Previous Adverse Drug Reactions Research Articles

Hospital-based survey of doctors' attitudes to adverse drug reactions and perception of drug-related risk for adverse reaction occurrence.

Doctors' attitudes to adverse drug reactions (ADRs) and perception of drug-related risk for ADR occurrence were investigated in four hospitals in Northern Italy using an interviewer-administered questionnaire. ADRs were a relevant concern in medical practice for 80% of the respondents and had been observed by 87%. ADRs were perceived to occur in no more than 5% of hospitalized patients and serious ADRs in less than 1%. The response patterns, however, differed according to the ward of work and the year of graduation of the doctors. Antibacterials, NSAIDs and antiarrhythmics were rated as higher risk drugs, while diuretics, lipid lowering agents, antihistamines, antiemetics and antispasmodics were rated as lower risk drugs. Risk perception was dishomogeneous mainly with respect to the ward of work. The estimated frequency of ADR occurrence, the perception of drug-related risk and previous ADR reporting behaviour were clearly correlated. The present results suggest that personal factors affect doctors' attitudes to ADRs, perception of drug-related risk and ADR reporting behaviour and may thus be relevant in developing and targeting educational strategies aimed at increasing awareness of ADRs and at encouraging ADR reporting.

Co-trimoxazole desensitization in HIV-seropositive patients.

Co-trimoxazole (trimethoprim-sulphamethoxazole) is an effective prophylactic agent against Pneumocystis carinii pneumonia (PCP). However, it is associated with a high frequency of adverse reactions in immunocompromised patients which may preclude its use. Fourteen patients with a definite history of adverse reactions to co-trimoxazole on standard PCP prophylactic dosage were selected for desensitization using a regimen of gradual incremental exposure over an 11-day period. Eight (57.1%) were successfully desensitized and have continued on oral co-trimoxazole at maximum 21 months' follow-up. This report demonstrates that oral desensitization as an outpatient procedure is an effective and safe option for both primary and secondary PCP prophylaxis in HIV-seropositive patients with previous adverse drug reactions.

Antibiotic treatment of gonorrhoea--clinical evidence for choice.

Introduction The clinician's choice of treatment for gonorrhoea focuses on clinical efficacy, patient acceptability and toxicity. These criteria inevitably encompass consideration of in vitro antimicrobial sensitivities, the pharmacokinetic properties of candidate antimicrobials, anticipated compliance, cost-effectiveness, ease of administration, patient's age, pregnancy and previous adverse drug reactions. Concomitant infection with other sexually transmitted pathogens should be sought and managed appropriately.

Drug history taking and the identification of drug related problems in an accident and emergency department.

To determine the incidence of drug related problems that fail to be noted on casualty cards in patients subsequently admitted, and to compare medication histories as recorded by accident and emergency (A&E) senior house officers (SHOs) and a pharmacist. An initial retrospective survey of 1459 acute inpatient admissions through A&E over a three month period was followed by a prospective study of 33 elderly patients. In the retrospective survey, 52 medication related problems were confirmed after examination of the medical records, of which only 16 were identified in A&E. In the prospective study, 125 currently prescribed items were identified by the pharmacist compared to 77 by A&E SHOs; 66% of the missed information was clinically relevant. Of 17 previous adverse drug reactions identified by the pharmacist only six were also recorded by the A&E officer. Only four over the counter medicines were identified by the A&E SHOs compared to 30 by the pharmacist. More accurate recording of drug history on casualty cards should be undertaken, particularly in respect of over the counter medication and the identification of drug related problems.

Some patient experiences with drugs and adverse drug reactions in an African teaching hospital

One hundred and seventy patients regularly attending a general medical outpatients' clinic at the Parirenyatwa Central Hospital (PCH) in Harare, Zimbabwe were interviewed about their knowledge of their present drug therapy and possible adverse drug reactions (ADRs), history of previous ADRs and action taken on experiencing them, information source and satisfaction with their therapy. Sixty seven patients knew what drugs they were taking and this level of awareness was associated with age, occupation and level of education of the patient. Only 19 patients knew about the possible ADRs of their drugs and this knowledge was associated with language ability, disease knowledge and knowledge of what drugs they were taking. Seventy eight patients had experienced ADRs and this was linked to age and knowledge of ADRs. Eighty one patients said that they would continue their drug treatment on experiencing ADRs, and this behaviour was associated with knowledge of disease and ADRs. More than half of the patients were not satisfied with the information given about their drugs, and very few had read about this subject. These results suggest that overall knowledge of drugs and ADRs amongst patients at the PCH is low, and that there is a need to increase patient education regarding therapy. This training should take into account the patient's demographic and socioeconomic background. Knowledge of ADRs was shown to increase the potential for compliance.

Predisposing factors in adverse reactions to drugs.

Predisposing factors were sought in 118 patients who developed adverse drug reactions in hospital. Significantly more patients of 60 years and over, and more women than men, developed adverse drug reactions. Patients with reactions had more drugs before the development of the reaction than patients who did not develop reactions. A previous adverse drug reaction and a history of allergic disease were significant factors, while a history of jaundice or the presence of diabetes mellitus and renal disease was not.