Conclusion: In this study, DCC increased the need for phototherapy by 47% in late preterm and term infants. Randomized control trials with larger sample size are required to confirm this finding.

Objective:Adverse drug reactions (ADRs) are known as a cause of hospital admission. We have carried out a prospective study to characterize and assess the frequency, probability, preventability, and severity of ADRs, which lead to hospital admission in children.Methods:In a prospective observational study, a cohort of children admitted to a tertiary pediatric hospital was randomly screened to assess ADR as the cause of admission from June 2014 to January 2015. ADRs causing admissions were detected based on patients’ records, interviewing their parents, and confirmation by medical team. The probability of the ADRs was assessed based on WHO criteria and Naranjo tool. The preventability assessment was performed using Schumock and Thornton questionnaire.Findings:Of the 658 evaluated emergency admissions, 27 were caused by an ADR giving an incidence of 4.1%. Among ADRs, 37.1% were estimated to be preventable. Antibiotics were the most common medication class which caused hospital admission.Conclusion:Pediatric pharmacotherapy still needs evidence-based strategies to improve child care including education, monitoring, planning for medications after ADR occurrence, and implementing preventive measures when applicable.