Potential drug-drug interactions and their risk factors in pediatric patients admitted to the emergency department of a tertiary care hospital in Mexico

Abstract

BackgroundDrug-drug interactions (DDIs) detected in a patient may not be clinically apparent (potential DDIs), and when they occur, they produce adverse drug reactions (ADRs), toxicity or loss of treatment efficacy. In pediatrics, there are only few publications assessing potential DDIs and their risk factors. There are no studies in children admitted to emergency departments (ED). The present study estimates the prevalence and describes the characteristics of potential DDIs in patients admitted to an ED from a tertiary care hospital in Mexico; in addition, potential DDI-associated risk factors are investigated.MethodsA secondary analysis of data from 915 patients admitted to the ED of the Hospital Infantil de México “Federico Gómez” was conducted. The Medscape Drug Interaction Checker software was used to identify potential DDIs. The results are expressed as number of cases (%), means (95% CI) and medians (25-75th percentiles). Count data regressions for number of total and severity-stratified potential DDIs were performed adjusting for patient characteristics, number of administered drugs, days of stay, presence of ADRs and diagnoses.ResultsThe prevalence of potential DDIs was 61%, with a median of 4 (2–8). A proportion of 0.2% of potential DDIs was “Contraindicated”, 7.5% were classified as “Serious”, 62.8% as “Significant” and 29.5% as “Minor”. Female gender, age, days of stay, number of administered drugs and diagnoses of Neoplasms (C00-D48), Congenital malformations (Q00-Q99), Diseases of the Blood, Blood-forming Organs and Immunity (D50-D89) and Diseases of the nervous system (G00-G99) were significantly associated with potential DDIs.ConclusionThe prevalence of potential DDIs in the ED is high, and strategies should therefore be established to monitor patients’ safety during their stay, in addition to conducting investigations to estimate the real harm potential DDIs inflict on patients.

Pilot study: Evaluation of potential drug–drug interactions in hospitalized pediatric patients

“…Morales-Rios et al are the only authors who have conducted a study in Mexico. 17 Although both studies included very similar populations and hospital services, they found a higher prevalence than our results. The use of different software to identify pDDIs could explain this difference.…”

“…These authors report in different multivariate models that taking numerous drugs is a risk factor for pDDIs. 17 Santibañez et al, in an observational study conducted in Chile, found a high prevalence of pDDIs in a pediatric intensive care unit where in just 44 patients analyzed, a total of 1240 potential interactions were found and 93.7% of these interactions presented in patients who had been prescribed 10 or more medications. 21 The large number of interactions presented in a small number of patients can be explained by the fact that the severity and complexity of the diseases treated in an intensive care unit requires an aggressive pharmacological approach and patients receiving increasing amounts of medication are more likely to present drug interactions.…”

Pediatri kliniğinde potansiyel ilaç-ilaç etkileşimlerinin değerlendirilmesi

“…The prevalence of potential DDIs (42%) was found be lower than the reported findings of other studies in pediatric hospitals in Mexico (61%) and Philadelphia (49%), but higher than the prevalence of DDIs found in other pediatric studies (3.8%) (5)(6)(7)14). This wide variability in the reported prevalence of DDIs in different studies can be explained by the included population, the underlying medical conditions of the involved patients, the study design, and the software used for their identification (6,12).…”

“…Another study reported that contraindicated DDIs occurred in 5%, major DDIs in 41%, moderate DDIs in 28%, and minor DDIs in 11% of all hospitalizations (6). Also, it was reported that the ratio of 'contraindicated' DDI was 0.2%, 'serious' DDIs were 7.5%, and 'significant-monitor closely' were 62.8% (7). The large difference in the prevalence of clinically important potential drug interactions might be due to the critical medical conditions of pediatric inpatients, which make them more susceptible to the administration of multiple drugs, complex treatment regimens, and care by physicians of different specialties for consultations (15,16).…”

“…The results of a pediatric database analysis in the United States showed that approximately half of hospitalized children were exposed to a potential DDI, of which 41% were considered 'major' according to the Micromedex DRUG-REAX classification system (6). The prevalence of potential DDIs was also investigated in children admitted to emergency departments and it was reported to be as high as 61% (7). Moreover, studies performed on adult populations extrapolated to the pediatric population may result in under or over prediction of the severity of DDIs (5).…”