Drug-related problems among patients with infectious disease admitted to medical wards of Wollega University Referral Hospital: Prospective observational study

Assessment of potential drug-related problems (PDRP) and clinical outcomes in bacterial meningitis patients admitted to tertiary care hospitals

Meningitis is an important cause of morbidity and mortality in children and adults. Its treatment strategy varies with age and gender. To assess potential drug-related problems (PDRP) and clinical outcomes in bacterial meningitis patients, a multicenter, clinical, descriptive, cross-sectional prospective observational study in 120 patients admitted to different tertiary care hospitals in Karachi was conducted. It includes both males 48% and females 52% belonging from all age groups i.e. peadiatrics (01 to 12 years), adults (18 to 65 years), and geriatrics (66 to 75 years). Out of these 72 patients were admitted in the public sector and 48 patients were admitted in private sector hospitals. Nosocomial infections were developed in 41% of patients during their stay at the hospital. Potentially nephrotoxic drugs were administered to all BM patients, these drugs should be administered carefully. Majorly Ceftriaxone was administered to 86% of patients, Vancomycin 71%, and meropenem 73% whereas 68% of patients were administered piperacillin-tazobactam. Organisms involved as causative agents in the majority of patients are Neisseria meningitides, Pseudomonas aeruginosa and, Streptococcus pneumoniae. DRPs impacted patient clinical outcomes in presence of many other factors like comorbidities, DDIs, Nis, administration of potentially nephrotoxic drugs, and administration of watch group and reserve group antibiotics without having culture sensitivity test, even after having CST no principles of de-escalation for antibiotics were done, which is a very important factor for hospitalized patients having IV antibiotics. The mortality rate among BM patients was 66%. The majority of patients (87%) stay at the hospital was 1-10 days. The present study helped in the identification of DRPs along with some other factors affecting the clinical outcomes in patients suffering from bacterial meningitis. Healthcare professionals should receive awareness and education on the importance of CST before initiating antibiotic therapy. Pharmacist-led medication review is necessary and should be followed to avoid negative outcomes and serious consequences related to DRPs.

A Methodological Review of Drug-Related Toxicological Studies in Saudi Arabia

This study aimed to conduct a methodological review of drug-related toxicological studies in Saudi Arabia. A systematic review and a methodological analysis were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Medline and Embase were searched for all types of studies reporting toxicological studies in the English language published until January 10, 2022. The search was conducted using both keywords and Medical Subject Headings (MeSH) terms. The methodological analysis of included studies was assessed using the Newcastle-Ottawa Scale. A total of 3,750 studies were extracted and screened. Of these, 30 observational studies (seven cohort studies and 23 cross-sectional studies) met the inclusion criteria. The methodological scores ranged from five to seven out of 10 possible points. Twelve studies had high quality, and 18 studies had moderate quality. Eight studies focused on adverse drug reactions, eight explored poisoning, four explored drug-related hospitalizations, nine explored drug-induced toxicity, and one explored drug overdose. This research project revealed that most of the drug-related toxicological studies conducted in Saudi Arabia were observational studies of moderate quality. Future studies should focus on the quality of the design and reporting.

Investigation of drug-related problems in patients hospitalized in chest disease wards: A randomized controlled trial

Objective: According to the World Health Organization (WHO), chest diseases are among the 10 diseases that cause the highest mortality worldwide. Drug-related problems (DRPs), readmission, and antimicrobial resistance are critical problems in chest disease wards. Active involvement of clinical pharmacists (CPs) who are focused on reducing the risks of potential problems is needed. The aim of this study is to investigate the effects of pharmaceutical care (PC) services on the pulmonology service. Method: A randomized controlled trial at a university hospital in Istanbul was conducted between June 2020 and December 2021. The participants were randomized into the control group (CG) and intervention group (IG). In the CG, CPs identified and classified the DRPs according to Pharmaceutical Care Network Europe v9.0 (PCNE) and provided solutions to DRPs for the IG. The effect of PC services was evaluated by the number and classification of DRPs, and readmissions within 30 days were compared between the two groups. Results: Out of 168 patients, 82 were assigned to the IG. The average number of medicines administered per patient in the CG and IG was 14.45 ± 7.59 and 15.5 ± 6.18, respectively. In the CG and IG, the numbers of patients with DRPs were 62 and 46, respectively. The total number of DRPs was 160 for CG and 76 for IG. A statistically significant difference was found in favor of the IG, in terms of the number of patients with DRPs, the total number of DRPs, and readmission within 30 days (p < 0.05). Conclusion: In this study, CP recommendations were highly accepted by the healthcare team. Pharmaceutical care services provided by CPs would decrease possible DRPs and led to positive therapeutic outcomes. Cognitive clinical pharmacy services have beneficial effects on health care, and these services should be expanded in all settings where patients and pharmacists are present.

Antimicrobial use-related drug therapy problems and associated factors among patients in the medical ward of Wachemo University Nigist Eleni Mohammed Memorial Comprehensive Specialized Hospital, Southwest Ethiopia

Objective

This study assessed the antimicrobial use-related drug therapy problems (DTPs) among patients admitted to the medical ward of Wachemo University Nigist Eleni Mohammed Memorial Comprehensive Specialized Hospital (WCUNEMMCSH), Southwest Ethiopia.

Methods

A hospital-based prospective observational study design was used to assess antimicrobial use-related DTPs among patients admitted to the medical ward of WCUNEMMCSH from June to August 2021. Data were collected using a structured data abstraction format.

Results

In all, 128 patients admitted to the medical ward were enrolled. Among the study participants, at least one form of antimicrobial DTP occurred in 98 (76.6%) of them. The most prevalent DTPs were unnecessary drug treatment in 42 (32.8%), the need for additional drug treatment in 36 (28.1%), and non-adherence in 30 (23.4%) of the patients. There were a total of 288 antimicrobial drug orders. Ceftriaxone 120 (41.7%) and azithromycin 69 (24.0%) were the most commonly prescribed antimicrobial drugs. In multivariate logistic analysis, the length of hospital stay (adjusted odds ratio (AOR) = 2.97, 95% confidence interval (CI): 1.06-8.32; p = 0.04) and the number of diagnosed diseases (AOR = 3.10, 95% CI: 1.12-8.15, p = 0.02) were predictors of antimicrobial use-related DTPs.

Conclusion

Antimicrobial use-related DTPs are common among patients admitted to the medical ward of WCUNEMMCSH. Health professionals should work together to reduce the high prevalence of DTPs among medical ward admitted patients in this hospital.

Prevalence and associated factors of medication-related problems among epileptic patients at ambulatory clinic of Mettu Karl Comprehensive Specialized Hospital: a cross-sectional study

Background

Despite appropriate treatment of epilepsy, the treatment outcome is poor in developing country. Therefore, the study was aimed to identify the magnitude and associated factors of epileptic patients at ambulatory clinic of south western Ethiopian hospital.

Methods

A hospital-based cross-sectional study was conducted on epileptic patients who had follow-up at Mettu Karl Comprehensive Specialized Hospital (MKCSH). Data collection was done through patient interview and medical charts review. The pharmaceutical care network Europe foundation classification system was used to assess the drug therapy problem and Naranjo algorithm of adverse drug reaction was employed to identify the probability of adverse drug reaction. The data were analyzed by SPSS version 23 after data were entered by Epidemiological Information (Epi Info) 7.2.1. The multivariable logistic regressions were utilized and P < 0.05 was used to declare association.

Results

Over the study period, more than half of the participants 172(57.7%) were males. The magnitude of drug-related problems was found to be 164(55.0%). Among epileptic patients about 323 drug-related problems (DRPs) were identified on average, 1.084 drug-related problems (DRPs) per patient. The widely occurred types of drug-related problems were needs additional drug therapy 72(22.29%), dose too low 52(16.09%) and dose to high which accounts 50(15.48%). Regarding the predictors of drug-related problems, being a female (AOR = 3.57, 95% CI:1.85–6.88, P ≤ 0.001), having frequent seizures (AOR = 2.47, 95% CI%:1.33–4.61, P = 0.004) and the presence of poly-pharmacy (AOR = 3.57, 95% CI: 1.49–8.5, P = 0.004) were predictors of drug-related problems.

Conclusion

More than half of the patients had a drug therapy problem. Number of medications taken by the patients, gender and the seizure frequency had a significant association with occurrence of drug therapy problems (DTPs). Therefore, the pharmaceutical care in general and drug information services in particular should be established to hinder any undesirable medication effects in our study area.

Pham S, P.M. Vo T, X. Duong C, A. Perwitasari D, H.K. Truong N, T.H. Quach D, N.P. Nguyen T, T.T. Duong V, M. Nguyen P, H. Nguyen T, Taxis K, Nguyen T. Pneumonia: Drug-Related Problems and Hospital Readmissions

Pneumonia is one of the most common infectious diseases and the fourth leading cause of death globally. According to US statistics in 2019, pneumonia is the most common cause of sepsis and septic shock. In the US, inpatient pneumonia hospitalizations account for the top 10 highest medical costs, totaling $9.5 billion for 960,000 hospital stays. The emergence of antibiotic resistance in the treatment of infectious diseases, including the treatment of pneumonia, is a globally alarming problem. Antibiotic resistance increases the risk of death and re-hospitalization, prolongs hospital stays, and increases treatment costs, and is one of the greatest threats in modern medicine. Drug-related problems (DRPs) in pneumonia - such as suboptimal antibiotic indications, prolonged treatment duration, and drug interactions - increase the rate of antibiotic resistance and adverse effects, thereby leading to an increased burden in treatment. In a context in which novel and effective antibiotics are scarce, mitigating DRPs in order to reduce antibiotic resistance is currently a prime concern. A variety of interventions proven useful in reducing DRPs are antibiotic stewardship programs, the use of biomarkers, computerized physician order entries and clinical decision support systems, and community-acquired pneumonia scores.

Non-Adherence to Antiepileptic Drugs and Associated Factors among Epileptic Patients at Ambulatory Clinic of Southwestern Ethiopian Hospital: A Cross-Sectional Study

BACKGROUND

Non-adherence to anti-epileptic drugs (AEDs) was the most common drug therapy issue that hampered epileptic patients' treatment success. As a result, the barriers to patients adhering to their treatment should be investigated in depth in order to prevent poor treatment outcomes.

METHODS

A hospital-based cross-sectional study was conducted on epileptic patients who had followed up at Mettu Karl Comprehensive Specialized Hospital (MKCSH). Data collection was done through patient interview and medical charts review. Hill-Bone Compliance to High Blood Pressure Therapy Scale was used to measure medication adherence. The data were analyzed using SPSS version 23 after data were entered by Epi Info7.2.1. The multivariable logistic regressions were utilized and P < 0.05 was used to declare association.

RESULTS

Over the study period, more than half of the participants 172 (57.7%) were males, and the median age of participants was 29 years. The magnitude of non-adherence to ant-epileptic drugs (AEDs) was 120 (40.27%). The results of multivariable analysis revealed that patients who had experienced the medication side effects, adjusted odds ratio (AOR) = 2.199; 95% CI: 1.21, 4.00, P = 0.010, a poly-pharmacy, adjusted odds ratio (AOR) = 5.166; 95% CI: 2.63, 10.14, P = <0.001 and the presence of a co-morbidity, adjusted odds ratio (AOR) =3.70; 95% CI: 2.058, 6.65, P = <0.001 were the predictors of medication non-adherence.

CONCLUSION

The magnitude of non-adherences to AEDs was found to be high. Phenobarbitone was the most prescribed AEDs. The number of medications taken by the patients, the presence of co-morbidity and the occurrence of medication side effects had a significant association with non-adherence to AEDs. Therefore, the pharmaceutical care in general and drug information services in particular should be established to enhance medication adherence in our study area.

"Childrens are not just "little adults". The rate of medication related problems and its predictors among patients admitted to pediatric ward of southwestern Ethiopian hospital: A prospective observational study

Background

The rate of medication related problems is high in developing countries due to the complexity of pediatrics medication management. Pediatric population should have their own dosage regimens. The pediatric dosage regimens were derived from the adult dose that might lead to sudden reach of sub or supra-therapeutic doses. As the result, the medication therapy management is difficult in this populations. Despite this, a scanty of studies were conducted on medication related problems among pediatric populations. Therefore, this study examined the prevalence and risk factors for the occurrence of the medication related problems among patients admitted to pediatric ward of Mettu karl referral hospital.

Patients and methods

The pediatric population who were received the pharmacotherapy for their disease was observed and followed for the occurrences of medication related problems at pediatric wards of Mettu karl referral hospital from February 12, 2020 to February 24, 2021. Patients whose age was less than or equal to 18 years and who were on drug therapy or who needs drug therapy during study period were included. The possibility of adverse drug reactions developed from the drug was assessed by using the Naranjo scale. Multivariable logistic regression analysis was used to determine the predictors of medication related problems.

Result

Over the study period, a total of 189 pediatric populations were included. Among these, 115 (60.8%) were males, and the mean age of the patients was 1.4339 ± 0.864 years. The mediciation related problems was found among 121(64.01%) of pediatric patients. Among seven types of drug therapy problems unnecessary drug therapy, need additional drug therapy, ineffective drug therapy and dose too high were the most predominantly occured DRP that accounted 74 (27.72%), 67 (25.09%), 43 (16.10%), 36 (13.48%), respectively. The mean number of hospital stay was 4.29 days with minimum and maximum stay of 2 and 9 days and antibiotics 364(51.3%) were the most common class of drugs that was associated with drug related problems. Being a neonate (AOR = 1.48, 95CI%: 1.69–7.42, P = <0.001), hospital stay greater than or equal to seven days (AOR = 1.98, 95CI%: 2.471–12.644, P = 0.016), and the presence of co-morbidity(AOR = 2.507, 95CI%: 3.270–4.949, P = 0.080) were the predictors of the medication related problems.

Conclusion

The prevalence of medication-related problems in pediatrics patient was found to be high. Being neonatal, prolonged hospital stay and the presence of a multiple disease were the predictors of medication-related problems in pediatric patients. Therefore special attention should be given for newborns, prolonged hospital stay and patients having co-morbidity. Besides this, the drug information service and the patients round activity should be started by clinical pharmacist to decrease the occurences of any preventable medication related problems.

•

DRP is the problem that interferes with a patient's pharmacotherapy that results in poor treatment outcomes.

•

The rate of medication related problems in developing countries is high.

•

“Children are not just “little adults” in which they should have their own pharmacokinetic and pharmacodynamics profile.

Magnitude and determinants of drug-related problems among patients admitted to medical wards of southwestern Ethiopian hospitals: A multicenter prospective observational study

BACKGROUND

Drug-related problem (DRP) is an event involving drugs that can impact the patient's desired goal of therapy. In hospitalized patients, DRPs happen during the whole process of drug use such as during prescription, dispensing, administration, and follow-up of their treatment. Unrecognized and unresolved DRPs lead to significant drug-related morbidity and mortality. Several studies conducted in different hospitals and countries showed a high incidence of DRPs among hospitalized patients. Despite the available gaps, there were scanties of studies conducted on DRPs among patients admitted to medical wards in Ethiopia. Therefore, this study assessed the magnitude of drug-related problems and associated factors among patients admitted to the medical wards of selected Southwestern Ethiopian hospitals.

PATIENTS AND METHODS

A multicenter prospective observational study was conducted at medical wards of Mettu Karl Hospital, Bedele General Hospital and Darimu General Hospital. Adult patients greater than 18 years who were admitted to the non-intensive care unit (ICU) of medical wards and with more than 48 h of length of stay were included. Identified DRPs were recorded and classified using the pharmaceutical care network Europe foundation classification system and adverse drug reaction was assessed using the Naranjo algorithm of adverse drug reaction probability scale. Hill-Bone Compliance to High Blood Pressure Therapy Scale was used to measure medication adherence. Multivariable logistic regression was used to analyze the associations between the dependent variable and independent variables.

RESULT

Of the 313 study participants, 178 (56.9%) were males. The prevalence of actual or potential DRPs among study participants taking at least a single drug was 212 (67.7%). About 125 (36.63%) patients had one or more co-morbid disease and the average duration of hospital stay of 7.14 ± 4.731 days. A total of 331 DRPs were identified with an average 1.06 DRP per patient. The three-leading categories of DRPs were unnecessary prescription of drugs 92 (27.79%), non-adherence (17.22%) and dose too high (16.92%). The most common drugs associated with DRPs were ceftriaxone (28.37%), cimetidine (14.88%), and diclofenac (14.42%). The area of residence (AOR = 2.550, 95CI%: 1.238-5.253, p = 0.011), hospital stay more than 7 days (AOR = 9.785, 95CI%: 4.668-20.511, p≤0.001), poly pharmacy (AOR = 3.229, 95CI%: 1.433-7.278, p = 0.005) were predictors of drug-related problem in multivariable logistic regression analysis.

CONCLUSION

The magnitude of drug therapy problems among patients admitted to the medical wards of study settings was found to be high. Therefore, the clinical pharmacy services should be established in hospitals to tackle the DTPs in this area. Additionally, healthcare providers of hospitals also should create awareness for patients seeking care from health facilities of the importance of rational drug usage.