Improving antibacterial prescribing safety in the management of COPD exacerbations: systematic review of observational and clinical studies on potential drug interactions associated with frequently prescribed antibacterials among COPD patients

Abstract

BackgroundGuidelines advise the use of antibacterials (ABs) in the management of COPD exacerbations. COPD patients often have multiple comorbidities, such as diabetes mellitus and cardiac diseases, leading to polypharmacy. Consequently, drug–drug interactions (DDIs) may frequently occur, and may cause serious adverse events and treatment failure.Objectives(i) To review DDIs related to frequently prescribed ABs among COPD patients from observational and clinical studies. (ii) To improve AB prescribing safety in clinical practice by structuring DDIs according to comorbidities of COPD.MethodsWe conducted a systematic review by searching PubMed and Embase up to 8 February 2018 for clinical trials, cohort and case–control studies reporting DDIs of ABs used for COPD. Study design, subjects, sample size, pharmacological mechanism of DDI and effect of interaction were extracted. We evaluated levels of DDIs and quality of evidence according to established criteria and structured the data by possible comorbidities.ResultsIn all, 318 articles were eligible for review, describing a wide range of drugs used for comorbidities and their potential DDIs with ABs. DDIs between ABs and co-administered drugs could be subdivided into: (i) co-administered drugs altering the pharmacokinetics of ABs; and (ii) ABs interfering with the pharmacokinetics of co-administered drugs. The DDIs could lead to therapeutic failures or toxicities.ConclusionsDDIs related to ABs with clinical significance may involve a wide range of indicated drugs to treat comorbidities in COPD. The evidence presented can support (computer-supported) decision-making by health practitioners when prescribing ABs during COPD exacerbations in the case of co-medication.

Neuropsychiatric safety of varenicline in the general and COPD population with and without psychiatric disorders: a retrospective cohort study in a real-world setting

“…Patients with COPD are considered a high-risk population with high prevalence of smoking and relatively older age, making these persons more susceptible for possible ADEs. 17 45 Of note, in our study, we did not observe an increased risk of overall NPAEs among patients with COPD using varenicline in both the psychiatric and non-psychiatric cohorts. Of note, regarding the occurrence of specific NPAEs, less anxiety was seen in the varenicline group than in the NRT group in both cohorts.…”

“…16 Importantly, COPD patients are older and suffer from many comorbidities making these patients more susceptible to drug-drug interactions potentially leading to related adverse drug events (ADEs). 17 Similarly, it has been reported that individuals with psychiatric disorders are prone to experience relapse of psychiatric symptoms. 18 19 Although many RCTs and post hoc analyses of some RCTs showed consistent results about varenicline safety in subjects with specific psychiatric disorder, [20][21][22][23][24][25][26][27] real-world varenicline safety among these high-risk population is only explored in few studies, 28 29 several related large observational studies of high-quality were all about general population, rather than specific high-risk population.…”

Chronic diseases and compliance with provincial guidelines for outpatient antibiotic prescription in cases of otitis media and respiratory infections: a population-based study of linked data in Quebec, Canada, 2010–2017

“…The need to add an antibiotic to regular medications taken for the management of a chronic illness may make the choice of antibiotic more challenging, given the risk of drug interactions; this complexity is likely to increase with the number of diseases. 17 Indeed, in another study on the treatment of urinary tract infections, the cumulation of chronic diseases in an individual increased the risk of receiving a noncompliant prescription by up to 12% for patients with 4 chronic conditions. 18 In these cases, not following guidelines can be the appropriate line of conduct to prevent drug interactions, but resources should be available to support primary care physicians.…”

Real-World Effects of Antibiotic Treatment on Acute COPD Exacerbations in Outpatients: A Cohort Study under the PharmLines Initiative

“…Of note, antibiotics should be prescribed if there is consolidation on a chest radiograph or clinical signs of pneumonia, even without purulent sputum. Moreover, as COPD outpatients are mostly elderly and have lots of comorbidities, the polypharmacy may be very often and could lead to the antibiotic-related drug-drug interactions, which should be noticed while clinicians use antibiotics for AECOPD treatment [39].…”