No abstract

Background/Aims: Tuberculosis has incidence and mortality rates that are among the highest for all communicable diseases. Adverse drug reactions (ADRs) to anti-tubercular drugs are common, and have a major impact on treatment maintenance and prognosis. It is important to understand the characteristics of ADRs and establish a suitable management plan. Methods: We retrospectively reviewed patients with ADRs during treatment with first-line antitubercular drugs such as isoniazid, rifampicin, ethambutol, and pyrazinamide from 2009 to 2018. Age, sex, and total treatment period, and the onset, severity, seriousness, and system organ class of ADRs, were analyzed to understand the characteristics of first-line anti-tubercular drug-related ADRs. Results: A total of 1,606 of 5,482 patients (29.3%) experienced ADRs after administration of first-line anti-tubercular drugs. The incidence of ADRs related to isoniazid, rifampicin, ethambutol, and pyrazinamide was 22.2%, 21.3%, 24.5%, and 29.6%, respectively. A total of 2,098 ADR reports were made (mean of 1.3 ± 0.6 per patient). The rates of mild, moderate, and severe ADRs were 32.4%, 61.1%, and 6.5%, respectively. There were 127 reports (6.1%) of serious ADRs. Skin and appendage disorders were most frequently reported (27.5%), followed by gastrointestinal disorders (17.5%), and liver and biliary system disorders (13.1%). The total treatment period was longer in patients who experienced ADRs (224.0 ± 3.1 days vs. 247.0 ± 4.7 days, p = 0.009). Conclusions: The incidence of ADRs to first-line anti-tuberculosis drugs was 29.3%, and 6.5% were severe ADRS. ADRs prolonged the overall treatment duration, indicating the importance of their detection and management.

Malnutrition is common in cirrhotic patients undergoing liver transplantation. It has been associated with a high risk of postoperative complications and mortality rates in patients undergoing surgery. Studies have shown that nutrition therapy may improve the clinical outcomes in cirrhotic patients undergoing liver transplantation. This study focuses on the role of nutrition support, including immunonutrition such as branched-chain amino acids and n-3 fatty acid, vitamins and long-term consideration of nutritional status.

Objective: Many medical institutions provide warnings when physicians prescribe medication with a history of adverse reaction to prevent adverse drug reaction. If the range of warning is too narrow, it cannot prevent adverse drug reactions due to a similar structure and component. However, if the range is too wide it provides too many warnings resulting in alert fatigue. In our study, we upgraded the algorithm for adverse drug reaction warning to lower the overall frequency of alert warning but improve the clinical significance of alerts. Methods: The authors upgraded the alert algorithm to include information about the potential for cross-reactivity, past adverse drug reaction type, severity, and causality. To verify the effect of the upgraded system, we compared the frequency of alerts of six months before and after the system upgrade, a satisfaction of physicians using the upgraded prescription system, and recurrence of drug allergy. Results: After six months of upgraded prescription system, the number of alerts decreased significantly from 10,474 cases per month to 1,060 cases per month (p ＜ 0.05). The recurrence of drug allergy decreased by 53%, from 57 cases to 27 cases per 6 months. Survey results show that physician satisfaction improved from 3.48 points to 4.15 points and improvement in patient care improved from 3.80 points to 4.33 points significantly (p ＜ 0.05). Conclusion:By reducing the number of clinically less important warnings, the upgraded prescription system can raise the interest in clinically significant adverse reactions and it can be effective in preventing recurrence of adverse drug reactions.