Attitude and practice of doctors toward adverse drug reactions (adrs) reporting in a Nigerian tertiary health facility

Background : Adverse drug reactions; (ADRs); constitute an important cause of morbidity and mortality worldwide. Spontaneous adverse drug reaction (ADR) reporting is the bedrock of post-marketing surveillance but under-reporting remains its major drawback. Objectives : This study aimed at evaluating the attitude and practice of ADR among doctors in a tertiary health facility in Oyo State; Nigeria; with a view to improving ADRs reporting. Methods : This was a cross-sectional questionnaire based study involving medical doctors working at the Ladoke Akintola University of Technology (LAUTECH) Teaching Hospital; Ogbomoso. Consenting doctors were evaluated on their attitude and practice of ADRs through self-administered questionnaire. Data obtained were entered and analyzed using SPSS version 17. Results : A total of 35 doctors responded to the questionnaires. Only about 57.1 considered ADR before prescribing; all of whom were also aware of the procedure for reporting. Awareness of the existence of National Pharmacovigilance Center (NPC) was 71.4. Thirty (85.7) of the respondents have encountered ADR; but only 2.9 have ever reported it with yellow form. Majority (85.7) of the respondents did not consider ADR reporting as a useful tool in the prevention of drug related morbidities and mortalities. Other factors that may hinder ADR reporting include: lack of awareness of the existence of yellow forms for reporting (68.6) and poor knowledge of procedure for reporting (48.6). Conclusion : ADR reporting rate was very low among the participants in this small study; large studies aimed at evaluating the determinants of ADR reporting should be considered. Should these findings be confirmed; training and re-retraining through Continuing Medical Education (CME); and establishment of pharmacovigilance committee would be required to ensure a national pharmaovigilance system

Immune activation; allergic drug toxicity and mortality in HIV-positive tuberculosis

This study was conducted to correlate serum levels of markers of immune activation with mortality and drug toxicity in HIV+TB. Design: Substudy of a randomised clinical trial of streptomycin-thiacetazone-isoniazid (STH) vs. rifampin-isiniazid-pyrazinamide (RHZ) in HIV + TB. Design: Substudy of a randomized clinical trial of streptomycin-thiacetazone-isoniazid (STH) vs. rifampin-isoniazid-pyrazinamide (RHZ) in HIV + TB. Results: Neopterinor =14 ng/mg; TNF-alpha receptorsor = 6.5 ng/ml; and negative skin test were independently associated with increased mortality (P0.01). Among STH-treated subjects; dermatologic toxicity and mortality (P0.05); although these two adverse events occurred independently. Activation markers increased from baseline after 2 months of therapy with the less rapidly bactericidal STH regimen; whereas they declined in those treated with RHZ; suggesting a relationship with continued mycobacterial replication. Conclusions: Immune activation in HIV+TB is associated with shortened survival and increased risk of drug toxicity. HIV+TB patients with elevated serum neopterin should be treated with a rapidly-bactericidal drug regimen which does not include thiacetazone