Adverse drug reactions related hospitalization identified by discharge ICD-9 codes in a univeristy hospital in Riyadh

To assess the feasibility of using International Classification of Disease code [ICD-9] to ascertain the prevalence, seriousness, and preventability of adverse drug reaction [ADRs]. A retrospective study between the years 1982 and 2005 was conducted at King Khaled University Hospital [KKUH], Riyadh, Saudi Arabia to examine the ICD-9 codes assigned on discharge to identify ADRs. A list of the ICD-9 codes related to ADRs were identified. These codes were entered into the hospital computer program at the study site to identify corresponding patients' medical records. The total number of patients admitted to the hospital each year was identified to calculate the prevalence of ADRs, and descriptive analysis was also conducted. A total of 89 patients were identified and included. Drug classes commonly associated with ADR include hormones and synthetic substitutes [14.6%], followed by primary systemic agents [13.5%]. Almost 50% of cases had chronic conditions and use other drugs when the ADR had occurred. The majority of the ADRs were type A [54%] preventable, while 39% were type B non preventable, and only 6% were type C occur with long term use. The prevalence per year ranged from 0.07% in 1993 to 0.003% in 1999. Identifying ADRs causing hospital admission by using ICD-9 coding system is easy and practical. However, under or inaccurate recording of ICD-9 codes may be a limitation to the use of such an important tool

Erythema multiforme under the treatment with amoxicillin/clavulanate: a case report and review of the literature

To report a case of Erythema Multiforme [EM] in a boy who was treated with oral Amoxicillin/Clavulanate for upper respiratory infection. A 14-years-old boy with upper respiratory infection was treated with amoxicillin/calvulanate 625 milligram every eight hours for a week for his symptoms. Four days later, he developed erythematous rash all over the body plus genital lesion, and mouth ulceration. The skin biopsies confirmed Erythema Multiforme [EM]. The drug was immediately stopped and he was given a corticosteroid orally and supportive therapy for his symptoms. Within a few days, his skin and mouth lesions were dramatically improved and he was discharged on prednisone tapering dose for additional ten days. Erythema multiforme [EM] is an acute mucocutaneous hypersensitivity reaction that occurs in response to certain types of drugs, chemicals or infections. The severity of the skin lesions is variable. A Medline search from 1984 to October 2007 revealed only five cases of amoxicillin/clavulanate induced EM. The Naranjo algorithm score was 4 for EM in our patient, representing a possible relationship of amoxicillin/clavulanate treatment. We described the case of a 14-year-old boy who developed EM while on amoxicillin/clavulanate. The patient completely recovered after stopping the offending drug and treated with oral prednisone and supportive therapy