A survey, to estimate drug-related hospitalization, was conducted by a clinical pharniacist who participated in medical rounds on a paediatric ward. Data were collected from patients' medical charts and verified by the attending physicians and the patients and/or their guardians. Adverse drug reactions and inappro--priate therapy were defined with criteria supported by medical publications. Approximately 18% of the 906 studied admissions were found to be drugrelated; 11.0% as a result of inappropriate drug therapy, 3.4% as a result of patient non-compliance and 3.2% because of adverse reactions. Antineoplastic agents were responsible for most adverse reactions that led to hospital admission. They were followed by corticosteroids, antimicrobials and by anticonvulsants. The last two groups of drugs were also responsible for hospitalization because of inappropriate drug therapy and patient non-compliance. Adverse drug reactions were more prevalent in females, in 6-10-year-old children, in patients of Ashkenazic origin and in patients who have experienced similar reactions in the past. Non-compliance was more prevalent in patients of Sephardic origin. I N T R O D U C T I O NDrug-related hospitalization could be a result of (a) adverse drug reactions, (b) inappropriate drug therapy and (c) patient non-compliance. All but one of the studies (1) that have been carried out so far were designed not only to estimate separately each of the above causes for medical admissions, but were also done on an adult population. Of adult hospitalization, 1.7-7.9% (mean 4.3%) were attributed to adverse drug reactions (2-12)) of which up to 75% (mean 36.3%) were fatal or life threatening. In three surveys conducted on paediatric populations, the percentage of adverse drug reactions contributing to hospital admissions ranged between 2 and 4.6% (mean 3.2%), depending on whether accidental poisonings were included or not (13)(14)(15). Up to 44.4% of the reactions (mean 29.7%) were severe or fatal (13,14). The majority of the reactions were caused by antineoplastic agents, corticosteroids, anticonvulsants and antimicrobials (14). The highest prevalence was between the ages of 6 and 10 and greater than 10 years of age (13,14).Inappropriate drug treatment, as a cause for hospitalization, was studied even less. In asthmatic children, 24.5% of the visits to the emergency room resulted from physicians'
A survey conducted by pharmacists working in four psychiatric hospitals in Israel to assess the prescribing of psychotropic drugs revealed that polypharmacy was common: patients were receiving up to 11 different drugs and up to six different psychotropic drugs. The average number of psychotropic drugs per patient was two. The most popular combinations of drugs used were; one containing an antipsychotic drug(s) and an antiparkinson drug(s) and the other was a combination of more than one antipsychotic agent. Up to 30 doses per day were taken orally by one patient. Drugs that could have easily been administered on a once-a-day time schedule were often administered several times a day. Differences in prescribing patterns in the various hospitals and often times on different wards of the same institution could more easily be attributed to different educational backgrounds, habits and personal beliefs and perhaps the physician's experience as well, rather than to the types of patients treated.
In this article, many of the reports which describe the various assay procedures for 8 of the most commonly monitored drugs in plasma (digoxin, gentamicin, phenobarbitone, phenytoin, procainamide, quinidine, salicylates and theophylline) are reviewed, together with studies dealing with interferences of other drugs with these assays. Factors which are evaluated include whether the interference was studied when the drug was taken by a patient or a volunteer or by adding it to serum in vitro, the concentration or dose of the interfering drug (when reported), and the clinical implications of the interference. Suggestions as to how to eliminate some of these potential sources of interference are made.
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