Impact of pharmacists' intervention on identification and management of drug-drug interactions in an intensive care setting

<p><b>INTRODUCTION</b>The primary and secondary objectives of this study were to identify and assess the risks associated with the occurrence of drug-drug interactions (DDIs) and to determine the value of pharmacists' interventions in the management of clinically significant DDIs, respectively.</p><p><b>METHODS</b>A prospective, case-control study was carried out on patients admitted to the intensive care unit (ICU), and involved a review of patients' medication chart daily by the pharmacist and the clinical parameters. All identified DDIs were carefully analysed in order to provide recommendations on the management of clinically significant DDIs.</p><p><b>RESULTS</b>The majority of DDIs were categorised as Type-C severity level (n = 305, 75.9%). 'Substitution' was recommended in 34 cases of clinically significant DDIs, 'dosage adjustment' in 17 (4.2%) and 'stop or avoid' in 13 (3.2%). The number of drugs prescribed (p = 0.001, rS = 0.539) and length of ICU stay (p = 0.001, rS = 0.364) were significantly associated and positively correlated with the occurrence of DDIs. Patients with DDIs had a longer length of ICU stay than those without DDIs (9.5 days vs. 2.4 days, p = 0.001). No significant difference was found between patients aged below 50 years and those above 50 years (odds ratio 0.488, 95% confidence interval 0.166-1.434) in terms of the risk of DDIs.</p><p><b>CONCLUSION</b>A large number of DDIs were identified in this study, but only a small number were clinically significant. Pharmacists' participation in daily ward rounds could play an important role in the detection and management of clinically significant DDIs.</p>

Patient-reported adverse drug reactions and drug-drug interactions: a cross-sectional study on malaysian HIV/AIDS patients

This study aimed to explore the adverse drug reactions [ADRs] reported by patients and to identify drug-drug interactions [DDIs] among human immunodeficiency virus/acquired immunodeficiency syndrome [HIV/AIDS] patients. This cross-sectional study was conducted at the Medication Therapy Adherence Clinic, Hospital Sungai Buloh, an HIV/AIDS referral centre. The patients were randomly selected and were encouraged to describe ADRs caused specifically by any of the prescribed antiretroviral drugs [ARDs]. Sociodemographic characteristics were recorded from the patients' medical records. In addition data on antiretroviral treatment [ART], DDIs and other conventional medication were also documented. A total of 325 randomly selected HIV/AIDS patients with a mean age of 22.94 years participated in the study. The most frequently prescribed ARDs were lamivudine [64.6%], zidovudine [40.6%] and efavirenz [42.5%]. Commonly reported ADRs were fatigue [54.8%], allergic reactions [41.5%], weight loss [41.5%], dry mouth [35.1%] and memory loss [35.1%]. Female [87.8%], non-complementary and alternative medicine [CAM] users [87.3%] and participants below 50 years old [81.1%] were identified as having a higher prevalence of ADRs compared to males [79.6%], CAM users [78.7%] and participants aged 50 years or more [77.5%]. Patient age was found to be significantly associated [p = 0.048] with the ADRs. In addition, a total of 44 cases of DDIs belonging to category D were also found in this study. This study enabled us to identify the most common ADRs and DDIs associated with the use of ART. Safe and effective treatment depends on the healthcare providers' knowledge of the same

Evaluation of the management of sexually transmitted infections by private practitioners in Pulau Pinang, Malaysia

To determine the current practices of private practitioners for the management of STIs in Pulau Pinang, Malaysia, evaluation of pharmacotherapy for STIs in private clinics and to ascertain the management of STIs compared to standard guidelines. Methods: Data was collected by self-administered questionnaire for private practitioners, which gathered information on their socio-demographic as well as practice characteristics. Descriptive statistical analysis was performed by using SPSS for Windows version 13.0. Results: Data was collected from 78 practitioners. Most of the treatment choices mentioned for the treatment of gonorrhea were inconsistent with the guidelines. About 51.2% of practitioners did not screen their patients for HIV/AIDS. Majority of private practitioners counseled their patients about HIV/AIDS on an irregular basis. A high percentage of 59% did not inform health authorities about STI cases and 32.1% mentioned that they did not use any guidelines. Conclusions: Management of STIs by private practitioners with respect to selection of antibiotics, patient counseling and case notification leaves a lot to be desired. Current management practices can adversely impact on HIV/AIDS transmission in the country. Interventions are needed to improve the management practices of private practitioners.