Adverse drug reactions among hospitalized elderly patients. Prospective study

BACKGROUND: It is not clear if old age is a risk factor for adverse drug reactions. AIM: To study the incidence of adverse drug reactions and the effect of age in patients admitted to an Internal Medicine Service in an university hospital. PATIENTS AND METHODS: Two hundred one patients, hospitalized at the Clinical Hospital of the Catholic University, were studied. These patients were followed using a prospective pharmacological surveillance method. For statistical purposes, patients aged 65 years old or older were compared with those younger than 65 years old. RESULTS: Patients over 65 years old had a 33% incidence of adverse drug reactions, mainly involving cardiovascular system and provoking metabolic disturbances. Younger subjects had a 24% incidence of adverse drug reactions, mainly involving the gastrointestinal system and the skin. Sixteen percent of adverse drug reactions were classified as severe and there was a direct relationship between its frequency and the number of drugs prescribed, the hospitalization length and the presence of renal failure. Younger patients with adverse drug reactions had lower serum albumin levels than those without adverse reactions. This relationship was not observed in older patients. CONCLUSIONS: The frequency of adverse drug reactions in hospitalized patients, is related to the number of drugs prescribed and the length of hospitalization.     

Adverse drug reactions resulting in hospital admission

A 14-month (1992/3) prospective study was performed in two departments of the University Hospital Centre (UHC) in Zagreb. The aim of the study was to assess the rate of drug-related hospitalizations, drugs that caused adverse drug reactions (ADRs), and all factors which could have been of importance for their appearance. One hundred and thirty (2.5%) of 5,227 patients were admitted to hospital because of ADRs. The most frequently ADR-related drugs were nonsteroidal anti-inflammatory drugs and analgesics (64.6%). They were followed by cardiovascular agents (20.8%) and antimicrobials (3.8%). Acetylsalicylic acid (aspirin) caused 38.5% of hospital admissions, other nonsteroidal anti-inflammatory drugs (NSAIDs) 23.1% and medigoxin 15.4% of hospitalizations. The most frequent ADRs were upper gastro-intestinal tract bleeding (64.6%), cardiac rhythm disturbances (13.9%), blood cell disorders (4.6%) and hypoglycemia (2.3%). Regarding the patients' age, 52.3% of patients was younger and 47.7% older than 65. Sixty-one point five percent of patients was taking more than one drug, older patients (48 patients--77.4%) have been taking a significantly higher number of drugs than the younger (32 patients--47.1%) (p < 0.0001) ones. Drug interactions caused 23.8% of ADRs. Only 11 (8.5%) of patients suspected themselves that the drug might have caused the ADR. Improvement was observed in the majority of patients (65.4%), 25.4% recovered completely, 4 (3.0%) died in the hospital because of ADRs. 3.0% of patients as well died of their underlying diseases, 2.3% were transferred to other departments for their underlying diseases, and one patient left the hospital on his free will.     

Adverse drug reactions leading to hospitalization in children

A computerized method for the counting of polymorphonuclear leukocytes (PMN's) on chemotactic membranes is described. Through the use of an optical scanner-computer accurate objective quantification is obtained which is similar to the results generated by visual tabulation of the same membranes. Futhermore, the electronic quantification method is both less time consuming and highly reproducible.     

Adverse effects associated with influenza vaccine in pediatrics

To investigate mechanisms of capillary network remodeling, we developed a serum-free angiogenesis in vitro system in three-dimensional fibrin matrices which allows the study of directional growth of endothelial sprouts, anastomosis, and remodeling ('pruning') of the primitive plexus toward more elaborated capillary trees. To follow the movements of living endothelial cells by inverse-fluorescence microscopy, we cocultured unlabeled endothelial cells with endothelial cells labeled with the carbocyanine dye 1,1'-dioctadecyl-3,3,3',3'-tetramethylindocarbocyanine perchlorate (DiI). We show that elongation and retraction of neighboring capillary sprouts occurs simultaneously, resembling a tug-of-war by which endothelial cells are withdrawn from shortening sprouts to become incorporated in other sprouts nearby. For the first time, we directly demonstrate the long-suspected parallel sliding movement of endothelial cells. We show that cell migration persists within immature capillaries even after sprouts have merged to continuous capillary loops, leading to overlapping growth of opposing sprout tips. As a novel concept of capillary remodeling, we distinguish two types of endothelial cell migration: sprouting and guided migration. Sprouting is the de novo invasion of a matrix by endothelial cells, and guided migration is the locomotion of cells along preexistent capillary-like structures. We show that guided migration leads to remodeling of immature capillary networks and to the retraction of sprouts. We describe a method for quantification of sprouting versus guided migration in DiI-mosaic-labeled capillary networks, and we present evidence that endothelial cell-derived basic fibroblast growth factor serves as a chemotactic signal for other cells to migrate along a preestablished capillary-like structure.     

Adverse drug reactions (ADRs) in hospitalized pediatric patients. A prospective study

The aim of this study was to determine the frequency and the characteristics of ADRs in 219 hospitalized pediatric patients, using an intensive and prospective drug surveillance method. The frequency of ADRs in these patients was 13.7%. The systems most commonly affected were the gastrointestinal (32.5%), the central nervous (20.0%), and the metabolic systems (17.5%). Asparaginase, methotrexate, phenytoin, phenobarbital, erythromycin, and salbutamol were probably the drugs associated with the ADRs. According to causality, 54.2% of the ADRs were regarded as probable, and 32.2% as possible. The majority of the ADRs were moderate (51.2%), 27.9% were severe. The main treatment of the ADRs was the withdrawal of the suspected drugs. The length of the stay in the hospital and the total number of drugs given to the patients influenced significantly the frequency of ADRs. 93% of the ADRs were dose-dependent.     

Adverse drug reactions. Nursing should notify them]

Professionals in the nursing field need be conscious of the importance of their role in the detection of suspected cases of adverse reactions to medication, in light of nurses' role in the control and follow-up of pharmacological treatment. Both the ignorance of the Medication Law, which obliges that notice of an adverse reaction to medication be served to the Center of Pharmacological Vigilance, as well as of the tools necessary for this notice, a yellow card, are the main causes why the number of these notifications is so low in the nursing profession.     

Adverse drug reactions: report of the Australian Veterinary Association Adverse Drug Reaction Subcommittee, 1994

Seventy-seven reports of suspected adverse drug reactions (ADRs) were received by the Adverse Drug Reaction Subcommittee (ADRSc) of the Australian Veterinary Association from April 1993 to December 1994 inclusive. The number of reports received/number of animals involved per species were: dogs (32/44), cats (18/31), horses (17/48), and cattle (10/21). Of these, 49 (64%) were classified as definite ADRs and 9 (12%) as probable ADRs. In 11 (14%) reports an ADR could not be substantiated or there was insufficient information available to make a decision. Eight reports were not classified because the manufacturer and the ADRSc disagreed as to the appropriate classification. Sixteen reports involved apparent hypersensitivity reactions, which resulted in death on 6 occasions. Six reports were associated with 'off label' use and 1 report with use of an expired product. Of the definite, probable and unclassified reports of suspect ADRs, the most frequent types of drugs involved were antimicrobial drugs (13 reports), anthelmintics (13), insecticides (11), vaccines (10), nonsteroidal anti-inflammatory preparations (5), chondroprotective agents (4),anaesthetic/sedative agents (4) and vitamin preparations (2). Single reports concerning definite, probable or unclassified ADRs to a vasodilator, a corticosteroid, a local anaesthetic and a disinfectant were received.     

Adverse drugs reactions associated with glaucoma medications

We undertook a non-concurrent prospective study of 191 Puerto Rican patients from August 1993 to April 1994. All patients had open angle glaucoma (OAG) (age ranged from 50 to 80 yrs; mean = 65 yrs). Patient's symptomatology associated to side effects of their glaucoma medicadons was reviewed. Incidence percent of ocular and/or systemic side effects per medication were: levobunolol 45.0%; betaxolol 42.0%; timolol 27.3%; pilocarpine 100%; dipivefrin 14.0%; and acetazolamide 250 mg 64.1%. Incidence percent of ocular and/or systemic side effects of topical beta-blockers used with concomittant medications were determined. Ocular side effects were more frequent in patients using levobunolol 44.2% than in those patients using betaxolol 42.0%, 8.5% of patients using levobunolol did report systemic side effects. No systemic side effects were reported by patients using betaxolol. Ocular side effects in patients using pilocarpine were frequent (100%); whereas the frequency of systemic side effects was low (6.1%). Systemic side effects were common in patients using carbonic anhydrase inhibitors. These results suggest that non-selective and cardio-selective topical Beta-blockers, differ in their ocular or systemic side effects.     

Therapeutic drug monitoring in pediatrics: a need for improvement

Therapeutic drug monitoring (TDM) is practiced for a number of frequently used drugs in infants and children. It is believed that monitoring drug levels will increase the probability of a therapeutic response and minimize the probability of adverse drug sequelae. Dose adjustments are based on measured drug levels interpreted relative to published therapeutic ranges which may or may not reflect the true relationship with either therapeutic or adverse effects. Potential errors derive from many sources, some amenable to solutions based on current knowledge, others awaiting improved understanding of the causes and consequences of unreliable therapeutic ranges.     

Compliance and adverse drug reactions: a prospective study with ethinylestradiol using continuous compliance monitoring

This study examined the relationship between adverse reactions and patient compliance with ethinylestradiol at 40 micrograms twice daily versus 20 micrograms four times daily. In a randomized study 61 female patients with primary infertility were prescribed the drug twice daily (n = 31) or four times daily (n = 30). Ethinylestradiol was administered for 7 days before the sperm cervical mucus penetration-test was performed for hormonal standardization of the cervical mucus quality. Drug compliance was measured by continuous monitoring using the Medication Event Monitoring System. Two parameters were evaluated: percentage of prescribed doses taken (administration compliance) and adherence to the prescribed dose schedule (regimen compliance, number of days with two or four dosing events recorded). Adverse drug reactions were assessed using a standardized questionnaire. Fourty-four women experienced side effects, of which 81% were rated by patients as being mild. Patient compliance was higher with the twice daily than with the four times daily regimen: 85% versus 65% prescribed doses taken (P < 0.05). There was no significant difference in compliance comparing patients with and without adverse reactions (82% versus 72%, respectively), but compliance was lower and more irregular with at least 3 versus one or two adverse reactions reported: 54% versus 84% in administration compliance and 31% versus 58% in regimen compliance (P < 0.05). Compliance was also lower in patients with nausea and vomiting than in those without these symptoms, 59% versus 91% and 34% versus 66% (P < 0.005), respectively, and lower with moderate or severe compared to mild side effects; 48% versus 85% and 25% versus 59% (P < 0.005).(ABSTRACT TRUNCATED AT 250 WORDS)     

Adverse drug events in hospitalized elderly

BACKGROUND: The study objectives were (a) to describe the occurrence, types, and preventability of adverse drug events (ADEs) in hospitalized patients 70 years of age and older; (b) to examine the association between potential risk factors and ADEs; and (c) to examine the relationship of an ADE occurrence and hospital length of stay (LOS) and functional decline. METHOD: Consecutive general medical admissions (n = 157) of community-dwelling persons were prospectively monitored daily for ADE occurrence. Admission assessment included demographic factors, cognition, preadmission medication use, and functional status. Discharge assessment included functional status. LOS, discharge diagnoses, and medication use during the hospitalization. RESULTS: Twenty-three patients (14.6%) experienced 28 probable ADEs, of which 54.2% (13/24) were judged to be potentially preventable. Patients experiencing an ADE had a significantly lower mean Mini-Mental State Examination score (23.6 +/- 4.3 vs 25.5 +/- 3.6, p = .039) and were prescribed significantly more new inpatient medications (4.0 +/- 2.3 vs 2.6 +/- 1.7, p = .01) compared to non-ADE patients. Age, gender, functional status prior to admission, percent with more than four active diagnoses, or number of preadmission medications were not associated with ADE status. Upon discharge, 50.0% of ADE patients experienced a decline in one or more activities of daily living (ADLs), compared with 24.1% of non-ADE patients (p = .017). ADE patients had a longer LOS (8.7 +/- 4.9 vs 6.6 +/- 3.0 days, p = .022) compared to non-ADE patients. CONCLUSIONS: ADEs were associated with number of new inpatient medications and admission cognitive status, but not demographic, disease, or physical function variables. Patients experiencing an ADE were more likely to experience a longer LOS and to decline in ADL function. ADEs may be one factor contributing to functional decline during hospitalization. Future research in this area should include larger samples and multivariable analyses controlling for potential confounders.     

Helminth surveillance as a prerequisite for anthelmintic treatment in intensive sow herds

Helminth prevalences in pigs in intensive production systems are often very low due to housing and management factors, and the present study was carried out to examine whether routine anthelmintic treatment in such herds can be replaced by coprological surveillance of the helminth status combined with anthelmintic treatment when necessary. After an initial examination, 25 out of 28 large herds of Danish sows (> or = 50 sows, production of fatteners) were found to have such light helminth infections that routine deworming could be replaced experimentally by coprological examination every 6 months of 10 weaners (10-12 weeks old), 10 fatteners (5-6 months old), 10 dry sows and 10 lactating sows. This coprological surveillance continued in 21 herds of the selected 25 herds for a 3-year period, while it was stopped immediately in one herd due to increasing Ascaris suum prevalences, and ceased after one year in three herds due to other reasons. A. suum was found in all but one of the 25 herds. The most heavily infected age group was the sows, in which the A. suum prevalence was consistently low in approximately half of the herds, while it increased slowly or rapidly in the other half. When this happened, treatment of the breeding stock was recommended which resulted in low prevalences for varying periods of time. Few farmers neglected the recommendations for some time or for all 3 years, which resulted in consistently high prevalences in the sows (e.g. 40-60%). The fatteners were in general more lightly infected with A. suum than the sows, and in approximately 3/4 of the herds the prevalence remained at a low level, while it fluctuated in the remaining herds. No weaners were ever found to excrete eggs, most likely due to unfavourable conditions for egg development in the farrowing pens. Throughout the study Oesophagostomum sp. eggs were found sporadically in the sows of two herds, and in a third herd, Oesophagostomum sp. was introduced after 2 years, probably due to close contact with a neighbour herd. Oesophagostomum sp. was not found in the remaining herds. Eggs of Trichuris sp. were found sporadically. In conclusion, it is recommended that veterinarian advisers evaluate the production systems before suggesting an anthelmintic routine. If helminth infections may be controlled by intensive management and housing alone, coprological surveillance combined with anthelmintic treatment when necessary may replace routine use of anthelmintics. If the surveillance reveals that the infection levels continue to be low unnecessary medication is avoided, and if the infection levels increase, the coprological data obtained can be used to optimize the anthelmintic strategy.