Assessment of Interactions of Drugs Prescribed for Pediatric Patients in Bangladesh

Abstract

Drug-drug interactions (DDIs) represent an important clinical problem. During inpatient admissions, infants, children, and adolescents are typically exposed to different medications, increasing their risk of potential drug-drug interactions (pDDIs). While drug interactions are reported to be common, there are only few publications of the prevalence of such interactions among pediatric patients in Bangladesh. The present study tries to estimates the prevalence and characteristics of pDDI exposure of pediatric patients treated in children’s hospitals. This observational retrospective study was carried out on 155 patients admitted to a children’s hospital located at Dhaka during January 2019 to August 2019. The medications of the patients were analyzed for pDDIs by using Medscape drug interaction checker. The prescriptions were analyzed for demographic characteristics, medical and detailed drug history. Drug-drug interactions (DDIs) were evaluated for total numbers, types and severity of DDIs. Total 155 prescriptions with mean age 2.12±2.08 years were analyzed and a total of 25 pDDIs were recorded. The prevalence of pDDI was 17%, of which 12 (48%) were pharmacodynamic interactions, 10 (40%) were pharmacokinetic interactions and 3 (12%) of unknown mechanism. According to the severity of interaction, 4 (18%) cases were categorized as serious, 15 (55%) cases as moderate and 6 (27%) cases as minor. The occurrence of DDIs were significantly associated (r=0.912, p<0.05) with the number of drugs prescribed. The present study has identified pDDIs and also documented interactions in pediatrics patients. It has highlighted the need for screening prescriptions of pediatric patients for pDDIs and proactive monitoring of patients who have identified risk factors in order to promote detection and prevention of possible adverse drug interactions.
 Bangladesh Pharmaceutical Journal 24(2): 91-98, 2021

Pharmacological interactions among Paediatrics in Tertiary Care Hospital

“…As per Micromedex, the level of severity, degree of documentation, onset of action, type and description of mechanism and clinical management of drugdrug interactions were noted. Half of the drug-drug interactions were found to be moderately severe which was similar in numerous past studies [1,7,8,10,[14][15][16][17] . Majority of the drug-drug interactions were fairly documented and also the onset of action of half of the drug-drug interactions was established to be not specified as per Micromedex.…”

“…Majority of the paediatric patients were found with only one drug-drug interaction per patient which was comparable to various previous studies [6][7][8]14,15] . The prevalence of drug-drug interaction was found to be 33.93 % which was greater in several prior studies and lower in several other prior studies [8,10,[14][15][16][17][18][19] . The most common drug class involved in drug-drug interactions was found to be antibiotics followed by supplements/vitamins which was comparable to the outcome established by Nawaz et al [15] .…”

“…This trend was varying with the study conducted by Ismail et al [14] . Most common majorly severe and moderately severe interaction was ciprofloxacin and metronidazole, and iron and pantoprazole respectively, which was differing in numerous prior studies [1,8,10,[14][15][16][17][18][19] . The type of mechanism was pharmacokinetic for the majority of drug-drug interactions.…”

“…In the present study, the paediatric patients were divided into a range of age groups from birth to 18 y of neonates (from birth to 28 d), infants (1 mo-1 y), children (1-12) y and adolescent (13)(14)(15)(16)(17)(18) y where maximum number of paediatric patients were found in the age group of children (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12) y. This trend was different from the results found in several previous studies [1,6,8,10,14,15] but in a study conducted by Ahmed et al [16] the results were found similar. The mean of age in our study is 9.3 which was differing from earlier studies conducted by Mistry et al [1] and Medina et al [6] .…”

“…Paediatrics are defined as those younger than 19 y. Newborn infants born before 37 w of gestational age are termed premature; those from birth to 28 d of age are neonates; 1 mo-1 y are infants; those above (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12) y are children and (13)(14)(15)(16)(17)(18) y are adolescents. These differences among various paediatric age groups have led to complex and error prone medication use process [1][2][3][4][5] .…”