Adverse events caused by potential drug-drug interactions in an intensive care unit of a teaching hospital

Abstract

ObjectiveTo evaluate the incidence of potential drug-drug interactions in an intensive care unit of a hospital, focusing on antimicrobial drugs.MethodsThis cross-sectional study analyzed electronic prescriptions of patients admitted to the intensive care unit of a teaching hospital between January 1 and March 31, 2014 and assessed potential drug-drug interactions associated with antimicrobial drugs. Antimicrobial drug consumption levels were expressed in daily doses per 100 patient-days. The search and classification of the interactions were based on the Micromedex® system.ResultsThe daily prescriptions of 82 patients were analyzed, totaling 656 prescriptions. Antimicrobial drugs represented 25% of all prescription drugs, with meropenem, vancomycin and ceftriaxone being the most prescribed medications. According to the approach of daily dose per 100 patient-days, the most commonly used antimicrobial drugs were cefepime, meropenem, sulfamethoxazole + trimethoprim and ciprofloxacin. The mean number of interactions per patient was 2.6. Among the interactions, 51% were classified as contraindicated or significantly severe. Highly significant interactions (clinical value 1 and 2) were observed with a prevalence of 98%.ConclusionThe current study demonstrated that antimicrobial drugs are frequently prescribed in intensive care units and present a very high number of potential drug-drug interactions, with most of them being considered highly significant.

Prevalence of Potential Drug-Drug Interactions in the Intensive Care Unit of a Tertiary Care Hospital: A Cross-Sectional Study

“…Discussing on the reliability of these interactions majority of the interactions (72.26%) had fair documentation in the literature followed by good documentation (21.27%) like other studies. 16,20,21 Indicating good knowledge and a sophisticated computer-based drug interaction check software in the emergency settings with the good training to the health care providers can help in avoiding the drug interactions which are harmful a to these patients and also helps in optimizing treatment to them. The majority of interactions were due to pharmacodynamics mechanisms similar to studies by Gupta et al Bista et al and Kothari et al 16,22,23 indicating the need of the proper knowledge of the drugs while administering in critical settings which can prevent the many of the interactions and reduce the adverse consequences.…”

Potential drug-drug interactions and their risk factors in pediatric patients admitted to the emergency department of a tertiary care hospital in Mexico

“…However, the prescription of multiple drugs to a patient can favor the presence of drug-drug interactions (DDIs), which can be identified when the pharmacological or clinical response to the administration of a combination of two drugs is different than expected based on both drugs’ known effects when individually prescribed [ 1 ]. The “Potential Drug-Drug Interaction” (potential DDI) concept refers to the possibility a drug has to alter the effects of another when both are simultaneously administered [ 2 ]. In medical practice, it is quite common using drug combinations with the capability to interact, and although not all DDIs detected in a patient may occur (potential DDIs), their identification is relevant since they can increase the risk for adverse drug reactions (ADRs), toxicity or loss of treatment efficacy, which in addition to adverse consequences for patients, can increase days of hospital stay and costs [ 3 – 6 ].…”

Dosing Three-Drug Combinations That Include Targeted Anti-Cancer Agents: Analysis of 37,763 Patients

“…Patients with advanced cancer are on a median of eight drugs for other health problems prior to starting treatment for malignancy . Patients in the intensive care unit are on even greater numbers of concurrent medications, with prior studies showing an average of 10.5 to 14.6 prescriptions per patient . Thus, it may be possible to use information such as that in the current study and an understanding of renal function, liver function, and drug metabolism to develop algorithms that will help guide safe starting doses for de novo combination therapy involving targeted agents for clinical practice in addition to clinical trials.…”