Factors For Adverse Drug Reactions Research Articles

Polypharmacy, potentially inappropriate medication and pharmacogenomics drug exposure in the Rhineland Study.

High medication use may contribute to the efficiency of drug therapy in general, but it could also increase the burden of adverse drug reactions. We aimed to assess medication use and the prevalence of three risk factors for adverse drug reactions: the use of polypharmacy, potentially inappropriate medication in the elderly and pharmacogenomic polymorphisms affecting the metabolism of drugs. Cross-sectional interview-based medication data (including over-the-counter drugs) was collected in a large population-based cohort (≥30years of age) in Bonn, Germany. Analyses were based on the first 5000 participants of the Rhineland Study (mean age 55years, 57% women). Of our participants, 66.0% reported the use of a drug regularly, which increased to 87.4% in participants aged ≥65years (n=1301). The rates of use of polypharmacy, potentially inappropriate medication and pharmacogenomic drugs were 15.9%, 6.4% and 20.5%, respectively. In participants <65years, 16.0% (95% CI 14.8, 17.3) had at least one risk factor. In participants aged ≥65years, 54.1% (95% CI 51.4, 56.8) had at least one and 27.4% (95% CI 25.0, 29.9) had at least two risk factors. Extrapolating these numbers to the German population implies that around 9 million of the 17 million individuals aged 65years or older are potentially at an elevated risk for adverse drug reactions, of which 4.6 million are at a potentially highly elevated risk for adverse drug reactions. Our study shows that drug use is common and the individual risk for an adverse drug reaction in our population is high. This suggests room for improvement in general medication use.

Pain, Complex Chronic Conditions and Potential Inappropriate Medication in People with Dementia. Lessons Learnt for Pain Treatment Plans Utilizing Data from the Veteran Health Administration.

Alzheimer’s disease and related dementias (ADRD), pain and chronic complex conditions (CCC) often co-occur leading to polypharmacy and with potential inappropriate medications (PIMs) use, are important risk factors for adverse drug reactions and hospitalizations in older adults. Many US veterans are at high risk for persistent pain due to age, injury or medical illness. Concerns about inadequate treatment of pain—accompanied by evidence about the analgesic efficacy of opioids—has led to an increase in the use of opioid medications to treat chronic pain in the Veterans Health Administration (VHA) and other healthcare systems. This study aims to investigate the relationship between receipt of pain medications and centrally (CNS) acting PIMs among veterans diagnosed with dementia, pain intensity, and CCC 90-days prior to hospitalization. The final analytic sample included 96,224 (81.7%) eligible older veterans from outpatient visits between October 2012–30 September 2013. We hypothesized that veterans with ADRD, and severe pain intensity may receive inappropriate pain management and CNS-acting PIMs. Seventy percent of the veterans, and especially people with ADRD, reported severe pain intensity. One in three veterans with ADRD and severe pain intensity have an increased likelihood for CNS-acting PIMs, and/or opioids. Regular assessment and re-assessment of pain among older persons with CCC, patient-centered tapering or discontinuation of opioids, alternatives to CNS-acting PIMs, and use of non-pharmacological approaches should be considered.

Prevalence, characteristics and predicting risk factors of adverse drug reactions among hospitalized older adults: A systematic review and meta-analysis.

Background:Occurrence of adverse drug reactions is a major global health problem mostly affecting older adults. Identifying the magnitude and predictors of adverse drug reactions is crucial to developing strategies to mitigate the burden of adverse drug reactions. This study’s objectives were to estimate and compare the prevalences of adverse drug reactions, to characterize them and to identify the predictors among hospitalized older adults.Methods:A comprehensive systematic literature search including both prevalence and risk factors of adverse drug reactions in hospitalized older adults was conducted using PubMed, Scopus and Google Scholar, involving all articles published in English. Descriptive statistics and comparison of means was performed using SPSS version 20.0 and metaprop command was performed in STATA version 13.0. Heterogeneity was assessed using I2 statistic.Results:A total of 18 studies, involving 80,695 participants with a median age of 77 years, were included in this study. The pooled prevalence of adverse drug reaction was 22% (95% confidence interval: 17%, 28%; I2 = 99.23%). Among high-income countries, the prevalence of adverse drug reactions was 29% (95% confidence interval: 16%, 42%) as compared to 19% (95% confidence interval: 14%–25%) in low and middle-income countries (p value = 0.176). Of the 620 adverse drug reactions categorized, most were type A (89%), which are generally predictable and preventable. Two-thirds (795, 67%) of the adverse drug reactions were probable and most (1194, 69%) were mild or moderate. The majority (60%) of the categorized adverse drug reactions were preventable and less than one-third (31%) were severe. The most consistently reported predictors of adverse drug reactions in hospitalized older patients were medication-related factors, including polypharmacy and potentially inappropriate medications followed by disease-related factors—renal failure, complex comorbidity, heart failure and liver failure.Conclusion:Almost one-quarter of all hospitalized older adults experienced at least one adverse drug reaction during their hospital stay. The majority of the adverse drug reactions were preventable. Medication-related factors were the most consistently reported predictors of adverse drug reactions followed by disease-related factors.

Prevalence of Adverse Drug Reactions to Second Line Anti Tuberculosis Drugs in Nigeria: A Cross-Sectional Study

Introduction: Multidrug resistant tuberculosis (MDR-TB) is treated with second line antituberculosis drugs. These drugs are notorious for inflicting serious adverse drug reactions (ADRs), which many studies have shown causes a wide range of economic and health problems including death. Aim: The study examined the prevalence of ADRs, associated risk factors, socio-demographic association and outcomes among patients treated for MDR-TB at a comprehensive tuberculosis treatment center in Nigeria. Method: The study was conducted at the Government Chest Hospital, Jericho, Ibadan. We applied a retrospective assessment of patient treatment data and ADRs reports stored at the study site from March 2013 and February 2016. Subsequently, a prospective study of ADRs was conducted on patients admitted into the same hospital. Causality relationship between the drugs and the reported ADRs was determined with a specially validated tool. The outcomes assessed include recovery from the ADRs, death and permanent deafness from the ADRs. Extracted data were analyzed using SPSS version 22.0. Risk Ratio was calculated for the influence of risk factors for adverse drug reactions. Logistic regression was performed to test for the strength of relationships between risk factors and incidence of ADRs among patients. Result: Almost all the participants in this study reported adverse drug reaction [99% (118/119)]. However, ototoxicity was the most prevalent ADR (35.3%), followed by electrolyte imbalance (12.6%), gastrointestinal track (10.1%) and psychiatric disorders (10.1%). Being older than 35 years and HIV negative or having a healthy BMI were not significant risk factors for developing ADRs. Duration of ADR above one month was significantly associated with the outcome of ADR. Conclusion: Ototoxicity, electrolyte imbalance, psychiatric disorders and gastrointestinal tract problems were the most frequently reported ADRs. Healthcare providers, government and donor agencies supporting the treatment should ensure that hearing aids and other forms of support are readily made available for the affected patients.

Safety of Pyrazinamide for the Treatment of Tuberculosis in Older Patients Over 75 Years of Age: A Retrospective Monocentric Cohort Study.

Pyrazinamide (PZA) has a controversial safety profile in older patients. We aimed to assess the frequency and risk factors for adverse drug reactions (ADRs) in patients over 75 years of age treated for tuberculosis with or without PZA. We conducted a retrospective monocentric study including patients aged over 75years treated for active tuberculosis between 2008 and 2018. The frequency, type, seriousness, and causality assessment of ADRs to anti-tuberculosis treatment were compared between patients receiving PZA or not. Risk factors for ADRs were investigated using univariable and multivariable analyses by logistic regression. Among the 110 patients included, 54 (49.1%) received PZA (group 1) and 56 (50.9%) did not (group 2). ADRs to anti-tuberculosis drugs occurred in 31 patients (57.4%) in groups 1 and 15 (26.8%) in group 2 (p=0.003). PZA-related ADRs occurred in 40.7% of exposed patients. Frequency of renal ADRs was higher in group 1 (9.3% vs 0%; p=0.026). Rates of hepatic (18.5% vs 12.5%; p=0.38), digestive (22.2% vs 8.9%; p=0.054), and allergic (14.8% vs 5.4%; p=0.12) ADRs were numerically higher in group 1 although the differences were not statistically significant. Serious ADRs occurred more frequently in group 1 (24.1% vs 8.9%; p=0.03). The use of PZA was the only independent risk factor for ADRs to anti-tuberculosis drugs (odds ratio 3.75, 95% CI 1.5-9.6; p=0.0056). No risk factors for PZA-related ADRs were identified. In older French patients, the use of PZA was associated with more frequent ADRs to anti-tuberculosis drugs.

Safety of the Xuesaitong injection in China: results from a large-scale multicentre post-marketing surveillance study in a real-world setting

Objective The safety profile of traditional Chinese medicine injections has emerged as the greatest challenge to their clinical application. The authors aimed to perform a post-marketing surveillance study in a real-world setting to evaluate the safety of the Xuesaitong (XST) injection in China. Methods This multi-centre, post-marketing, observational study enrolled patients who received XST injections in 42 centres in China between March 2015 and November 2017. Adverse drug reactions (ADRs) and adverse drug events (ADEs) were collected and evaluated in a post-marketing database. Logistic regression analysis was performed to analyse the risk factors for ADRs. Results A total of 30,008 consecutive patients with a mean age of 62.29 ± 14.58 years were included in this post-marketing study. The incidences of ADEs and ADRs were 0.5% and 0.33%, respectively. The most common clinical manifestations were damage to skin and appendages (47.66%). There were four new kinds of ADEs found in the present monitoring study. The majority of ADRs were type B (62.62%) and occurred within 24 h after XST injection treatment. No severe ADRs were reported in this analysis. Multivariate logistic regression analysis showed that the hospital level (OR = 0.607; 95% CI = 0.407–0.906; p = .0144), hypertension (OR = 1.979; 95% CI, 1.323–2.959; p = .0009) and solvent type (OR = 2.951; 95% CI, 1.608–5.417; p = .0005) were risk factors for ADR occurrence. Conclusion XST injection is well tolerated and has a favourable safety profile for patients in a real-world setting. This post-marketing study provided further evidence of the safety of XST injections for clinical applications.

Magnitude, Nature, and Risk Factors of Adverse Drug Reactions Associated with First Generation Antipsychotics in Outpatients with Schizophrenia: A Cross-Sectional Study.

BackgroundADRs to antipsychotics are amongst the major challenges in the treatment of patients with psychotic disorders. The extent of patient-reported ADRs assessed in many studies using standardized scales is found to be inconsistent. However, there is a paucity of such research in Eritrea. The aim of the study is therefore to determine the magnitude, nature, and the possible risk factors associated with ADRs of the first generation antipsychotics in outpatients with schizophrenia at Saint Mary Neuro-Psychiatric National Referral Hospital in Asmara, Eritrea, using the LUNSERS self-rating scale.MethodsA cross-sectional, descriptive and analytical study design utilizing a quantitative approach was employed. Data were collected from patients’ self-administered questionnaires, interviews, and medical records. The collected variables were analyzed using SPSS 22.0 with descriptive statistics, correlation, t-tests, ANOVA, and multiple regression. Statistical significance was tested at P-value<0.05.ResultsIn this study, 93.8% of the research participants experienced at least one ADR. LUNSERS total mean score of the relevant items was 28.01 (SD=18.46) with 24.7% of the study participants scoring medium-to-high. The prevalence of the categories of ADRs was psychic (91.3%), autonomic (78.1%), extra-pyramidal (76.9%), miscellaneous (66.5%), hormonal (58.3%), anti-cholinergic (44.2%), and allergic reactions (44.2%). At multivariate level, factors significantly and positively associated with total ADR score were smoking (P=0.028) and being at secondary educational level (P=0.015).ConclusionThere was high prevalence of ADRs with moderate-to-high overall ADR scores in a significant number of patients. The most frequently reported ADRs were psychic, autonomic, extra-pyramidal, hormonal, and miscellaneous. Smoking and secondary level of education were found to be the main determinants of ADRs.

Risk factors of adverse drug reactions of first-line antiretroviral therapy in HIV patients at RSUD Dr. Moewardi

Acquired Immuno Deficiency Syndrome (AIDS) is an infection caused by the Human Immunodeficiency Virus (HIV). The antiretrovirals (ARVs) combination is the basis for the management of therapy in HIV/AIDS patients, but it often raises problems like adverse drug reactions (ADRs). This study was conducted to determine the risk factors for the occurrence of ADRs in the use of first-line ARVs. It employed a cross-sectional design with retrospective data collection in patients visiting the Voluntary Cell Counting (VCT) room of RSUD Dr. Moewardi in November-December 2018. The data collected were sociodemographic, behavioral, and clinical characteristics, laboratory test results, and ARV profiles. Findings show that the risk factors for ADRs in the use of first-line ARVs are CD4 of &lt;200 and 0-24 months of taking ARVs.

Risk Factor Considerations in Statistical Signal Detection: Using Subgroup Disproportionality to Uncover Risk Groups for Adverse Drug Reactions in VigiBase.

IntroductionIn the treatment of the individual patient, a vision is to achieve the best possible balance between benefit and harm. Such tailored therapy relies upon the identification and characterisation of risk factors for adverse drug reactions. Information relevant to risk factor considerations can be captured in adverse event reports and could be utilised in statistical signal detection.ObjectiveThe aim of this study was to explore whether statistical screening of a broad range of risk factors within a global database of adverse event reports could uncover signals of risk groups for adverse drug reactions.MethodsSubgroup disproportionality analysis was applied to 15.4 million reports entered in VigiBase, the World Health Organization (WHO) global database of individual case safety reports, up to August 2017. Disproportionality analyses for drug–adverse event pairs were performed (1) in the full database and (2) across a range of subgroups defined by the following covariates: patient age, sex, body mass index, pregnancy, underlying condition, reporting country, and geographical region. Drug–adverse event pairs disproportionately over-reported in such subgroups, but not in the full database, and with a substantial difference between the two observed-to-expected ratios, were highlighted as statistical signals. These were further prioritised, through filtering and sorting, for clinical assessment, whereafter clinically relevant signals were communicated to the pharmacovigilance community and the public.ResultsAssessments were performed for 354 prioritised statistical signals, resulting in seven communicated signals describing previously unrecognised potential risk groups related to age (elderly), sex (male and female), body mass index (underweight and obese), and geographical region (Asia), all except one for already established adverse drug reactions. Important aspects considered in the assessments included an evaluation of the disproportionate over-reporting in the subgroup by reviewing alternative explanations and reporting patterns for similar drugs/adverse events/subgroups, and a search for plausible mechanisms to support the risk hypothesis.ConclusionsThis study reveals that it is possible to uncover signals of risk groups for adverse drug reactions through incorporation of broad risk factor screening into statistical signal detection in a global database of adverse event reports. Our findings suggest the potential to use such statistical methodologies for risk characterisation in subpopulations of concern.Electronic supplementary materialThe online version of this article (10.1007/s40264-020-00957-w) contains supplementary material, which is available to authorized users.

SWEDEGENE\u2014a Swedish nation-wide DNA sample collection for pharmacogenomic studies of serious adverse drug reactions

SWEDEGENE is a Swedish nation-wide sample collection established to facilitate studies of clinical and genetic risk factors for adverse drug reactions (ADRs). Most cases are recruited among patients reported to the ADR registry at the Swedish Medical Products Agency by health-care professionals. Clinical data are collected both from medical and laboratory records and through interviews using standardized questionnaires. Genome-wide scans and whole-genome sequencing are done, and association studies are conducted using mainly controls from the Swedish TwinGene biobank with data on diagnoses and prescribed drugs. SWEDEGENE was established in 2008 and currently contains DNA and information from about 2550 adults who have experienced specific ADRs, and from 580 drug exposed controls. Results from genome-wide association studies have now been published, and data from whole-genome sequencing are being analyzed. SWEDEGENE has the potential to offer a new means of developing individualized and safe drug therapy through patient pre-treatment screening.

The Incidence and Risk Factors for Adverse Drug Reactions Related to Tanreqing Injection: A Large Population-Based Study in China.

Background: Tanreqing injection (TRQ) is a traditional Chinese medicine commonly used in China to treat pulmonary diseases presenting as phlegm-heat syndrome. Robust data on the safety of TRQ from real-world observational cohorts are currently lacking. Objective: To evaluate as the incidence, type, and predictors of adverse events (AEs) and adverse drug reactions (ADRs) of TRQ in clinical practice in China. Methods: We conducted a population-based cohort, multicenter study to evaluate the incidence, manifestation, outcomes, and risk factors of AEs and ADRs following TRQ use in China. Between April 2014 and May 2015 a total of 30,322 consecutive inpatients/emergency attendance patients from 90 hospitals across China administrated TRQ were followed-up for 7 days. Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated using logistic regression to identify predictors of ADRs. Results: The incidence of AEs and ADRs was 1.4 and 0.3%, respectively. Skin and subcutaneous tissue disorders were the most common ADRs. All ADRs were mild or moderate in severity, except for one serious case of anaphylactic reaction. The majority of ADRs (72.8%) occurred in the first 2 h after TRQ administration. Two-thirds of patients (66.1%) in the study were prescribed TRQ off-label, including infants aged ≤24 months. A history of food allergy (OR 4.50, 95% CI: 1.35–15.00), drug allergy (OR 2.77, 95% CI: 1.56–4.94), and fast infusion speed (off-label use) (OR 2.10, 95% CI: 1.27–3.50) were associated with an increased risk of ADRs. Conclusion: TRQ is well tolerated in the general population, yet off-label use is prevalent. Efforts are required to educate prescribers to adhere to the drug label in order to minimize potential patient harm.

Risk factors for adverse drug reactions in older inpatients of geriatric wards at admission: Multicenter study.

To investigate the characteristics of adverse drug reactions (ADR) and their risk factors among very old patients in five geriatric wards in Japan. A retrospective observational multicenter study was carried out to investigate factors related to ADR in older inpatients from geriatric wards of five university hospitals in Japan. Data including drugs profile and short-form comprehensive geriatric assessment were obtained from medical charts. ADR were identified from geriatrician's reports. For each ADR, symptoms and causal drugs were clarified, and factors associated with ADR were analyzed statistically. In 1155 patients (52.5% women, mean age 82.8 ± 7.0 years), the proportion with ADR was 15.4%. There was a great variety of signs and symptoms of ADR, and a great variety of drugs suspected to be the cause of ADR. On multiple logistic regression analysis, ADR was significantly associated with an increase in drugs (odds ratio 1.11, 95% CI 1.07-1.16) and emergency admission (odds ratio 2.76, 95% CI 1.82-4.15). Receiver operating characteristic curve analysis showed that the optimal cut-off number of drugs for predicting ADR was ≥7. In geriatric inpatients, polypharmacy (especially ≥7 drugs) and emergency admission were associated with ADR. Because there was a great variety of ADR in the study, clinicians must consider reviewing all drugs to prevent adverse drugs reactions during admission in this vulnerable population. Geriatr Gerontol Int 2019; ••: ••-••. Geriatr Gerontol Int 2020; 20: 144-149.

PMU3 RISK FACTORS FOR ADVERSE DRUG REACTIONS IN PATIENTS UNDERGOING GENERAL SURGERY: A PROSPECTIVE OBSERVATIONAL STUDY

To assess the risk factors of Adverse Drug Reactions (ADRs) observed in patients admitted to the general surgery wards. A hospital based prospective observational study was conducted among 180 inpatients in the department of general surgery for a period of six months. Patients aged above 18 years and who were operated under at least one anesthetic drug were included in the study. Risk factors of ADRs were identified using binomial and multinomial logistic regression analysis. A total of 180 patients were recruited in the study out of which 149 (83%) patients were presented with at least one ADR and a total of 296 ADRs were observed. General anesthetics (45.4%) contributed to the highest number of ADRs followed by local anesthetics (26.7%). Risk estimates revealed that there is a significant association between smoking (Odds ratio [OR] = 8.60, 95% CI 1.31-22.56, p=0.03), ASA (American society of anesthesiologists) physical status ≥ 3 (OR=2.386, 95% CI 1.799-3.401, p=0.005), amputation surgery (OR=3.058, 95% CI 1.63-5.34, p=0.011), cancer related surgeries (OR=2.303, 95% CI 1.011-4.594, p=0.049) and occurrence of ADRs. This study has identified smoking, ASA grade≥3, amputation and cancer related surgeries as early predictors for the development of ADRs during perioperative period. The independent risk factors identified lay a great emphasis on the need of individualized drug therapy which will significantly improve the therapeutic outcomes and reduce the economic burden on patients

Use and misuse of new antiepileptic drugs

The term ‘old antiepileptic drugs (AEDs)’ refers to antiseizure medications marketed prior to 1970. Starting with 1989, a large number of ‘new AEDs’ have been introduced gradually into routine clinical pratice and some of these medications are now considered to be valuable options for first-line treatment. The golden rule governing AED therapy consists in tailoring the choice of the drug to the characteristics of the individual. In that regard, the key question is not whether to use an old- or a new-generation AED, but which medication represents the most appropriate choice taking into account the person’s seizure type(s), epilepsy syndrome (including etiology), age, gender, comorbidities, concomitant treatments and other risk factors for adverse drug reactions. Cost considerations are also important, particularly in low-income countries. In general, new medications are not more efficacious than older generations agents. Although some of the newer AEDs are associated with a lower risk of adverse effects (including teratogenicity) and cause fewer adverse drug interactions compared with older agents, the advantages of newer medications are often overstimated, mainly as a result of drug promotion in the marketplace. This presentation will highlight situations where the choice of a new medication is preferable, as well as scenarios where new medications are clearly misused.

A prospective pharmacovigilance study in the infectious diseases unit of a tertiary care hospital.

The frequency, causality, severity, preventability and risk factors of ADRs (adverse drug reactions) in infectious disease units are not well defined in the literature. Thus, the aim of this study was to determine the characteristics of the ADRs encountered in an infectious disease unit of a tertiary teaching hospital. The patients who were admitted to the infectious disease unit of a tertiary teaching hospital longer than 24 hours between January and December of 2016 were followed prospectively. Patients were observed and questioned for any sign of ADRs. The proportion of ADRs and patient characteristics were investigated. Causality was evaluated by the Naranjo algorithm, severity was determined using the Hartwig classification, and preventability was assessed using the Schumock and Thornton scale. 210 patients were admitted to the unit during the study period, of whom 44 patients (20.9%) experienced 51 ADRs. 5.9% of ADRs were found to be serious according to the Hartwig severity classification. In addition, 88.1% of ADRs were not preventable. The most frequently detected ADR was skin and subcutaneous tissue reactions (33.3%), and systemic antimicrobials were the most common type of drugs that caused an ADR. Prolonged hospitalization (p < 0.001) and usage of an increased number of drugs (p < 0.001) were found to be significant risk factors for ADR development. Prolonged hospital stay and polypharmacy are significant risk factors that increase the incidence of ADRs in infectious disease units. The likelihood of unavoidable ADRs should arouse the attention of clinicians when prescribing antimicrobials.

Adverse Effects of Fluoroquinolones: A Retrospective Cohort Study in a South Indian Tertiary Healthcare Facility.

The Food and Drug Administration (FDA) safety review revealed that the use of fluoroquinolones (FQs) is linked with disabling and potentially permanent serious adverse effects. These adverse effects compromise the tendons, muscles, joints, nerves, and central nervous system of the human body. The purpose of the study was to investigate the incidence and risk factors for adverse drug reactions (ADRs) caused by FQs in comparison with other antibiotics used. A retrospective cohort study was conducted over seven months in Kasturba Medical College Hospital, Manipal, India. Patients who were prescribed with FQs were selected as the study cohort (SC; n = 482), and those without FQs were the reference cohort (RC; n = 318). The results showed that 8.5% (41) of patients developed ADRs in the SC, whereas 4.1% (13) of patients developed ADRs in the RC. With oral and parenteral routes of administration, almost a similar number of ADRs were observed. Levofloxacin caused the highest number of ADRs reported, especially with the 750-mg dose. Based on a multiple logistic regression model, FQ use (odds ratio (OR): 2.27; 95% confidence interval (CI): 1.18–4.39; p = 0.015) and concomitant steroid use (OR: 3.19; 95% CI: 1.31–7.79; p = 0.011) were identified as independent risk factors for the development of ADRs among antibiotics users, whereas age was found to be protective (OR: 0.98; 95% CI: 0.97–1.00; p = 0.047). The study found a higher incidence of ADRs related to FQs compared to other antibiotics. The study concludes a harmful association between FQ use and the development of ADRs. Moreover, FQs are not safe compared to other antibiotics. Hence, the use of FQs should be limited to the conditions where no other alternatives are available.

Use of the STOPP and START criteria to address polypharmacy for elderly patients in University Hospital Lewisham Clinical Decisions Unit

Background: Polypharmacy and inappropriate prescribing are risk factors for adverse drug reactions, which commonly cause complications in older people. The STOPP (Screening Tool of Older Persons’ Prescriptions)/START (Screening Tool to Alert Doctors to Right Treatment) criteria are screening tools, which aim to improve prescribing in the elderly. Objectives: The aim was to improve prescribing, using the STOPP/START criteria, for patients aged 65 and above, who were admitted to the Clinical Decisions Unit at University Hospital Lewisham. We focused on the most common prescribing errors in clinical decision unit, an emergency medicine department. Methods: We reviewed all patients aged 65 and above admitted to the Clinical Decisions Unit in September. Data was collected from clinical documentation and archived drug charts. This pilot study of 114 patients revealed the most common prescribing errors, of which 8 were STOPP and 11 were START criteria. A plan–do–study–act methodology was implemented over 1 month, involving presentations, emails and posters. Prescribing patterns were then reviewed over 4 weeks in December in 111 patients. Results: Focusing on the 8 STOPP and 11 START criteria, there was a significant reduction in the proportion of patients with at least one STOPP error (17.5% to 9%, p = 0.04). However, the decrease in the percentage of patients with at least one START error was insignificant (24.6% to 20.7%, p = 0.24). Conclusion: By identifying problematic areas of prescribing and using targeted interventions, the proportion of STOPP errors made in clinical decision unit reduced significantly. This study highlights the prevalence of prescription errors in the clinical decision unit and the impact of using screening tools to reduce incorrect prescribing.

Efficacy and safety of cycloserine-containing regimens in the treatment of multidrug-resistant tuberculosis: a nationwide retrospective cohort study in China.

BackgroundOur aim was to assess whether the use of cycloserine (CS) would bring additional benefit for multidrug-resistant tuberculosis (MDR-TB) patients, and to estimate the incidence and associated risk factors of adverse drug reactions (ADRs) from CS.Patients and methodsIn this study, we retrospectively reviewed the clinical outcomes and ADRs of MDR-TB patients treated with CS containing regimens between January 2012 and June 2015 in China.ResultsA total of 623 MDR-TB cases enrolled in this study received regimens containing CS. Of these cases, in 411 of the patients 374 (66.0%) were “cured” and 37 (5.9%) “complete treatment” by the end of the study. The elderly, patients with prolonged previous exposure to and history of anti-TB drugs, and pre-existing co-morbidity were more likely to be associated with adverse outcomes of MDR-TB patients (P<0.05). Hyperuricemia (22.8%, 142/623) was the most frequently observed ADR among these cases, while the most noted ADRs associated with the administration of CS was psychiatric symptoms, accounting for 4.3% (27/623) of study population. Nineteen (70.4%) out of 27 cases with psychiatric symptoms occurred before the 6-month timepoint, and were notably, the highest proportion of serious adverse, 29.6% (8/27) of which were noted after discontinuation of CS.ConclusionOur study demonstrates that a CS-containing regimen achieved a highly successful outcome in the treatment of MDR-TB and promising tolerance in Chinese population. The potential emergence of serious psychiatric symptoms highlights that patients need to be closely monitored for these conditions during treatment that includes CS.

Evaluation of adverse drug reactions in dermatology department of a charitable hospital in India

Background: Adverse drug reactions (ADRs) can be confined to either skin or be a part of systemic reaction such as drug hypersensitivity syndrome or toxic epidermal necrolysis. Objective: The objective is to evaluate the incidence, causality, severity, preventability, and risk factors of ADRs in the dermatology department of a charitable hospital in India. Patients and Methods: A prospective observational study was carried out over a period of 8 months in the dermatology department. The WHO and Naranjo's scales evaluated the suspected ADRs for causality assessment, severity by Hartwig and Siegel Scale, and preventability by modified Schumock and Thornton Scale. Results: A total number of 200 eligible patients were enrolled in the study. Out of 200, 18 patients developed ADRs. The incidence of dermatological ADRs in the study was 9%. The most commonly manifested ADRs were Stevens–Johnson syndrome (SJS) (22.2%) followed by skin rashes (16.7%) and others. The maximum number of ADRs were observed with antibiotics (33.5%), followed by antiepileptic drugs (16.7%) and nonsteroidal anti-inflammatory drugs (NSAIDs) (16.7%). According to the WHO and Naranjo's scales, most of the reactions were probable with 61.1% and 55.6%, respectively. Most of the ADRs were moderately severe (66.6%) and were not preventable (55.6%). Conclusions: SJS and rashes were the most commonly observed clinical pattern of ADRs. The most common drug class responsible for ADRs was antibiotics, followed by antiepileptic drug and NSAID's. Dermatological ADRs varied in their causality, severity, and preventability.

An Evaluation of Potential Inappropriate Prescribing Among Older Persons in Nigeria

Potential Inappropriate prescribing (PIP), Drug-Drug interactions (DDI) and polypharmacy are major risk factors for adverse drug reactions among older persons. Although these factors in many cases co-exist in prescriptions to older persons, very few studies have evaluated the inter-relationship between these factors concomitantly. This study aimed to evaluate PIP and DDI and to determine the associations between PIP, DDI, and polypharmacy among Nigerian older persons. This study was a retrospective evaluation of medicine utilization among older persons at Olabisi Onabanjo University Teaching Hospital, Nigeria, using a medical chart review. Older persons aged &amp;ge;60 years, with chronic diseases that attended the medical outpatient clinics of the hospital between 1st January and 31st December 2016 were included. Eligible patients&amp;rsquo; records were randomly sampled. Information including patients&amp;rsquo; demographics, medical and medication histories and current medications were extracted with a checklist. PIP and DDI were evaluated using the 2015 updated Beers Criteria. Associations were determined using Chi-squared test and a binary logistic regression. A total of 352 participants, mean age 69.03&amp;plusmn;7.35 years were evaluated. According to the Beers Criteria, PIP and DDI among the participants were (124/352, 35.2%) and (20/352, 5.7%) respectively. Majority of the participants (192/352, 54.5%) received polypharmacy. A few participants (12/352. 3.4%) received prescriptions containing PIP, DDI, and polypharmacy concomitantly. DDI was significantly associated with PIP in a logistic regression (OR=0.18, 95%CI=0.05-0.68, p=0.01) and with polypharmacy in a Chi-squared test (OR=3.55, 95%CI=1.16-10.83, p=0.02). This study concludes that PIP, DDI and polypharmacy are interrelated and should be considered when prescribing to older persons.