Key potentially inappropriate drugs in pediatrics: The KIDs list

Rachel S. Meyers, Ernest Mario School of Pharmacy
Jennifer Thackray, Memorial Sloan-Kettering Cancer Center
Kelly L. Matson, University of Rhode Island
Christopher McPherson, St. Louis Children's Hospital
Lisa Lubsch, Southern Illinois University at Edwardsville
Robert C. Hellinga, University of New Mexico Hospital
David S. Hoff, Children’s Hospitals and Clinics of Minnesota


OBJECTIVES The safe use of medications in pediatric patients requires practitioners to consider the unique pharmacokinetics and pharmacodynamics of drugs prescribed in this age group. In an effort to create a standard of care for the safe use of medications in this population, a list of drugs that are potentially inappropriate for use in pediatric patients has been developed and titled the “KIDs List.” METHODS A panel of 7 pediatric pharmacists from the Pediatric Pharmacy Association were recruited to evaluate primary, secondary, and tertiary literature; FDA Pediatric Safety Communications; the Lexicomp electronic database; and product information for drugs that should be considered potentially inappropriate for use in pediatric patients. Information was rated using predefined criteria. A PubMed search was conducted using the following terms: adverse drug events OR adverse drug reactions. The search was limited to humans; age <18 >years; case reports, observational studies, or clinical trials; and English language. No date range was used. Results were used to create an evidence-based list of candidate drugs that was then peer-reviewed and subjected to a 30-day public comment period prior to being finalized. RESULTS A PubMed search yielded 4049 unique titles, of which 210 were deemed relevant for full review. Practitioner recommendations highlighted an additional 77 drugs. FDA Pediatric Safety Communications and the Lexicomp database yielded 22 and 619 drugs, respectively. After critical analysis, peer review, and public review the final KIDs List contains 67 drugs and/or drug classes and 10 excipients. CONCLUSIONS This extensive effort led to compilation of the first list of drugs that are potentially inappropriate for prescribing in all or in a select subgroup of pediatric patients. If avoidance is not clinically possible, the drug should be used with caution and accompanied by appropriate monitoring. ABBREVIATIONS ADR, adverse drug reaction; CNS, central nervous system; FDA, Food and Drug Administration; GRADE, Grading of Recommendations Assessment, Development, and Evaluation; PPA, Pediatric Pharmacy Association; WHO, World Health Organization.