Pestotnik S L, Classen D C, Evans R S, Stevens L E, Burke J P
Department of Clinical Epidemiology, LDS Hospital, Salt Lake City, UT 84143.
Ann Pharmacother. 1993 Apr;27(4):497-501. doi: 10.1177/106002809302700418.
To develop computerized methods to monitor and recommend dosage changes for patients treated with excessive dosages of imipenem/cilastatin (I/C) and to determine the incidence of I/C-associated seizures in our patient population.
Prospective observational and interventional study of all patients admitted to LDS Hospital and treated with I/C from May 1, 1987, through June 30, 1991.
LDS Hospital, Salt Lake City, UT, a 520-bed, tertiary care center associated with the University of Utah School of Medicine.
Using a hospital information system we developed computerized algorithms to identify and monitor patients receiving I/C. These algorithms screened the computer-stored medical records of all inpatient admissions for I/C prescription orders. Computer-decision support algorithms estimated the renal function of each I/C-treated patient and provided suggestions when dosages were determined to be excessive. Additional computer-generated alerts identified patients who were receiving anticonvulsants concomitantly with I/C or whose therapy reflected dosage changes in the previous 24 hours. A list of all I/C-treated patients with alerts was reviewed daily by a clinical pharmacist and prescribing physicians were contacted if the computer-generated suggestions were clinically relevant.
The number and characterization of I/C-associated seizures.
From May 1, 1987, through June 30, 1991, we prospectively monitored 107,600 patients of whom 1951 were treated with I/C. The following risk factors for I/C-associated seizures were observed in the I/C-treated population: CNS disease (6 percent), seizure disorders (0.6 percent), and abnormal renal function (70 percent). The observational and interventional methods employed in this study resulted in 79 percent of the patients receiving I/C dosages appropriate for their corresponding renal function. During the 50-month study period, we detected four seizures (0.20 percent) in the I/C-treated patients. All 4 patients were receiving I/C dosages that were excessive with respect to their renal function.
Our rate of seizure (0.2 percent) was lower than the 1-2 percent rate reported in the literature despite the fact that more than 70 percent of the patients who received I/C had risk factors for seizure. We believe that appropriate dosing of I/C results in a low rate of associated seizures. Computer-assisted monitoring of I/C dosages in relation to renal function resulted in a reduced incidence of seizures.
开发计算机化方法，以监测接受超剂量亚胺培南/西司他丁（I/C）治疗的患者并推荐剂量调整，并确定我院患者中I/C相关癫痫发作的发生率。
对1987年5月1日至1991年6月30日期间入住LDS医院并接受I/C治疗的所有患者进行前瞻性观察和干预研究。
犹他州盐湖城的LDS医院，这是一家拥有520张床位的三级医疗中心，与犹他大学医学院相关联。
我们使用医院信息系统开发了计算机化算法，以识别和监测接受I/C治疗的患者。这些算法筛查了所有住院患者的计算机存储病历中的I/C处方订单。计算机决策支持算法估计了每位接受I/C治疗患者的肾功能，并在确定剂量过高时提供建议。另外，计算机生成的警报可识别出正在同时接受I/C和抗惊厥药物治疗的患者，或其治疗在过去24小时内反映出剂量变化的患者。临床药剂师每天会查看所有带有警报的接受I/C治疗患者的列表，如果计算机生成的建议具有临床相关性，则会联系开处方的医生。
I/C相关癫痫发作的数量和特征。
从1987年5月1日至1991年6月30日，我们前瞻性监测了107,600名患者，其中1951名接受了I/C治疗。在接受I/C治疗的人群中观察到以下I/C相关癫痫发作的危险因素：中枢神经系统疾病（6%）、癫痫症（0.6%）和肾功能异常（70%）。本研究采用的观察和干预方法使79%的接受I/C治疗的患者接受了与其相应肾功能相适应的剂量。在为期50个月的研究期间，我们在接受I/C治疗的患者中检测到4例癫痫发作（0.20%）。所有4例患者接受的I/C剂量相对于其肾功能均过高。
尽管接受I/C治疗的患者中有超过70%存在癫痫发作的危险因素，但我们的癫痫发作率（0.2%）低于文献报道的1%-2%。我们认为，I/C的适当给药导致相关癫痫发作率较低。计算机辅助监测I/C剂量与肾功能的关系可降低癫痫发作的发生率。
