Ribeiro Marisa Rosimeire, Motta Antonio Abílio, Marcondes-Fonseca Luiz Augusto, Kalil-Filho Jorge, Giavina-Bianchi Pedro
Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, Sao Paulo, SP, BR.
Clinics (Sao Paulo). 2018;73:e185. doi: 10.6061/clinics/2018/e185. Epub 2018 Feb 8.
To assess the risk factors, incidence and severity of adverse drug reactions in in-patients.
This prospective study evaluated 472 patients treated at a teaching hospital in Brazil between 2010 and 2013 by five medical specialties: Internal Medicine, General Surgery, Geriatrics, Neurology, and Clinical Immunology and Allergy. The following variables were assessed: patient age, gender, comorbidities, family history of hypersensitivity, personal and family history of atopy, number of prescribed drugs before and during hospitalization, hospital diagnoses, days of hospitalization. The patients were visited every other day, and medical records were reviewed by the investigators to detect adverse drug reactions.
There were a total of 94 adverse drug reactions in 75 patients. Most reactions were predictable and of moderate severity. The incidence of adverse drug reactions was 16.2%, and the incidence varied, according to the medical specialty; it was higher in Internal Medicine (30%). Antibiotics were the most commonly involved medication. Chronic renal failure, longer hospital stay, greater number of diagnoses and greater number of medications upon admission were risk factors. For each medication introduced during hospitalization, there was a 10% increase in the rate of adverse drug reaction. In the present study, the probability of observing an adverse drug reaction was 1 in 104 patients per day.
Adverse drug reactions are frequent and potentially serious and should be better monitored in patients with chronic renal failure or prolonged hospitalization and especially in those on 'polypharmacy' regimens. The rational use of medications plays an important role in preventing adverse drug reactions.
评估住院患者药物不良反应的危险因素、发生率及严重程度。
这项前瞻性研究对2010年至2013年间在巴西一家教学医院接受治疗的472例患者进行了评估，这些患者分属五个医学专科：内科、普通外科、老年医学、神经科以及临床免疫与过敏科。评估了以下变量：患者年龄、性别、合并症、过敏家族史、特应性个人及家族史、住院前及住院期间的处方药数量、医院诊断结果、住院天数。每隔一天对患者进行访视，研究人员查阅病历以检测药物不良反应。
75例患者共出现94例药物不良反应。大多数反应是可预测的，且为中度严重程度。药物不良反应的发生率为16.2%，根据医学专科不同发生率有所差异；内科的发生率更高（30%）。抗生素是最常涉及的药物。慢性肾衰竭、住院时间较长、诊断数量较多以及入院时用药数量较多均为危险因素。住院期间每引入一种药物，药物不良反应发生率增加10%。在本研究中，每天每104例患者中出现药物不良反应的概率为1例。
药物不良反应很常见且可能很严重，对于慢性肾衰竭患者、住院时间延长的患者，尤其是采用“多药联合”治疗方案的患者，应加强监测。合理用药在预防药物不良反应方面起着重要作用。
