Cohort study on adverse drug reactions in adults admitted to the medical wards of a tertiary hospital in Nigeria: Prevalence, incidence, risk factors and fatality

Abstract

Prospective cohort study on 1280 adult patients admitted to the medical wards of a tertiary institution over 12 months. Patients were assessed for ADRs during and throughout admission; causality and preventability of ADRs were assessed. Results: Sixty-seven (5.2%) patients had ADRs, 51 (3.9%) caused hospitalisation while 17(1.3%) occurred during hospitalisation, and 42 (62.7%) of total ADRs were preventable. Nonsteroidal anti-inflammatory drugs, 14 (20.3%), antidiabetics, 12 (17.4%) and antibacterial, 11 (15.8%) were the most implicated drug classes. Gastrointestinal tract (37%), central nervous system (30.2%), and skin (24.7%) were the most affected organ/systems, while upper gastrointestinal bleeding and hypoglycaemia were the most observed ADRs. ADRs led to deaths in 7 (10.4%) patients, with an overall case fatality rate of 0.5%. The highest number of deaths were among patients with Stevens-Johnson syndrome 2/7 (28.6%) and hepatotoxicity 2/7 (28.6%). Risk factors, adjusted odds ratio (AOR [95% confidence interval, CI]) for ADRs leading to hospitalisation was male sex 3.11 (1.11, 8.73) while for ADRs during hospitalisation were number of drugs used before admission (AOR [95% CI] = 6.67 [1.16, 38.47]) and comorbidities (AOR [95% CI] = 3.0 [1.13, 8.01]). Patients admitted with ADRs had prolonged hospital stay (AOR [95% CI] = 3.37 [1.11, 8.71]). Conclusion: Preventable ADRs are common and important causes of hospitalisation and inpatients' morbidity and mortality among medical patients in Nigeria. Upper gastrointestinal bleeding and hypoglycaemia, resulting from nonsteroidal antiinflammatory drugs and antidiabetic drugs were the most observed ADRs.

Serious adverse drug reactions in sub‐Saharan Africa in the era of antiretroviral treatment: A systematic review

“…These included studies that did not distinguish between serious and non‐serious ADRs, as well as studies of “umbrella topics”, such as drug‐related harm, which did not report ADRs separately. Fifteen studies 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 were included in this systematic review (Figure 1 ).…”

“…Fourteen studies 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 47 , 48 , 49 , 50 , 51 , 52 , 53 reported as outcome the proportion of admissions attributed to ADRs. To estimate the summary proportion of admissions attributed to ADRs, we first pooled all group 1 studies and tested for heterogeneity.…”

“…The remaining 13 studies were all conducted as active surveillance studies, eight of which were in adults, 37 , 38 , 39 , 41 , 42 , 43 , 47 , 49 , 50 , 52 four in children, 36 , 40 , 51 , 53 and one in a mixed adult and pediatric population. 48 As this latter study presented data for adults and children separately, we could extract separate adult and pediatric datasets from it.…”

Patterns of Antimicrobials Prescribed to Patients Admitted to a Tertiary Care Hospital: A Prescription Quality Audit

“…Most prescribers understand that overprescription of antibiotics may lead to antibiotic resistance; however, they admit to the overuse of antibiotics and the prescription of antibiotics in the absence of bacterial infection [ 22 ]. Antibiotics were the third leading cause of adverse drug reactions reported in the prospective cohort study of adverse drug reaction monitoring on medical wards [ 13 ]. This has a consequential potential increase in health care cost and warrants a pragmatic strategy to curbing the menace.…”

“…This was a retrospective evaluation of a larger prospective study that was carried out in the six medical wards of the University College Hospital, Ibadan, Nigeria, between 2012 and 2013, for which ethical approval and written informed consent were obtained [ 13 ]. In-patients receiving an antibiotic for systemic treatment of bacterial infection were evaluated.…”