Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee;
Departments of Pediatrics and.
Pediatrics. 2020 Nov;146(5). doi: 10.1542/peds.2020-0858. Epub 2020 Oct 9.
Little is known about the prescribing of medications with potential drug-drug interactions (DDIs) in the pediatric population. The objective of this study was to determine the prevalence and variation of prescribing medications with clinically significant DDIs across children's hospitals in the United States.
We performed a retrospective cohort study of patients <26 years of age who were discharged from 1 of 52 US children's hospitals between January 2016 and December 2018. Fifty-three drug pairings with clinically significant DDIs in children were evaluated. We identified patient-level risk factors associated with DDI using multivariable logistic regression. Adjusted hospital-level rates of DDI exposure were derived by using a generalized linear mixed-effects model, and DDI exposure variations were examined across individual hospitals.
Across 52 children's hospitals, 47 414 (2.0%) hospitalizations included exposure to a DDI pairing (34.9 per 1000 patient-days) during the study period. One-quarter of pairings were considered contraindicated (risk grade X). After adjusting for hospital and clinical factors, there was wide variation in the percentage of DDI prescribing across hospitals, ranging from 1.05% to 4.92%. There was also substantial hospital-level variation of exposures to individual drug pairings. Increasing age, number of complex chronic conditions, length of stay, and surgical encounters were independently associated with an increased odds of DDI exposure.
Patients hospitalized at US children's hospitals are frequently exposed to medications with clinically significant DDIs. Exposure risk varied substantially across hospitals. Further study is needed to determine the rate of adverse events due to DDI exposures and factors amenable for interventions promoting safer medication use.
对于儿科人群中具有潜在药物-药物相互作用（DDI）的药物的处方情况知之甚少。本研究的目的是确定美国儿童医院中具有临床显著 DDI 的药物处方的流行率和变异性。
我们对 2016 年 1 月至 2018 年 12 月期间从美国 52 家儿童医院出院的<26 岁患者进行了回顾性队列研究。评估了 53 种具有儿童临床显著 DDI 的药物配对。我们使用多变量逻辑回归确定了与 DDI 相关的患者水平危险因素。通过使用广义线性混合效应模型得出调整后的医院 DDI 暴露率，并检查了各个医院之间的 DDI 暴露变化。
在 52 家儿童医院中，47414 例（2.0%）住院患者在研究期间接触到 DDI 配对（每 1000 患者-天 34.9 例）。四分之一的配对被认为是禁忌的（风险等级 X）。在调整了医院和临床因素后，医院之间 DDI 处方的比例存在很大差异，范围从 1.05%到 4.92%。个别药物配对的暴露也存在显著的医院水平差异。年龄增长、复杂慢性疾病数量、住院时间和手术遭遇与 DDI 暴露的可能性增加独立相关。
美国儿童医院住院患者经常接触具有临床显著 DDI 的药物。暴露风险在医院之间存在很大差异。需要进一步研究确定因 DDI 暴露而导致不良事件的发生率以及可促进更安全用药的干预措施。
