Department of Pharmacy, University of Peshawar, Peshawar, Khyber Pakhtunkhwa, Pakistan.
BMC Pharmacol Toxicol. 2019 Jul 26;20(1):45. doi: 10.1186/s40360-019-0325-7.
Pneumonia patients are usually hospitalized due to severe nature of the disease or for the management of comorbid illnesses or associated symptoms. Such patients are prescribed with multiple medications which increase the likelihood of potential drug-drug interactions (pDDIs). Therefore, in this study the prevalence, levels (severity and documentation), predictors (risk factors), and clinical relevance of pDDIs among inpatients diagnosed with pneumonia have been investigated.
Clinical records of 431 hospitalized patients with pneumonia were checked for pDDIs using drug interactions screening software (Micromedex-DrugReax). Odds-ratios for predictors were calculated using logistic regression analysis. Clinical relevance of pDDIs was assessed by evaluation of patients' clinical profiles for potential adverse outcomes of the most frequent pDDIs. Abnormal patients' signs/symptoms and laboratory investigations indicating adverse outcomes of interactions were reported.
Of total 431 profiles, pDDIs were reported in 73.1%. Almost half of the profiles were having major-pDDIs (53.8%). Total number of pDDIs were 1318, of which 606 were moderate- and 572 were major-pDDIs. Patient's profiles identified with the most frequent interactions were presented with signs, symptoms, and abnormalities in labs indicating decrease therapeutic response, electrolyte abnormalities, hypoglycemia, bleeding, hepatotoxicity, and hypertension. These adverse events were more prevalent in patients taking higher doses of the interacting drugs as compared to lower doses. Logistic regression analysis revealed significant association for major-pDDIs with 6-10 prescribed medicines (OR = 26.1; p = 0.002), > 10 prescribed medicines (OR = 144; p < 0.001), and tuberculosis (OR = 8.2; p = 0.004).
PDDIs are highly prevalent in patients with pneumonia. Most frequent and clinically important pDDIs need particular attention. Polypharmacy and tuberculosis increase the risk of pDDIs. Identifying patients more at risk to pDDIs and careful monitoring of pertinent signs/symptoms and laboratory investigations are important measures to reduce pDDIs and their related adverse consequences.
肺炎患者通常因病情严重或合并症或相关症状需要住院治疗。此类患者通常会开具多种药物，这增加了药物相互作用（pDDI）的可能性。因此，本研究旨在调查诊断为肺炎的住院患者中 pDDI 的流行率、程度（严重程度和记录）、预测因素（危险因素）和临床相关性。
使用药物相互作用筛选软件（Micromedex-DrugReax）检查 431 名住院肺炎患者的临床记录，以查找 pDDI。使用逻辑回归分析计算预测因素的优势比。通过评估患者的临床特征，评估 pDDI 的临床相关性，以确定最常见的 pDDI 的潜在不良后果。报告了异常患者的体征/症状和实验室检查结果，表明相互作用的不良后果。
在 431 份患者记录中，有 73.1%的患者报告存在 pDDI。近一半的记录存在主要的 pDDI（53.8%）。总共报告了 1318 个 pDDI，其中 606 个为中度 pDDI，572 个为主要 pDDI。具有最常见相互作用的患者记录表现出迹象、症状和实验室检查异常，表明治疗反应降低、电解质异常、低血糖、出血、肝毒性和高血压。与较低剂量相比，接受相互作用药物较高剂量的患者更易发生这些不良事件。逻辑回归分析显示，与 6-10 种处方药物（OR=26.1；p=0.002）、>10 种处方药物（OR=144；p<0.001）和结核病（OR=8.2；p=0.004）相关的主要 pDDI 具有显著相关性。
肺炎患者中 pDDI 的发生率很高。最常见和最重要的 pDDI 需要特别注意。多药治疗和结核病增加了 pDDI 的风险。识别更容易发生 pDDI 的患者，并密切监测相关的体征/症状和实验室检查是减少 pDDI 及其相关不良后果的重要措施。
