Mortality from adverse drug reactions in adult medical inpatients at four hospitals in South Africa: a cross‐sectional survey

Abstract

AIMSFatal adverse drug reactions (ADRs) are important causes of death, but data from resource-limited settings are scarce. We determined the proportion of deaths in South African medical inpatients attributable to ADRs, and their preventability, stratified by human immunodeficiency virus (HIV) status. METHODSWe reviewed the folders of all patients who died over a 30 day period in the medical wards of four hospitals. We identified ADR-related deaths (deaths where an ADR was 'possible', 'probable' or 'certain' using WHO-UMC criteria and where the ADR contributed to death). We determined preventability according to previously published criteria. RESULTSADRs contributed to the death of 2.9% of medical admissions and 56 of 357 deaths (16%) were ADR-related. Tenofovir, rifampicin and co-trimoxazole were the most commonly implicated drugs. 43% of ADRs were considered preventable. The following factors were independently associated with ADR-related death: HIV-infected patients on antiretroviral therapy (adjusted odds ratio (aOR) 4.4, 95% confidence interval (CI) 1.6, 12), exposure to more than seven drugs (aOR 2.5, 95% CI 1.3, 4.8) and increasing comorbidity score (aOR 1.3, 95% CI 1.1, 1.7). CONCLUSIONSIn our setting, where HIV and tuberculosis are highly prevalent, fatal in-hospital ADRs were more common than reported in high income settings. Most deaths were attributed to drugs used in managing HIV and tuberculosis. A large proportion of the ADRs were preventable, highlighting the need to strengthen systems for health care worker training and support.

Adverse Drug Reactions among Patients Admitted to Eritrean Hospitals: Prevalence Causes and Risk Factors a prospective analysis of 5848 patients

“…ADR related death in our study (0.82%) was also similar to the findings from India (0.83%) and South Africa (2.9%) but much higher than the findings of studies conducted in developed countries like US (0.32%), UK (0.15%) and EU (0.25%) countries [17,1,2,6]. Though the occurrence rate of ADRs in our study (15.8%) was found to be similar with the findings from UK (14.7%), US (15.1%) and EU (17.0%), ADR related death was much higher in our case and also in other developing countries like India and South Africa which may reflect the differences in the level of development of the healthcare delivery systems between developing and developed countries.…”

Mortality from adverse drug reaction-related hospitalizations in south-west Ethiopia: A cross-sectional study

“…The Naranjo ADR causality assessment scale was administered by the author (MTA) followed by ADR severity scaling using the modified Hartwig et al method . A consensus review was performed between the first author and an internal medicine specialist to confirm the causal relationship of an ADR to the suspected medication using a similar approach to a previous study . Applying the Naranjo algorithm scores for definite and probable categories, we categorized patient admissions as ADR‐related or non‐ADR‐related.…”

“…Treatment of epidemics and other infectious diseases are of particular concern in developing countries, where antituberculosis (anti‐TB) drugs, antiretrovirals and antibacterials are commonly associated with ADR‐related hospitalization. There is a “double burden” in developing countries where there are rising rates of concomitant infectious and non‐communicable diseases that require therapy with multiple medications with increased potential for interactions .…”

Adverse Drug Reactions Reported to a National HIV & Tuberculosis Health Care Worker Hotline in South Africa: Description and Prospective Follow-Up of Reports

“…Anti-tuberculosis treatment was implicated in 39.1 % of DILI reports, often in combination with other drugs. DILI due to anti-tuberculosis treatment was recently identified as the second most common cause of ADR-related deaths in medical wards in South Africa [21]. The frequency of queries regarding severe DILI highlights the need for training of HCWs in diagnosis and management of this ADR.…”