Background: Healthcare professionals’ knowledge and attitudes towards adverse drug reactions (ADRs) and ADR reporting play a significant role in pharmacovigilance. This study aims to investigate the gap between knowledge and practice in ADR reporting among hospital pharmacists.Methods: This study is a multi-center, cross-sectional study based on a questionnaire survey. A semi-structured questionnaire was developed including knowledge, attitudes, and practices (KAP) towards ADR reporting. From October to November 2021, questionnaires were filled out on the internet by hospital pharmacists from a central province of China. The data analysis used a one-way ANOVA to analyze the differences between the pharmacist’s characteristics and knowledge and attitude, respectively. The ordinal logistic regression method was used to analyze the predictors of practice.Results: A total of 1,026 valid questionnaires from 512 medical institutions were collected. It was found that 88.8% of participants have a clear understanding of the ADR definition, while 59.6% of them have misunderstandings about the reporting time of new and serious adverse reactions. Most pharmacists showed positive attitudes towards ADR reporting. Higher education background, higher professional title, attending training, and clinical pharmacist resulted in higher knowledge scores. Higher education background, shorter working years, attending training, and from non-tertiary hospital related to higher attitude scores. In terms of practice, age, hospital type, working years, training, and pharmacist type all have significant associations with practice scores. Pharmacists’ knowledge score and attitude score were significant predictors of practice score with OR being 1.19 (95% CI: 1.06, 1.33) and 1.04 (95% CI: 1.005, 1.07).Conclusion: Although most hospital pharmacists showed positive attitudes towards ADR reporting, their knowledge and practice were still insufficient. Hospital pharmacists’ knowledge and attitude are associated with their practice towards ADR reporting. The training had a significant impact on the pharmacist’s knowledge, attitude, and practice.

The outbreak of coronavirus disease 2019 (COVID-19) has led to the emergence of global health care. In this study, we aimed to explore the association between drug treatments and the incidence of drug-induced liver injury (DILI) in hospitalized patients with COVID-19. A retrospective study was conducted on 5113 COVID-19 patients in Hubei province, among which 395 incurred liver injury. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated by Cox proportional hazards models. The results showed that COVID-19 patients who received antibiotics (HR 1.97, 95% CI: 1.55–2.51, p < 0.001), antifungal agents (HR 3.10, 95% CI: 1.93–4.99, p < 0.001) and corticosteroids (HR 2.31, 95% CI: 1.80–2.96, p < 0.001) had a higher risk of DILI compared to non-users. Special attention was given to the use of parenteral nutrition (HR 1.82, 95% CI: 1.31–2.52, p < 0.001) and enteral nutrition (HR 2.71, 95% CI: 1.98–3.71, p < 0.001), which were the risk factors for liver injury. In conclusion, this study suggests that the development of DILI in hospitalized patients with COVID-19 needs to be closely monitored, and the above-mentioned drug treatments may contribute to the risk of DILI.

Objective:To describe patterns of utilization of traditional Chinese medicine (TCM) in the treatment of patients with coronavirus disease 2019 (COVID-19).Methods:Adult patients with COVID-19 who received TCM treatment were divided into a non-serious group (mild and moderate types) and a serious group (severe and critical types) according to their admission conditions. The medical records and prescriptions of these patients were investigated to determine their TCM utilization patterns.Results:In all, 3,872 COVID-19 patients were included. Oral Chinese traditional patent medicine (CPM) was the most commonly used type of TCM, followed by decoction. The proportion of multi-drug combinations was higher than single drug use (55.0% vs. 45.0%). Decoction combined with oral CPM was the most common combination (39.1%, 1,514/3,872). Orally administered, injected, and externally applied CPM were significantly more common in the serious group than in the non-serious, while decoction and non-drug TCM treatments were more common in the non-serious than in the serious group. Multi-drug combinations were used for the majority of patients in both groups, mainly in the form of decoctions combined with oral CPM. Among the serious patients, injected CPM was more often used in patients who died during treatment (35.0%, 36/103). The two most common medication patterns were decoction combined with oral CPM and oral CPM alone in the two finally discharged groups. Oral CPM alone or used in combination with injected CPM were seen most commonly in the death group. Significant differences were established in TCM utilization and medication patterns among patients in three groups who had different prognoses and outcomes.Conclusions:The treatment measures and medication patterns of TCM commonly used in COVID-19 patients with the range of conditions found in this study should be further explored in the future to provide a more complete reference for COVID-19 treatment.

As a traditional Chinese medicine, Lianhua Qingwen capsules have been widely used to treat Coronavirus Disease 2019 (COVID-19). This study was aimed to demonstrate the association between treatment with Lianhua Qingwen capsules and the clinical outcomes of hospitalized patients with COVID-19. This retrospective study was conducted at four hospitals in Central China. Data of hospitalized COVID-19 patients were collected between December 19, 2019 and April 26, 2020. Based on whether Lianhua Qingwen capsules were used, patients were classified into Lianhua Qingwen and non-Lianhua Qingwen (control) groups. To control for confounding factors, we used conditional logistic regression in a propensity-score matched (PSM) cohort (1 : 1 balanced), as well as logistic regression without matching as sensitivity analysis. A total of 4918 patients were included, 2760 of whom received Lianhua Qingwen capsules and 2158 of whom did not. In the PSM model, after adjusting for confounders, the in-hospital mortality was similar between the Lianhua Qingwen group and the control group (6.8% vs. 3.3%, adjusted OR, 0.66 [95% CI, 0.38-1.15], p = 0.138 ). The negative conversion rate of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection was higher in the Lianhua Qingwen group (88.3% vs. 96.1%, adjusted OR, 4.02 [95% CI, 2.58-6.25], p < 0.001 ). The incidence of acute liver injury was comparable between the two groups (14.0% vs. 11.5%, adjusted OR: 0.85 [95% CI, 0.71-1.02], p = 0.083 ), and the incidence of acute kidney injury was lower in the Lianhua Qingwen group (5.3% vs. 3.0%, adjusted OR: 0.71 [95% CI, 0.50-1.00], p = 0.048 ). Treatment with Lianhua Qingwen capsules was not significantly associated with in-hospital mortality in COVID-19 patients. In the Lianhua Qingwen group, the negative conversion rate of SARS-CoV-2 infection was higher and the incidence of acute kidney injury was lower than in the control group.

What is Known and Objective? In China, patients with drug-induced liver injury (DILI) are commonly treated with one or more types of hepatoprotective drugs, despite a lack of evidence. We performed this study to investigate the association between the treatment pattern of DILI, including withdrawal of suspected drugs and use of hepatoprotective drugs, and recovery following DILI. Methods. A retrospective study was conducted at a tertiary hospital in Central China. Data of patients with a diagnosis of DILI hospitalized between January 2015 and December 2020 were collected through the Electronic Medical Records System. We excluded cases that did not meet the biochemical criteria of DILI and had a Roussel Uclaf Causality Assessment Method score of less than 3. Univariate and multivariate logistic regression models were used to analyze the association between treatment patterns and clinical outcomes. Results and Discussion. In total, 699 patients were included. Suspected drugs were discontinued in 619 patients (88.6%). 693 patients (99.1%) were treated with hepatoprotective drugs, among whom only 14.7% patients received monotherapy with hepatoprotective drugs. Recovery following DILI was seen in 593 cases (84.8%). By multivariate analysis, the number of hepatoprotective drugs combined did not show significance ( p = 0.363 ), while the withdrawal of suspected drugs was associated with recovery following DILI ( p = 0.015 ). What is New and Conclusion. The withdrawal of suspected drugs is associated with the recovery following DILI, and hepatoprotective drug combinations do not contribute to better outcomes than monotherapy. The findings indicate that DILI patients should stop suspected drugs as soon as possible and the combination therapy of hepatoprotective drugs is unnecessary.