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Kiesel LM, Bertsche A, Kiess W, Siekmeyer M, Bertsche T, Neininger MP. Drug-Drug Interactions Involving High-Alert Medications that Lead to Interaction-Associated Symptoms in Pediatric Intensive Care Patients: A Retrospective Study. Paediatr Drugs 2024:10.1007/s40272-024-00641-x. [PMID: 38963501 DOI: 10.1007/s40272-024-00641-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/16/2024] [Indexed: 07/05/2024]
Abstract
BACKGROUND Children treated in a pediatric intensive care unit (PICU) often receive several drugs together, among them drugs defined as high-alert medications (HAMs). Those drugs carry a high risk of causing patient harm, for example, due to a higher potential for interactions. HAMs should therefore be administered with caution, especially in a PICU. OBJECTIVES The objective of the current study was to identify drug-drug interactions involving HAMs that increase the risk of interaction-associated symptoms in pediatric intensive care. METHODS In a retrospective study, we analyzed the electronic documentation of patients hospitalized for at least 48 h in a general PICU who received at least two different drugs within a 24-h interval. We assessed potential drug-drug interactions involving HAM on the basis of the two drug information databases UpToDate and drugs.com. Furthermore, we analyzed whether symptoms were observed after the administration of drug pairs that could lead to interaction-associated symptoms. For drug pairs involving HAM administered on at least 2% of patient days, and symptoms observed at least ten times after a respective drug pair, we calculated odds ratios, 95% confidence intervals, and p-values by using a univariate binary logistic regression. RESULTS Among 315 analyzed patients, 81.3% (256/315) received drugs defined as high-alert medication for pediatric patients. Those high-alert medications were involved in 20,150 potential drug-drug interactions. In 14.0% (2830/20,150) of these, one or more symptoms were observed that could be a possible consequence of the interaction, resulting in 3203 observed symptoms affecting 56.3% (144/256) of patients receiving high-alert medication. The odds ratios for symptoms observed after a drug-drug interaction were increased for eight specific symptoms (each p ≤ 0.05), especially hemodynamic alterations and disturbances of electrolyte and fluid balance. The odds ratio was highest for decreased blood pressure observed after the administration of the drug pair fentanyl and furosemide (OR 5.06; 95% confidence interval 3.5-7.4; p < 0.001). Increased odds ratios for specific symptoms observed after drug-drug interactions resulted from eight combinations composed of eight different drugs: digoxin, fentanyl, midazolam, phenobarbital, potassium salts and vancomycin (high-alert medications), and the diuretics furosemide and hydrochlorothiazide (non-high-alert medications). The resulting drug pairs were: potassium salts-furosemide, fentanyl-furosemide, vancomycin-furosemide, digoxin-furosemide, digoxin-hydrochlorothiazide, fentanyl-phenobarbital, potassium salts-hydrochlorothiazide, and midazolam-hydrochlorothiazide. CONCLUSIONS In a cohort of PICU patients, this study identified eight specific drug pairs involving high-alert medications that may increase the risk of interaction-associated symptoms, mainly hemodynamic alterations and electrolyte/fluid balance disturbances. If the administration of those drug pairs is unavoidable, patients should be closely monitored.
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Affiliation(s)
- Lisa Marie Kiesel
- Clinical Pharmacy, Institute of Pharmacy, Medical Faculty, Leipzig University, and Drug Safety Center, Leipzig University and Leipzig University Hospital, Leipzig, Germany
| | - Astrid Bertsche
- Division of Neuropediatrics, University Hospital for Children and Adolescents, Greifswald, Germany
- Center for Pediatric Research, University Hospital for Children and Adolescents, Leipzig, Germany
| | - Wieland Kiess
- Center for Pediatric Research, University Hospital for Children and Adolescents, Leipzig, Germany
| | - Manuela Siekmeyer
- Center for Pediatric Research, University Hospital for Children and Adolescents, Leipzig, Germany
| | - Thilo Bertsche
- Clinical Pharmacy, Institute of Pharmacy, Medical Faculty, Leipzig University, and Drug Safety Center, Leipzig University and Leipzig University Hospital, Leipzig, Germany.
| | - Martina Patrizia Neininger
- Clinical Pharmacy, Institute of Pharmacy, Medical Faculty, Leipzig University, and Drug Safety Center, Leipzig University and Leipzig University Hospital, Leipzig, Germany
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Klopotowska JE, Leopold JH, Bakker T, Yasrebi-de Kom I, Engelaer FM, de Jonge E, Haspels-Hogervorst EK, van den Bergh WM, Renes MH, Jong BTD, Kieft H, Wieringa A, Hendriks S, Lau C, van Bree SHW, Lammers HJW, Wierenga PC, Bosman RJ, de Jong VM, Slijkhuis M, Franssen EJF, Vermeijden WJ, Masselink J, Purmer IM, Bosma LE, Hoeksema M, Wesselink E, de Lange DW, de Keizer NF, Dongelmans DA, Abu-Hanna A. Adverse drug events caused by three high-risk drug-drug interactions in patients admitted to intensive care units: A multicentre retrospective observational study. Br J Clin Pharmacol 2024; 90:164-175. [PMID: 37567767 DOI: 10.1111/bcp.15882] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/03/2023] [Accepted: 08/05/2023] [Indexed: 08/13/2023] Open
Abstract
AIMS Knowledge about adverse drug events caused by drug-drug interactions (DDI-ADEs) is limited. We aimed to provide detailed insights about DDI-ADEs related to three frequent, high-risk potential DDIs (pDDIs) in the critical care setting: pDDIs with international normalized ratio increase (INR+ ) potential, pDDIs with acute kidney injury (AKI) potential, and pDDIs with QTc prolongation potential. METHODS We extracted routinely collected retrospective data from electronic health records of intensive care units (ICUs) patients (≥18 years), admitted to ten hospitals in the Netherlands between January 2010 and September 2019. We used computerized triggers (e-triggers) to preselect patients with potential DDI-ADEs. Between September 2020 and October 2021, clinical experts conducted a retrospective manual patient chart review on a subset of preselected patients, and assessed causality, severity, preventability, and contribution to ICU length of stay of DDI-ADEs using internationally prevailing standards. RESULTS In total 85 422 patients with ≥1 pDDI were included. Of these patients, 32 820 (38.4%) have been exposed to one of the three pDDIs. In the exposed group, 1141 (3.5%) patients were preselected using e-triggers. Of 237 patients (21%) assessed, 155 (65.4%) experienced an actual DDI-ADE; 52.9% had severity level of serious or higher, 75.5% were preventable, and 19.3% contributed to a longer ICU length of stay. The positive predictive value was the highest for DDI-INR+ e-trigger (0.76), followed by DDI-AKI e-trigger (0.57). CONCLUSION The highly preventable nature and severity of DDI-ADEs, calls for action to optimize ICU patient safety. Use of e-triggers proved to be a promising preselection strategy.
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Affiliation(s)
- Joanna E Klopotowska
- Department of Medical Informatics, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Amsterdam, The Netherlands
| | - Jan-Hendrik Leopold
- Department of Medical Informatics, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Amsterdam, The Netherlands
| | - Tinka Bakker
- Department of Medical Informatics, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Amsterdam, The Netherlands
| | - Izak Yasrebi-de Kom
- Department of Medical Informatics, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Amsterdam, The Netherlands
| | - Frouke M Engelaer
- Department of Intensive Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Evert de Jonge
- Department of Intensive Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Esther K Haspels-Hogervorst
- Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Walter M van den Bergh
- Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Maurits H Renes
- Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Bas T de Jong
- Department of Intensive Care, Isala Hospital, Zwolle, The Netherlands
| | - Hans Kieft
- Department of Intensive Care, Isala Hospital, Zwolle, The Netherlands
| | - Andre Wieringa
- Department of Clinical Pharmacy, Isala Hospital, Zwolle, The Netherlands
| | - Stefaan Hendriks
- Department of Intensive Care, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Cedric Lau
- Department of Hospital Pharmacy, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Sjoerd H W van Bree
- Department of Intensive Care, Hospital Gelderse Vallei, Ede, The Netherlands
| | | | - Peter C Wierenga
- Department of Hospital Pharmacy, Hospital Gelderse Vallei, Ede, The Netherlands
| | - Rob J Bosman
- Department of Intensive Care Medicine, OLVG Hospital, Amsterdam, The Netherlands
| | - Vincent M de Jong
- Department of Intensive Care Medicine, OLVG Hospital, Amsterdam, The Netherlands
| | - Mirjam Slijkhuis
- Department of Clinical Pharmacy, OLVG Hospital, Amsterdam, The Netherlands
| | - Eric J F Franssen
- Department of Clinical Pharmacy, OLVG Hospital, Amsterdam, The Netherlands
| | - Wytze J Vermeijden
- Department of Intensive Care, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Joost Masselink
- Department of Hospital Pharmacy, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Ilse M Purmer
- Department of Intensive Care, Haga Hospital, The Hague, The Netherlands
| | - Liesbeth E Bosma
- Department of Hospital Pharmacy, Haga Hospital, The Hague, The Netherlands
| | - Martin Hoeksema
- Department of Intensive Care, Zaans Medisch Centrum, Zaandam, The Netherlands
| | - Elsbeth Wesselink
- Department of Hospital Pharmacy, Zaans Medisch Centrum, Zaandam, The Netherlands
| | - Dylan W de Lange
- Department of Intensive Care, University Medical Center, University Utrecht, Utrecht, The Netherlands
| | - Nicolette F de Keizer
- Department of Medical Informatics, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Amsterdam, The Netherlands
| | - Dave A Dongelmans
- Department of Intensive Care, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Pulmonary Hypertension & Thrombosis, Amsterdam, The Netherlands
| | - Ameen Abu-Hanna
- Department of Medical Informatics, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Amsterdam, The Netherlands
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Vocca C, Siniscalchi A, Rania V, Galati C, Marcianò G, Palleria C, Catarisano L, Gareri I, Leuzzi M, Muraca L, Citraro R, Nanci G, Scuteri A, Bianco RC, Fera I, Greco A, Leuzzi G, De Sarro G, D’Agostino B, Gallelli L. The Risk of Drug Interactions in Older Primary Care Patients after Hospital Discharge: The Role of Drug Reconciliation. Geriatrics (Basel) 2023; 8:122. [PMID: 38132493 PMCID: PMC10742527 DOI: 10.3390/geriatrics8060122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 12/08/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023] Open
Abstract
INTRODUCTION Drug-drug interactions (DDIs) represent an important clinical problem, particularly in older patients, due to polytherapy, comorbidity, and physiological changes in pharmacodynamic and pharmacokinetic pathways. In this study, we investigated the association between drugs prescribed after discharge from the hospital or clinic and the risk of DDIs with drugs used daily by each patient. METHODS We performed an observational, retrospective, multicenter study on the medical records of outpatients referred to general practitioners. DDIs were measured using the drug interaction probability scale. Potential drug interactions were evaluated by clinical pharmacologists (physicians) and neurologists. Collected data were analyzed using the Statistical Package for the Social Sciences. RESULTS During the study, we evaluated 1772 medical records. We recorded the development of DDIs in 10.3% of patients; 11.6% of these patients required hospitalization. Logistic regression showed an association among DDIs, sex, and the number of drugs used (p = 0.023). CONCLUSIONS This observational real-life study shows that the risk of DDIs is common in older patients. Physicians must pay more attention after hospital discharge, evaluating the treatment to reduce the risk of DDIs.
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Affiliation(s)
- Cristina Vocca
- Operative Unit of Clinical Pharmacology and Pharmacovigilance, Renato Dulbecco University Hospital, 88100 Catanzaro, Italy; (C.V.); (V.R.); (G.M.); (C.P.); (L.C.); (I.G.); (G.D.S.)
| | - Antonio Siniscalchi
- Department of Neurology and Stroke Unit, Annunziata Hospital of Cosenza, 87100 Cosenza, Italy;
| | - Vincenzo Rania
- Operative Unit of Clinical Pharmacology and Pharmacovigilance, Renato Dulbecco University Hospital, 88100 Catanzaro, Italy; (C.V.); (V.R.); (G.M.); (C.P.); (L.C.); (I.G.); (G.D.S.)
| | - Cecilia Galati
- Research Center FAS@UMG, Department of Health Science, Magna Graecia University, 88100 Catanzaro, Italy;
| | - Gianmarco Marcianò
- Operative Unit of Clinical Pharmacology and Pharmacovigilance, Renato Dulbecco University Hospital, 88100 Catanzaro, Italy; (C.V.); (V.R.); (G.M.); (C.P.); (L.C.); (I.G.); (G.D.S.)
| | - Caterina Palleria
- Operative Unit of Clinical Pharmacology and Pharmacovigilance, Renato Dulbecco University Hospital, 88100 Catanzaro, Italy; (C.V.); (V.R.); (G.M.); (C.P.); (L.C.); (I.G.); (G.D.S.)
- Research Center FAS@UMG, Department of Health Science, Magna Graecia University, 88100 Catanzaro, Italy;
| | - Luca Catarisano
- Operative Unit of Clinical Pharmacology and Pharmacovigilance, Renato Dulbecco University Hospital, 88100 Catanzaro, Italy; (C.V.); (V.R.); (G.M.); (C.P.); (L.C.); (I.G.); (G.D.S.)
| | - Ilaria Gareri
- Operative Unit of Clinical Pharmacology and Pharmacovigilance, Renato Dulbecco University Hospital, 88100 Catanzaro, Italy; (C.V.); (V.R.); (G.M.); (C.P.); (L.C.); (I.G.); (G.D.S.)
| | - Marco Leuzzi
- Department of Primary Care, ASP Catanzaro, 88100 Catanzaro, Italy; (M.L.); (L.M.); (G.N.); (A.S.); (R.C.B.); (I.F.); (A.G.); (G.L.)
| | - Lucia Muraca
- Department of Primary Care, ASP Catanzaro, 88100 Catanzaro, Italy; (M.L.); (L.M.); (G.N.); (A.S.); (R.C.B.); (I.F.); (A.G.); (G.L.)
| | - Rita Citraro
- Department of Health Science, Magna Graecia University, 88100 Catanzaro, Italy;
| | - Giacinto Nanci
- Department of Primary Care, ASP Catanzaro, 88100 Catanzaro, Italy; (M.L.); (L.M.); (G.N.); (A.S.); (R.C.B.); (I.F.); (A.G.); (G.L.)
| | - Antonio Scuteri
- Department of Primary Care, ASP Catanzaro, 88100 Catanzaro, Italy; (M.L.); (L.M.); (G.N.); (A.S.); (R.C.B.); (I.F.); (A.G.); (G.L.)
| | - Rosa Candida Bianco
- Department of Primary Care, ASP Catanzaro, 88100 Catanzaro, Italy; (M.L.); (L.M.); (G.N.); (A.S.); (R.C.B.); (I.F.); (A.G.); (G.L.)
| | - Iolanda Fera
- Department of Primary Care, ASP Catanzaro, 88100 Catanzaro, Italy; (M.L.); (L.M.); (G.N.); (A.S.); (R.C.B.); (I.F.); (A.G.); (G.L.)
| | - Antonietta Greco
- Department of Primary Care, ASP Catanzaro, 88100 Catanzaro, Italy; (M.L.); (L.M.); (G.N.); (A.S.); (R.C.B.); (I.F.); (A.G.); (G.L.)
| | - Giacomo Leuzzi
- Department of Primary Care, ASP Catanzaro, 88100 Catanzaro, Italy; (M.L.); (L.M.); (G.N.); (A.S.); (R.C.B.); (I.F.); (A.G.); (G.L.)
| | - Giovambattista De Sarro
- Operative Unit of Clinical Pharmacology and Pharmacovigilance, Renato Dulbecco University Hospital, 88100 Catanzaro, Italy; (C.V.); (V.R.); (G.M.); (C.P.); (L.C.); (I.G.); (G.D.S.)
- Research Center FAS@UMG, Department of Health Science, Magna Graecia University, 88100 Catanzaro, Italy;
- Department of Health Science, Magna Graecia University, 88100 Catanzaro, Italy;
| | - Bruno D’Agostino
- Department of Environmental Biological and Pharmaceutical Sciences and Technologies, University of Campania “Luigi Vanvitelli”, 81100 Caserta, Italy;
| | - Luca Gallelli
- Operative Unit of Clinical Pharmacology and Pharmacovigilance, Renato Dulbecco University Hospital, 88100 Catanzaro, Italy; (C.V.); (V.R.); (G.M.); (C.P.); (L.C.); (I.G.); (G.D.S.)
- Research Center FAS@UMG, Department of Health Science, Magna Graecia University, 88100 Catanzaro, Italy;
- Department of Health Science, Magna Graecia University, 88100 Catanzaro, Italy;
- Medifarmagen SRL, Renato Dulbecco University Hospital, 88100 Catanzaro, Italy
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Gigante B, Levy JH, van Gorp E, Bartoloni A, Bochaton-Piallat ML, Bäck M, Ten Cate H, Christersson C, Ferreiro JL, Geisler T, Lutgens E, Schulman S, Storey RF, Thachil J, Vilahur G, Liaw PC, Rocca B. Management of patients on antithrombotic therapy with severe infections: a joint clinical consensus statement of the ESC Working Group on Thrombosis, the ESC Working Group on Atherosclerosis and Vascular Biology, and the International Society on Thrombosis and Haemostasis. Eur Heart J 2023; 44:3040-3058. [PMID: 37439553 DOI: 10.1093/eurheartj/ehad388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 05/01/2023] [Accepted: 05/29/2023] [Indexed: 07/14/2023] Open
Abstract
Patients with severe infections and a pre-existing indication for antithrombotic therapy, i.e. antiplatelet agents, anticoagulant drugs, or their combinations, require integrated clinical counselling among coagulation, infectious disease, and cardiology specialists, due to sepsis-induced coagulopathy that frequently occurs. Bacterial and viral pathogens constitute an increasing threat to global public health, especially for patients with ongoing antithrombotic treatment who have a high risk of thrombotic recurrences and high susceptibility to severe infections with increased morbidity and mortality. Similarly, sepsis survivors are at increased risk for major vascular events. Coagulopathy, which often complicates severe infections, is associated with a high mortality and obligates clinicians to adjust antithrombotic drug type and dosing to avoid bleeding while preventing thrombotic complications. This clinical consensus statement reviews the best available evidence to provide expert opinion and statements on the management of patients hospitalized for severe bacterial or viral infections with a pre-existing indication for antithrombotic therapy (single or combined), in whom sepsis-induced coagulopathy is often observed. Balancing the risk of thrombosis and bleeding in these patients and preventing infections with vaccines, if available, are crucial to prevent events or improve outcomes and prognosis.
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Affiliation(s)
- Bruna Gigante
- Division of Cardiovascular Medicine, Department of Medicine, Karolinska Institutet, Solnavägen 30. 17164 and Department of Cardiology, Danderyds Hospital, Entrévägen 2, 182 88, Stockholm, Sweden
| | - Jerrold H Levy
- Departments of Anesthesiology, Critical Care, and Surgery (Cardiothoracic), Duke University School of Medicine, Durham, United States; 2301 Erwin Road, Durham, NC 27710, USA
| | - Eric van Gorp
- Department of Viroscience, Erasmus MC, Rotterdam, PO box 2040 [Room Ee1726], 3000 CA Rotterdam, The Netherlands
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, Infectious Diseases Unit, University of Florence, Largo Brambilla 3, 50100 Florence, Italy
| | - Marie-Luce Bochaton-Piallat
- Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, 1 rue Michel-Servet 1, CH-1211 Genève, Switzerland
| | - Magnus Bäck
- Department of Translational Cardiology, Karolinska Institutet and Karolinska University Hospital, CMM L8:01, 171 76 Stockholm, Sweden
- INSERM U1116, University of Lorraine, Nancy University Hospital, 2 rue Jean Lamour, 54505 Vandoeuvre les Nancy Cedex, France
| | - Hugo Ten Cate
- Department of Internal medicine, Thrombosis Expertise Center, Maastricht University Medical Center and CARIM school for cardiovascular diseases, Universiteitsingel 50, PO Box 616, 6200 MD Maastricht, The Netherlands
- Center for Thrombosis and Haemostasis, Gutenberg University Medical Center, Langenbeckstr. 1, Bldg. 403, 55131 Mainz, Germany
| | - Christina Christersson
- Department of Medical Sciences, Cardiology, Uppsala University, Akademiska Sjukhuset, 75185, Uppsala, Sweden
| | - José Luis Ferreiro
- Department of Cardiology and Bio-Heart Cardiovascular Diseases Research Group; Bellvitge University Hospital - Bellvitge Biomedical Research Institute (IDIBELL); CIBERCV; L'Hospitalet de Llobregat, Hospital Duran i Reynals - Edifici Terapèutic - 2a planta Gran Via de l'Hospitalet, 199, 08908 Hospitalet de Llobregat Barcelona -Spain
| | - Tobias Geisler
- Department of Cardiology and Angiology, University Hospital Tübingen, Otfried-Müller-Straße 10, 72076 Tübingen, Germany
| | - Esther Lutgens
- Cardiovascular Medicine, Experimental CardioVascular Immunology Laboratory, Mayo Clinic, 200 First St SW, 55905, Rochester, MN, USA
- Institute for Cardiovascular Prevention (IPEK), Ludwig-Maximilians Universität, München, Germany & German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Pettenkoferstrasse 9, 80336, Munich, Germany
| | - Sam Schulman
- Department of Medicine and Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, ON, Canada HHS - General Hospital 237, Barton Street East, Hamilton, ON, L8L 2X2, Canada
- Department of Obstetrics and Gynecology, I.M. Sechenov First Moscow State Medical University, Bol'shaya Pirogovskaya Ulitsa, 2, стр. 4, Moscow 119435, Russia
| | - Robert F Storey
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Pegasus House, 463a Glossop Road, Sheffield, S10 2QD, UK
| | - Jecko Thachil
- Department of Haematology, Manchester University Hospitals, Oxford road, Manchester, M13 9WL, UK
| | - Gemma Vilahur
- Institut de Recerca Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, CIBERCV, Avda. Sant Antoni Maria Claret 167, 08025 Barcelona, Spain
| | - Patricia C Liaw
- Department of Medicine, Thrombosis & Atherosclerosis Research Institute (TaARI), McMaster University, 237 Barton Street East Hamilton, Ontario L8L 2X2, Canada
| | - Bianca Rocca
- Department of Safety and Bioethics, Section on Pharmacology, Catholic University School of Medicine, Largo F. Vito 1, 00168 Rome, Italy
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Caneschi A, Bardhi A, Barbarossa A, Zaghini A. The Use of Antibiotics and Antimicrobial Resistance in Veterinary Medicine, a Complex Phenomenon: A Narrative Review. Antibiotics (Basel) 2023; 12:antibiotics12030487. [PMID: 36978354 PMCID: PMC10044628 DOI: 10.3390/antibiotics12030487] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 02/25/2023] [Accepted: 02/27/2023] [Indexed: 03/05/2023] Open
Abstract
As warned by Sir Alexander Fleming in his Nobel Prize address: “the use of antimicrobials can, and will, lead to resistance”. Antimicrobial resistance (AMR) has recently increased due to the overuse and misuse of antibiotics, and their use in animals (food-producing and companion) has also resulted in the selection and transmission of resistant bacteria. The epidemiology of resistance is complex, and factors other than the overall quantity of antibiotics consumed may influence it. Nowadays, AMR has a serious impact on society, both economically and in terms of healthcare. This narrative review aimed to provide a scenario of the state of the AMR phenomenon in veterinary medicine related to the use of antibiotics in different animal species; the impact that it can have on animals, as well as humans and the environment, was considered. Providing some particular instances, the authors tried to explain the vastness of the phenomenon of AMR in veterinary medicine due to many and diverse aspects that cannot always be controlled. The veterinarian is the main reference point here and has a high responsibility towards the human–animal–environment triad. Sharing such a burden with human medicine and cooperating together for the same purpose (fighting and containing AMR) represents an effective example of the application of the One Health approach.
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Affiliation(s)
| | - Anisa Bardhi
- Correspondence: (A.B.); (A.B.); Tel.: +39-051-2097-500 (Andrea Barbarossa)
| | - Andrea Barbarossa
- Correspondence: (A.B.); (A.B.); Tel.: +39-051-2097-500 (Andrea Barbarossa)
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