Assessment of Drug-Drug Interaction in Ayder Comprehensive Specialized Hospital, Mekelle, Northern Ethiopia: A Retrospective Study

The Prevalence and Severity of Potential Drug-Drug Interactions in Internal Medicine Ward at Soba Teaching Hospital

Background

Multiple drug therapies are commonly used to achieve a desired therapeutic goal, especially in hospitalized patients. However, drug-drug interactions might occur and threaten the patients' safety.

Objective

This study aims to assess the prevalence and severity of potential drug-drug interactions (PDDIs) in the internal medicine ward at Soba Teaching Hospital.

Methods

A retrospective cross-sectional hospital-based study was carried out in the internal medicine ward at Soba Teaching Hospital from June 2021 to December 2021. The data was collected from patients' medical records. PDDIs were identified using Lexicomp® drug interaction software.

Results

A total of 377 patients were included in this study, and overall prevalence of PDDIs was 62.9%. We have identified 989 potential DDIs and 345 pairs of interacting drugs, the mean of the PDDIs per patient was 4.17 ± 4.079. Among 345 PDDIs most were of moderate interactions 70.1% (n=242) followed by Minor interactions 19.1% (n=66). The most common type of interaction was of category C representing 63.5% (n=219). A significant association was observed between the occurrence of PDDIs with patients' age, presence of chronic diseases, length of hospital stay, and number of medications received by the patients.

Conclusion

Drug-drug interactions were highly prevalent in the internal medicine ward. Therefore, certain attempts are required to increase the awareness of the physicians about these interactions and minimize their occurrence.

Evaluation of Antibiotics Use and its Predictors at Pediatrics Ward of Jimma Medical Center: Hospital Based Prospective Cross-sectional Study

Background

One of the biggest emerging public health issues is the alarming increase in the prevelance of antibiotic resistance across the globe, which is linked to significant morbidity and mortality and demands special attention. The most significant risk factor for antimicrobial resistance (AMR), which is increasing considerably in Ethiopia and is responsible for increased adverse effects, treatment failure, and rising health-care costs, is inappropriate antibiotic usage. The purpose of this study was to assess the use of antibiotics in inpatient settings at an Ethiopian teaching hospital providing tertiary care.

Methods

The hospital-based prospective cross-sectional study was undertaken at JMC in southwest Ethiopia. Data were collected by using structured checklist which contains patient's sociodemographic characteristics and pattern of antimicrobial use. All cards of patients which fulfill the inclusion criteria were selected by using a systematic random sampling technique. Bivariate analysis was done to know the association between independent variable and the outcome variable.

Results

The medical records of 402 pediatric patients who had taken at least one systemic antibiotic were examined. The most frequently prescribed combination antibiotics were ampicillin+gentamycin (43.33%) followed by ceftriaxone+gentamycin (15.23%). Gentamycin 116 (24.11%) was the most frequently used antimicrobial. Overall 19.29% of antibiotic use was improper. A higher percentage of participants 149 (22.41%) experienced inappropriate antibiotic usage as a result of inappropriate frequency. Pediatric patients stay in hospital ≥7 days (AOR; 2.45, 95%CI: 2.32-5.34), prescribed antibiotics ≥2 3.12 (AOR: 3.12, 95%CI: 6.32-13.37) and prescribed empirical treatment types (AOR; 2.65, 95%CI: 4.23-8.87) were independent predictors of inappropriate antibiotics use.

Conclusion

Antibiotics were generally used inappropriately at high rates. Gentamycin and crystalline penicillin were the most prescribed antibiotics. Longer hospital stay, antibiotics prescription ≥2, and empirical treatments were the independent predictors of inappropriate antibiotic use.

Off-label medication use in pediatrics and associated factors at public hospitals in east Gojjam zone, Ethiopia

Objective

Due to a lack of appropriate pediatric preparations, health providers frequently use adult formulations in an off-label manner. This study aimed to assess pediatric off-label medication use patterns and associated factors in East Gojjam, Ethiopia.

Methods

Institutional-based cross-sectional study was conducted from December 2020 to June 2021 at three randomly selected hospitals. Data were collected by using self-structured questionnaires and a data abstraction checklist from health care workers and prescriptions, respectively. The collected data were analyzed using SPSS version 25. Logistic regression analysis was used to assess the association between independent and dependent variables.

Results

A total of 285 eligible health professionals from the pediatric unit and pharmacies, and 1,800 eligible prescriptions were involved in the study. The response rate of healthcare workers was 94.37%. Around 74.4% of professionals had good knowledge about off-label medication. Only 8% of participants had taken training on pediatric off-label medications. Of all prescriptions, 27.6% of them have contained at least one off-label medication. Phenobarbitone (16.1%) and phenytoin (12.7%) were the most frequently prescribed off-label medication. In all, 496 (27.6%) prescriptions contained off-label drugs in the form of overdose, cutting adult tablets into small portions, and formulating tablets/capsules into solution. Lack of information on off-label prescribing, shortage of pediatric drugs, and suitable dosage forms showed significant association with off-label prescribing with p-value < 0.001.

Conclusion

Almost one-third of pediatric prescriptions contained off-label medication. Only a small number of healthcare workers had taken training on pediatric off-label medications. Lack of sufficient information on risks of off-label medication, shortage of pediatric medication, and suitable pediatric dosage forms were associated with the use of off-label medication compared to non-use. Further research should be done on the long-term effects associated with off-label prescribing in pediatrics to assess whether the potential risks are balanced with the therapeutical benefit.

Drug-Drug interaction among admitted patients at primary, district and referral hospitals' medical wards in East Gojjam Zone, Amhara Regional State, Ethiopia

Objectives:

This study was aimed to assess the type, prevalence, characteristics of drug interaction and factors associated from admitted patients in medical wards at primary, district and referral hospitals in East Gojjam Zone, Amhara Regional State, Ethiopia.

Methods:

A facility-based retrospective cross-sectional study design was conducted among admitted patients in medical wards at different hospitals of East Gojjam Zone from September 2019 to February 2020. Patient-specific data were extracted from patient medical prescription papers using a structured data collection tool. Potential drug–drug interaction was identified using www.drugs.com as drug–drug interaction checker. Data were analyzed using SPSS version 23.0. To identify the explanatory predictors of potential drug–drug interaction, logistic regression analysis was done at a statistical significance level of p-value < 0.05.

Results:

Of the total 554 prescriptions, 51.1% were prescribed for females with a mean (±standard deviation) age of 40.85 ± 23.09 years. About 46.4% prescriptions of patients had one or more comorbid conditions, and the most frequent identified comorbid conditions were infectious (18.6%) and cardiac problems (6.3%) with 0.46 ± 0.499 average number of comorbid conditions per patient. Totally, 1516 drugs were prescribed with 2.74 ± 0.848 mean number per patient and range of 2–6. Two hundred and forty-two (43.7%) prescriptions had at least one potential drug–drug interaction, and it was found that 292 drug interactions were presented. Almost half of the drug–drug interaction identified was moderate (50%). Overall, the prevalence rate of drug–drug interaction was 43.7%. Older age (adjusted odds ratio = 8.301; 95% confidence interval (5.51–12.4), p = 0.000), presence of comorbidities (adjusted odds ratio = 1.72; 95% confidence interval (1.10–2.68), p = 0.000) and number of medications greater or equal to 3 (adjusted odds ratio = 2.69; 95% confidence interval (1.42–5.11), p = 0.000) were independent predictors for the occurrence of potential drug–drug interaction.

Conclusion:

The prevalence of potential drug–drug interaction among admitted patients was relatively high. Pharmacodynamic drug–drug interaction was the common mechanism of drug–drug interaction with moderate degree. Therefore, close follow-up of hospitalized patients is highly recommended.

Appropriateness and Pattern of Antibiotic Prescription in Pediatric Patients at Adigart General Hospital, Tigray, Ethiopia

Background

Inappropriate and unnecessary use of antibiotics can increase morbidity, mortality, medical expenses or patient cost, and microbial antibiotic resistance. However, in developing countries like Ethiopia, information regarding appropriateness of antibiotic prescribing pattern to guide improvement strategies is scant.

Objective

The aim of this study was to assess appropriateness and pattern of antibiotic prescription in pediatric patients at pediatric ward of Adigrat General Hospital.

Methods

Hospital-based retrospective cross-sectional study was conducted to assess the antibiotic prescribing pattern in pediatric inpatient and outpatient ward of Adigrat General Hospital from December 1, 2018 to April 30, 2019. Data was collected by using structured data collection checklist, and the systematic random sampling technique was employed to enroll the required sample size during the study period. Appropriateness of drug use in pediatrics was evaluated using Ethiopian Standard Treatment guideline and WHO pediatric guideline.

Result

A total of 692 pediatric patients' medical charts were reviewed. The median age of patients on antibiotics was 3.26 years (IQR: 2-4). Majority (49.13%) of the patients were hospitalized for 5-9 days. SCAP (195), tonsillitis (114), and cellulitis (99) were most frequently encountered pediatric diseases. Penicillins (37.86%) followed by cephalosporins (31.79%) antibiotics were the most prescribed antibiotics in pediatric wards. This study also showed that ceftriaxone and ceftriaxone+amoxicillin were the most frequently used single and combination antibiotics, respectively. The prescribing practices were not stick to WHO core indicators and standards. Inappropriate prescription of antibiotics was observed in 28.3% of patients. Advanced age of children, children aged between 6 to 10 years (AOR = 3.225; CI = 1.080 − 9.630; P = .036) and 11-18 years (AOR = 18.691; CI = 5.156 − 67.756; P = .000), was the independent determinant of inappropriate drug use.

Conclusion

Inappropriate antibiotic prescribing was encountered in 28.3% of children. The rate of generic prescription was not in line with WHO recommendation. Advanced age of children was the independent factor for inappropriate use of antibiotics.

Hospital-based ciprofloxacin use evaluation in Eastern Ethiopia: a retrospective assessment of clinical practice

INTRODUCTION

ciprofloxacin is a second-generation fluoroquinolone, which has been used as one of the top three antibacterial agents prescribed in Ethiopia. However, its use has deviated from the recommendation of standard treatment guidelines resulting in a gradual increase in antimicrobial resistance. Therefore, this study aimed to evaluate the annual use of ciprofloxacin in 2016 based on the standard Ethiopian treatment and World Health Organization guidelines, in governmental hospitals, in Eastern Ethiopia from 1st May to 30th June 2018.

METHODS

a hospital-based retrospective cross-sectional study was conducted to evaluate medical records of patients who had taken ciprofloxacin in 2016. The total sample size (n=522) was proportionally allocated to each hospital based on the respective consumption data. A simple random sampling method was employed to collect the required sample. The collected data were entered into SPSS version 21 and analyzed using descriptive analysis.

RESULTS

in this study, 522 medical records were reviewed, with a male to female ratio of 1.03: 1. Ciprofloxacin was indicated in 478 (91.6%) participants whose age was greater than eighteen years. The majority were treated in the medical and emergency outpatient departments (n=477, 91.4%). Urinary tract infections (n=224, 42.9%), acute febrile illnesses (n=68, 13.0%), and typhoid fever (n=54, 10.4%) were the top indications to which ciprofloxacin was prescribed. Non-steroidal anti-inflammatory drugs (NSAIDs) (n=241, 34.7%) and antimicrobials (n=135, 19.6%) were among the most frequently co-indicated agents. Based on the standard Ethiopian treatment guidelines, therapy was appropriate in 30% (n= 159) of patients. The major reason for inappropriate utilization (95%) was the wrong duration of antibiotic use (n=228). Evaluation based on World Health Organization criteria showed that indication, dose, and frequency were in line with the recommendation.

CONCLUSION

ciprofloxacin was primarily indicated for urinary tract infections. The drug was appropriately used in less than one-third of patients, with the wrong duration being the main reason for overall inappropriate utilization. This trend may potentially impose a high risk to the emergence of drug-resistant microorganisms. To this end, further studies addressing the susceptibility pattern of bacterial isolates towards ciprofloxacin should be carried out.

Prevalence of potential drug-drug interactions and associated factors among outpatients and inpatients in Ethiopian hospitals: a systematic review and meta-analysis of observational studies

BACKGROUND

Drug-drug interaction is an emerging threat to public health. Currently, there is an increase in comorbid disease, polypharmacy, and hospitalization in Ethiopia. Thus, the possibility of drug-drug interaction occurrence is high in hospitals. This study aims to summarize the prevalence of potential drug-drug interactions and associated factors in Ethiopian hospitals.

METHODS

A literature search was performed by accessing legitimate databases in PubMed/MEDLINE, Google Scholar, and Research Gate for English-language publications. To fetch further related topics advanced search was also applied in Science Direct and HINARI databases. The search was conducted on August 3 to 25, 2019. All published articles available online until the day of data collection were considered. Outcome measures were analyzed with Open Meta Analyst and CMA version statistical software. Der Simonian and Laird's random effect model, I² statistics, and Logit event rate were also performed.

RESULTS

A total of 14 studies remained eligible for inclusion in systematic review and meta-analysis. From the included studies, around 8717 potential drug-drug interactions were found in 3259 peoples out of 5761 patients. The prevalence of patients with potential drug-drug interactions in Ethiopian hospitals was found to be 72.2% (95% confidence interval: 59.1, 85.3%). Based on severity, the prevalence of major, moderate, and minor potential drug-drug interaction was 25.1, 52.8, 16.9%, respectively, also 1.27% for contraindications. The factors associated with potential drug-drug interactions were related to patient characteristics such as polypharmacy, age, comorbid disease, and hospital stay.

CONCLUSIONS

There is a high prevalence of potential drug-drug interactions in Ethiopian hospitals. Polypharmacy, age, comorbid disease, and hospital stay were the risk factors associated with potential drug-drug interactions.

Prevalence and nature of potential drug-drug interactions among hospitalized HIV patients presenting with suspected meningitis in Uganda

Background

Management of co-infections including cryptococcal meningitis, tuberculosis and other opportunistic infections in persons living with HIV can lead to complex polypharmacotherapy and increased susceptibility to drug-drug interactions (DDIs). Here we characterize the frequency and types of potential DDIs (pDDIs) in hospitalized HIV patients presenting with suspected cryptococcal or tuberculous meningitis.

Methods

In a retrospective review of three cryptococcal meningitis trials between 2010 and 2017 in Kampala, Uganda, medications received over hospitalization were documented and pDDI events were assessed. IBM Micromedex DRUGDEX® online drug reference system was used to identify and describe potential interactions as either contraindicated, major, moderate or minor. For antiretroviral DDIs, the Liverpool Drug Interactions Checker from the University of Liverpool was also used to further describe interactions observed.

Results

In 1074 patients with suspected meningitis, pDDIs were present in 959 (overall prevalence = 89.3%) during the analyzed 30 day window. In total, 278 unique interacting drug pairs were identified resulting in 4582 pDDI events. Of all patients included in this study there was a mean frequency of 4.27 pDDIs per patient. Of the 4582 pDDI events, 11.3% contraindicated, 66.4% major, 17.4% moderate and 5% minor pDDIs were observed. Among all pDDIs identified, the most prevalent drugs implicated were fluconazole (58.4%), co-trimoxazole (25.7%), efavirenz (15.6%) and rifampin (10.2%). Twenty-one percent of the contraindicated pDDIs and 27% of the major ones involved an antiretroviral drug. Increased likelihood of QT interval prolongation was the most frequent potential clinical outcome. Dissonance in drug interaction checkers was noted requiring clinicians to consult more than one database in making clinical decisions about drug combinations.

Conclusions

The overall prevalence of pDDIs in this population is high. An understanding of drug combinations likely to result in undesired clinical outcomes, such as QT interval prolongation, is paramount. This is especially important in resource limited settings where availability of therapeutic drug monitoring and laboratory follow-up are inconsistent. Adequate quantification of the increased likelihood of adverse clinical outcomes from multiple drug-drug interactions of the same kind in a single patient is needed to aid clinical decisions in this setting.

Survey on Polypharmacy and Drug-Drug Interactions Among Elderly People with Cardiovascular Diseases at Yekatit 12 Hospital, Addis Ababa, Ethiopia

Background

Elderly people are most commonly associated with cardiac disease. Cardiovascular diseases are interlinked with co-morbidities which require multiple drug therapy in addition to cardiovascular drugs. This results to polypharmacy which carries a high risk of potential drug-drug interactions. Elderly patients are at a particular risk of drug related problems because of increased level of polypharmacy and the physiological changes which accompany aging. This study was aimed to assess polypharmacy and potential drug-drug interactions (DDIs) among elderly people with cardiovascular diseases at Yekatit 12 hospital.

Methodology

A retrospective cross-sectional study using patients chart review was conducted on all elderly people with cardiovascular diseases at Yekatit 12 hospital in the period between March 2018 and March 2019. The types, seriousness and level of potential DDIs were checked using Medscape online drug interaction checker.

Results

The mean number of drugs per prescription was 4.25 ± 1.754 and the prevalence of polypharmacy (concurrent use of 5 and more drugs) was 42.7%. Polypharmacy and potential DDIs were significantly associated with polymorbidity (P = 0.000), being hospitalized (P = 0.047) and congestive heart failure (P = 0.016). A total of 850-potential DDIs were identified, the mean number of potential DDIs was 3.37 per prescription. The potential DDIs were mainly significant (73.29%) in nature and pharmacodynamics (73.06%) in mechanism. The prevalence of total and serious potential DDIs were 84.3% and 17.3%, respectively. Most commonly interacting drug combination was aspirin + enalapril (30.2%).

Conclusion

A higher incidence of polypharmacy and increased risk of potential DDIs in elderly people with cardiovascular disease are major therapeutic issues at Yekatit 12 hospital.

Polifarmacia en adulto mayor, impacto en su calidad de vida. Revision de literatura

Objetivo Conocer mediante el análisis del estado del conocimiento, el impacto de polifarmacia en calidad de vida de adultos mayores y cuál ha sido el rol de enfermería frente a esta problemática de salud.Métodos Revisión descriptiva de 62 artículos originales de diversos diseños metodológicos, en bases de datos: EBSCO, PubMed, Web of Science, SciELO, Elsevier, SCOPUS y Dialnet.Resultados La polifarmacia en adultos mayores se presenta con mayor frecuencia en el sexo femenino, en personas con bajo nivel de escolaridad, sumados a factores socioeconómico. Un gran porcentaje de adultos mayores presenta efecto cascada en consumo de fármacos, por cantidad de medicamentos consumidos y número de médicos consultados, produciendo interacciones farmacológicas, afectando funcionalidad y calidad de vida.Conclusiones Es necesario mayor control de medicamentos consumidos por adultos mayores, para evitar efectos nocivos. Los profesionales de enfermería deben tener un rol educativo en este grupo etario, para disminuir polifarmacia e impulsar estilos de vida que fomenten el envejecimiento saludable.

Regional prescription surveillance of phosphate binders in the western Saitama area: the substantial role of ferric citrate hydrate in improving serum phosphorus levels and erythropoiesis

BACKGROUND

In April 2015, five types of phosphate binders (PBs) were available by prescription in Japan, namely calcium carbonate, sevelamer hydrochloride, lanthanum carbonate, bixalomer, and ferric citrate hydrate (FeC). FeC reduces serum phosphorus levels and increases the body's iron stores. However, it is unclear whether FeC lowers serum phosphorus relative to other agents in a regional practical setting.

METHODS

We performed a retrospective observational cohort study of regional hemodialysis surveillance in the western Saitama area of Japan, which included 1374 hemodialysis patients enrolled from 32 satellite dialysis units. The clinical data and prescribing information were retrospectively collected and analyzed. The difference in serum phosphorus among the groups administered five types of PBs (new or additional) from April to September 2015 was the primary outcome.

RESULTS

As of April 2015, the median values of serum phosphorus, corrected calcium, and intact parathyroid hormone were 5.4 mg/dL, 9.1 mg/dL, and 147 pg/dL, respectively (N = 1374). Unexpectedly, with an increase in the number of PBs administered, serum phosphorous levels increased (p < 0.001). The significant changes in the serum phosphorus and hemoglobin levels were associated with the prescription of FeC but not with that of the other PBs.

CONCLUSIONS

This regional survey suggests that serum phosphorus is well managed and that FeC has the potential to reduce the serum phosphorus level relative to other PBs and to ameliorates anemia.