Drug-related problems and its determinant among hospitalized neonates with sepsis at Jimma University Medical Center, Ethiopia: a prospective observational study

Journal of Pharmaceutical Health Care and Sciences - Tập 7 Số 1 - 2021
Mengist Awoke Yizengaw1, Tsegaye Melaku1, Mohammed Beshir2
1Department of Clinical Pharmacy, School of Pharmacy, Institute of Health, Jimma University, PO. Box 378, Jimma, Ethiopia
2Department of Pediatrics, Jimma University Medical Center, PO. Box 378, Jimma, Ethiopia

Tóm tắt

Abstract Background Neonatal populations are quite susceptible to drug-related problems (DRPs) because of clinical heterogeneity and clinical practice trends. However, studies reporting DRPs in the neonatal population are quite limited. Objective This study aimed to assess the magnitude and types of DRPs and determinant factors among neonates admitted with neonatal sepsis at the Neonatal Intensive Care Unit (NICU) of the Jimma University Medical Center (JUMC), Ethiopia. Methods A hospital-based prospective observational study was conducted involving 201 neonates with sepsis admitted to the NICU from May to August 30, 2018. DRPs were classified using Cipolle’s classification method. Statistical Package for Social Science Version 22 was employed for data analysis. Logistical regression was carried out to determine the determinants of DRPs. A p-value < 0.05 was considered to be statistically significant. Results Of 201 neonates with sepsis included in this study, 125 (62.2%) were males and the median age of the neonate was 5 days. The mean (±standard deviation) number of medications taking during their hospital stay was 2.6 ± 0.7. DRPs were identified in 98 neonates, at a rate of 48.8% (95% CI, 41.7–55.9). Dose too high (42, 35.8%) and need additional drug therapy (40, 34.1%) were the commonly identified DRPs. Taking antibiotics plus other medications (Adjusted Odds Ratio (AOR) =5.2, 95%CI [1.2–22.0], p = 0.02) was a determinant factor for the occurrence of DRPs. Conclusion The burdens of DRPs occurrence were high in hospitalized neonates with sepsis. The most common DRPs identified were dose too high and need additional drug therapy. Combined use of other medicines with antibiotics was a predictor of DRP occurrence. The innovative way to tackle the occurrence of DRPs, such as the incorporation of clinical pharmacy service provider into the neonatal care team, which will prevent, detect and/or minimize the occurrence of DRPs, is highly recommended.

Từ khóa


Tài liệu tham khảo

You D, Hug L, Ejdemyr S, Idele P, Hogan D, Mathers C, et al. Global, regional, and national levels and trends in under-5 mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN inter-agency Group for Child Mortality Estimation. Lancet. 2015;386(10010):2275–86. https://doi.org/10.1016/S0140-6736(15)00120-8.

Singh M, Narang A, Bhakoo O. Predictive perinatal score in the diagnosis of neonatal sepsis. J Trop Pediatr. 1994;40(6):365–8. https://doi.org/10.1093/tropej/40.6.365.

Westerlund T, Marklund B. Assessment of the clinical and economic outcomes of pharmacy interventions in drug-related problems. J Clin Pharm Ther. 2009;34(3):319–27. https://doi.org/10.1111/j.1365-2710.2008.01017.x.

Europe PCN. Classification for drug related problems. Eur Pharmaceut Care Netw. 2010;6:1–9.

Cipolle RJ, Strand LM, Morley PC. Pharmaceutical care practice: the patient-centered approach to medication management. 3rd ed: McGraw Hill Professional; 2012. p. 100–33.

Fernandez-Llimos F, Faus MJ. From “drug-related problems” to “negative clinical outcomes”. Am J Health Syst Pharm. 2005;62(22):2348–50. https://doi.org/10.2146/ajhp050358.

Gastelurrutia P, Benrimoj SI, Espejo J, Tuneu L, Mangues MA, Bayes-Genis A. Negative clinical outcomes associated with drug-related problems in heart failure (HF) outpatients: impact of a pharmacist in a multidisciplinary HF clinic. J Card Fail. 2011;17(3):217–23. https://doi.org/10.1016/j.cardfail.2010.10.009.

Einarson TR. Drug-related hospital admissions. Ann Pharmacother. 1993;27(7–8). https://doi.org/10.1177/106002809302700702.

Saldanha V, Araújo IB, SIVC L, Martins RR, Oliveira AG. Risk factors for drug-related problems in a general hospital: a large prospective cohort. PLoS One. 2020;15(5):e0230215. https://doi.org/10.1371/journal.pone.0230215.

Kirking DPNDM. Understanding problems in the use of medications. In: Access pharmacy; 2019.

Sorrentino EAC. Medication errors in the neonate. J Matern Fetal Neonatal Med. 2012;25(4):91–3. https://doi.org/10.3109/14767058.2012.714994.

Rodieux FWM, van den Anker JN, Pfister M. Effect of kidney function on drug kinetics and dosing in neonates, infants, and children. Clin Pharmacokinet. 2015;54(12):1183–204. https://doi.org/10.1007/s40262-015-0298-7.

Nunes BM, Xavier TC, Martins RR. Antimicrobial drug-related problems in a neonatal intensive care unit. Revista Brasileira de terapia intensiva. 2017;29(3):331–6. https://doi.org/10.5935/0103-507X.20170040.

Rashed AN, Neubert A, Tomlin S, Jackman J, Alhamdan H, AlShaikh A, et al. Epidemiology and potential associated risk factors of drug-related problems in hospitalised children in the United Kingdom and Saudi Arabia. Eur J Clin Pharmacol. 2012;68(12):1657–66. https://doi.org/10.1007/s00228-012-1302-x.

Rashed AN, Wilton L, Lo CC, Kwong B, Leung S, Wong IC. Epidemiology and potential risk factors of drug-related problems in Hong Kong paediatric wards. Br J Clin Pharmacol. 2014;77(5):873–9. https://doi.org/10.1111/bcp.12270.

Ibrahim N, Wong ICK, Tomlin S, Sinha MD, Rees L, Jani Y. Epidemiology of medication-related problems in children with kidney disease. Pediatr Nephrol. 2015;30(4):623–33. https://doi.org/10.1007/s00467-012-2149-1.

Leopoldino RD, Santos MT, Costa TX, Martins RR, Oliveira AG. Drug related problems in the neonatal intensive care unit: incidence, characterization and clinical relevance. BMC Pediatr. 2019;19(1):134. https://doi.org/10.1186/s12887-019-1499-2.

Birarra MK, Heye TB, Shibeshi W. Assessment of drug-related problems in pediatric ward of Zewditu memorial referral hospital, Addis Ababa, Ethiopia. Int J Clin Pharmacol. 2017;39(5):1039–46. https://doi.org/10.1007/s11096-017-0504-9.

Garrouste-Orgeas MPF, Bruel C, Max A, Lau N, Misset B. Overview of medical errors and adverse events. Ann Intensive Care. 2012;2(2). https://doi.org/10.1186/2110-5820-2-2.

Bekele NA, Hirbu JT. Drug therapy problems and predictors among patients admitted to medical wards of Dilla University referral hospital, South Ethiopia: a case of antimicrobials. Infect Drug Resist. 2020;13:1743–50. https://doi.org/10.2147/IDR.S247587.

Tekleab AM, Amaru GM, Tefera YA. Reasons for admission and neonatal outcome in the neonatal care unit of a tertiary care hospital in Addis Ababa: a prospective study. Res Rep Neonatol. 2016;6:17–23. https://doi.org/10.2147/RRN.S95455.

Seid SS, Ibro SA, Ahmed AA, Akuma AO, Reta EY, Haso TK, et al. Causes and factors associated with neonatal mortality in neonatal intensive care unit (NICU) of Jimma University medical center, Jimma, south West Ethiopia. Pediatr Health Med Therapeut. 2019;10:39–48. https://doi.org/10.2147/PHMT.S197280.

Desalew A, Sintayehu Y, Teferi N, Amare F, Geda B, Worku T, et al. Cause and predictors of neonatal mortality among neonates admitted to neonatal intensive care units of public hospitals in eastern Ethiopia: a facility-based prospective follow-up study. BMC Pediatr. 2020;20(1):1–11. https://doi.org/10.1186/s12887-020-02051-7.

EMHCACA. Standard treatment guidelines for general hospitals. 3rd ed; 2014. p. 355–406.

Organization WH. WHO recommendations on newborn health: guidelines approved by the WHO guidelines review committee; 2017. [cited 2020 September 20]. Available from: https://apps.who.int/iris/bitstream/handle/10665/259269/WHO-MCA-17.07-eng.pdf?sequence=1.

WHO. WHO guidelines on newborn health; 2017. [cited 2020 June 22]. Available from: https://www.who.int/maternal_child_adolescent/newborns/guidelines/en/.

Fuchs A, Bielicki J, Mathur S, Sharland M, Van Den Anker J. Antibiotic use for sepsis in neonates and children: 2016 evidence update: WHO-reviews; 2016. p. 1–53.

Neonatal Care. A compendium of AAP clinical practice guidelines and policies: American Academy of Pediatrics; 2018. [cited 2020 July 18]. Available from: https://ebooks.aappublications.org/content/neonatal-care-a-compendium-of-aap-clinical-practice-guidelines-and-policies.

Neonatology. In: CCA MO, Buonocore G, Bracci R, Weindling M, editors. A practical approach to neonatal diseases: Springer; 2012.

Report on the expert meeting on neonatal and Paediatric sepsis. London: European Medicines Agency, 2016 Contract No.: 1.[cited 2018 April 15]. Available from: https://www.ema.europa.eu/en/documents/report/report-expert-meeting-neonatal-paediatric-sepsis_en.pdf. Accessed 15 Apr 2018

Nascimento ARF, Leopoldino RWD, Santos MET, Costa TX, Martins RR. Drug-related problems in cardiac neonates under intensive care. Revista Paulista de Pediatria. 2020;38. https://doi.org/10.1590/1984-0462/2020/38/2018134.

Ramadaniati HU, Anggriani Y, Wowor VM, Rianti A. Drug-related problems in chronic kidneys disease patients in an Indonesian hospital: do the problems really matter. Int J Pharm Phar Sci. 2016;8(12):298–302. https://doi.org/10.22159/ijpps.2016v8i12.15193.

Cardone KE, Bacchus S, Assimon MM, Pai AB, Manley HJ. Medication-related problems in CKD. Adv Chronic Kidney Dis. 2010;17(5):404–12. https://doi.org/10.1053/j.ackd.2010.06.004.

Pallás CR, De-la-Cruz J, Del-Moral MT, Lora D, Malalana MA. Improving the quality of medical prescriptions in neonatal units. Neonatology. 2008;93(4):251–6. https://doi.org/10.1159/000111530.

McKenney WM. Understanding the neonatal immune system: high risk for infection. Crit Care Nurse. 2001;21(6):35–7. https://doi.org/10.4037/ccn2001.21.6.35.

Viktil KK, Blix HS, Moger TA, Reikvam A. Polypharmacy as commonly defined is an indicator of limited value in the assessment of drug-related problems. Br J Clin Pharmacol. 2007;63(2):187–95. https://doi.org/10.1111/j.1365-2125.2006.02744.x.

Leendertse AJ, Egberts AC, Stoker LJ, van den Bemt PM. Frequency of and risk factors for preventable medication-related hospital admissions in the Netherlands. Arch Intern Med. 2008;168(17):1890–6. https://doi.org/10.1001/archinternmed.2008.3.

Thông tin
Thông tin xuất bản

Journal of Pharmaceutical Health Care and Sciences

Tập 7 Số 1

Thông tin tác giả