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波兰儿科肺病科(包括囊性纤维化患者)的潜在药物相互作用分析。

Potential drug-drug interactions analysis in Polish pediatric pneumonology units, including cystic fibrosis patients.

作者信息

Adamiszak Arkadiusz, Drobińska Julia, Wojsyk-Banaszak Irena, Grześkowiak Edmund, Bienert Agnieszka

机构信息

Department of Clinical Pharmacy and Biopharmacy, Poznan University of Medical Sciences, Poznan, Poland.

Doctoral School, Poznan University of Medical Sciences, Poznan, Poland.

出版信息

J Clin Pharmacol. 2024 Oct;64(10):1326-1334. doi: 10.1002/jcph.2478. Epub 2024 Jun 3.

Abstract

The lack of data on drug-drug interactions in pediatrics represents a relevant problem in making appropriate therapeutic decisions. Our study aimed to investigate the incidence and risk factors for potential drug-drug interactions (pDDIs) in pediatric pneumonology units, including cystic fibrosis patients. We performed a 6-month prospective observational study during which clinical pharmacists, using the Lexicomp Drug Interactions checker, screened medical records to identify pDDIs. Spearman's rank coefficient, logistic regression, and the Mann-Whitney U test were used to identify correlations, analyze risk factors for pDDIs, and compare cystic fibrosis patients with the rest, respectively. Recommendations were provided for the D and X pDDIs categories. Within the 218 patients, 428 pDDIs were identified, out of which 237 were classified as clinically significant. Almost 60% of patients were exposed to at least one relevant interaction. The number of pDDIs correlated with the number of; drugs (r = 0.53, P <  .001), hospitalization length (r = 0.20, P <  .01), and off-label medicines (r = 0.25, P <  .001). According to the multivariate analysis, at least 6 administered medications (OR = 4.15; 95% CI = 2.21-7.78), 4 days of hospitalization (OR = 6.41; 95% CI = 2.29-17.97), and off-label therapy (OR = 3.37; 95% CI = 1.69-6.70) were the risk factor for pDDIs. Despite significant differences in the number of medications taken, comorbidities, and off-label drugs, cystic fibrosis patients were not more exposed to pDDI. Given the lack of data on pDDIs in the pediatric population, the need for close cooperation between clinicians and clinical pharmacists to improve the safety and efficacy of pharmacotherapy is highlighted.

摘要

儿科领域缺乏药物相互作用的数据是做出恰当治疗决策时的一个相关问题。我们的研究旨在调查儿科肺病科(包括囊性纤维化患者)中潜在药物相互作用(pDDIs)的发生率及风险因素。我们进行了一项为期6个月的前瞻性观察研究,在此期间临床药师使用Lexicomp药物相互作用检查器筛查病历以识别pDDIs。采用Spearman秩系数、逻辑回归和Mann-Whitney U检验分别来识别相关性、分析pDDIs的风险因素以及比较囊性纤维化患者与其他患者。针对D类和X类pDDIs给出了建议。在218名患者中,识别出428例pDDIs,其中237例被归类为具有临床意义。近60%的患者至少经历过一次相关相互作用。pDDIs的数量与药物数量(r = 0.53,P <.001)、住院时长(r = 0.20,P <.01)及超说明书用药(r = 0.25,P <.001)相关。根据多变量分析,至少服用6种药物(OR = 4.15;95% CI = 2.21 - 7.78)、住院4天(OR = 6.41;95% CI = 2.29 - 17.97)和超说明书治疗(OR = 3.37;95% CI = 1.69 - 6.70)是pDDIs的风险因素。尽管在用药数量、合并症和超说明书用药方面存在显著差异,但囊性纤维化患者并未更多地暴露于pDDI。鉴于儿科人群中pDDIs数据的缺乏,强调了临床医生和临床药师密切合作以提高药物治疗安全性和有效性的必要性。

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