Introduction: Concomitant use of several drugs for a patient is often necessary for achieving therapeutic response. Understanding the profile of Drug-Drug Interactions (DDI) will help health care providers to optimise therapy for better patient outcomes, reinforcing the concept of rational drug use. Aim: To analyse the frequency, mechanisms and severity of DDIs in a tertiary care hospital at Kerala. Materials and Methods: A retrospective cross-sectional study among 350 inpatients of a tertiary care hospital in Kerala from August 2020 to September 2020. Prescriptions containing ≥3 drugs were collected from inpatient medical records. A drug interaction check was performed using the Lexicomp drug interaction checker software. Results: DDIs were present in 74.6% of prescriptions and the average number of interactions was found to be 2.78. Most number for interactions was in the age group 61-80. Average number of DDI was significantly high among patients >60 years. Percentage of prescriptions with DDI and average number of DDI was found to be increasing with increase in number of drugs. Average number of interactions were maximum (5.01) in the group >10. Drug groups most commonly involved in interactions were antiplatelets, oral hypoglycaemic agents, bronchodilators, antibiotics, diuretics, insulin, statins, beta blockers, Proton Pump Inhibitors (PPI) and Non-Steroidal Anti-Inflammatory Drugs (NSAIDs). The most common interventions for minimising the impact of DDIs were changing the timing of drug administration, monitoring for symptoms/signs/lab values/drug levels or both. There was a significant positive correlation between duration of hospital stay and number of DDI. Conclusion: This study threw light upon the pattern and profile of DDIs among inpatients of a tertiary care hospital in Kerala. Elderly people (>60 years) were most prone for DDIs. Percentage of prescriptions with DDI and average number of DDIs was found to be increasing with increase in number of drugs. There was a positive correlation between duration of hospital stay and number of DDI.
Background: Adverse drug reactions (ADR) are the leading cause of mortality and morbidity in all health care systems. Hospital based ADR monitoring and reporting programmes can throw some light upon the profile of ADRs and ways to prevent them, facilitating rational drug use. An attempt has been made in this study to analyse the seriousness, predictability, preventability, severity and outcome of ADRs occurring in a tertiary care hospital.Methods: This was a retrospective observational study based on the data collected from ADRs reported to an approved ADR monitoring centre (AMC). Data collected was evaluated for seriousness, predictability, preventability, severity and outcome using appropriate scales. Simple descriptive statistics was used for analysis.Results: The total number of ADRs reported was 300. Among this 39% reactions were serious. The commonest reason for considering as serious reaction was prolongation of hospitalization. The overall predictability was 40.4%. Total preventability was found to be 18.3%. Assessment of severity showed 55.3 %, 41.7%, 3% reactions in mild, moderate and severe grades respectively. 64.3% patients had recovered from the reaction and 30% were recovering at the time of reporting ADR. Only 0.3% ADRs caused death.Conclusions: Authors hope this study will foster the culture of reporting and analysing ADRs among health care professionals and students. The findings from the study can create awareness among health care professionals regarding the impact of ADRs on the treatment course.
Background: Pharmacovigilance is the science and activities related to detection, assessment, understanding and prevention of adverse drug reactions (ADR). The major challenge faced by the pharmacovigilance programme of India is underreporting. It is mainly due to lack of awareness, knowledge, attitude and practice among health care professionals. The main objective of this study was to assess the knowledge, attitude and practices of second professional MBBS students towards ADR reporting and to provide a session on pharmacovigilance as an intervention to increase their awareness since they are the future budding doctors.Methods: This questionnaire based study was conducted among 158 second professional MBBS students of Travancore Medical College, Kollam, Kerala. A pretest was conducted using the questionnaire followed by which a two-hours session on ADR reporting and Pharmacovigilance was given. A posttest was done with the same questionnaire. The response of the KAP questionnaire were analysed separately for pretest and posttest in percentages and based on scores and was compared.Results: Out of the158 students participated all the students successfully completed the questions of both pretest and posttest within stipulated time frame. In pretest 3 (1.9%), 101 (64%), 43 (27.1%) candidates were categorized to excellent, good and poor respectively. In posttest 155 (98.1%), 3 (1.9%) were in excellent and good category respectively. There was not even a single candidate in poor category. There was a marked increase in the knowledge and awareness of the students after the two hours intervention session on ADR reporting and pharmacovigilance which was statistically significant (p= 0.001).Conclusions: This study revealed the awareness of second professional MBBS students towards ADR reporting and Pharmacovigilance in our institution and also clearly showed the importance of early sensitization through educational interventions, which improved the KAP in pharmacovigilance in them. Educating medical students will improve the challenge of underreporting of ADRs and will increase the numbers of ADRs reported in our country.
Objectives: The aim of the study was to estimate the prevalence of polypharmacy, identify the age groups commonly associated with polypharmacy, study the correlation between duration of hospital stay and polypharmacy, and identify the diseases commonly associated with polypharmacy Methods: Record-based, prospective, and cross-sectional study among 370 inpatients of a tertiary care hospital in Kerala. Prescriptions containing ≥3 drugs were collected from inpatient medical records of patients with at least 3 days hospital stay. The number of drugs ≥5 was considered as polypharmacy in the present study. Results: The prevalence of polypharmacy was 93% and average the number of drugs per prescription was 8.81±3.097. Average number of drugs per prescription was significantly high among patients >60 years. Percentage of prescriptions with polypharmacy among patients with duration of stay 3–5 days, 6–8 days, and ≥ 9 days was found to be 89.4, 98.6, and 100, respectively. There was a significant positive association between duration of hospital stay and percentage of prescriptions with polypharmacy as well as average number of drugs per prescription. Diseases or comorbidities most commonly associated with polypharmacy were hypertension, diabetes mellitus, cerebrovascular accidents, coronary artery disease, and dyslipidemia. Conclusion: The prevalence of polypharmacy was high in the present study (93%) when compared to similar studies. Age >60 years was strongly associated with the prevalence of polypharmacy, but gender was not found to be factor. Duration of hospital stay was an important factor positively associated with percentage of prescriptions with polypharmacy as well as number of drugs per prescription.
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