Prescribing practices of lopinavir/ritonavir, hydroxychloroquine and azithromycin during the COVID-19 epidemic crisis and pharmaceutical interventions in a French teaching hospital

Gourieux, B.; Reisz, Fanny; Belmas, Anne Sophie; Danion, François; Fourtage, Marion; Nai, Thierry; Reiter-Schatz, A.; Ruch, Yvon; Walther, J.; Nivoix, Yasmine; Michel, Bruno

doi:10.1136/ejhpharm-2020-002449

Cited by 5 publications

(14 citation statements)

References 17 publications

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“…Beyond the medication effects, several cardiac manifestations have been described in patients with COVID-19 including acute myopericarditis, acute coronary syndrome, congested heart failure, cardiogenic shock, and cardiac arrhythmias as a result of the injuries caused by the virus and systemic inflammation [ 287 ]. These cardiac manifestations were not only shown with CQ or HCQ use, but also with other drugs used in the treatment of COVID-19 such as corticosteroids, rivabirin, LPVr, and AZM [ 288 , 289 , 290 , 291 ]. This suggests that COVID-19 could have a role in these cardiac safety reports.…”

Section: Discussionmentioning

confidence: 99%

Safety of Short-Term Treatments with Oral Chloroquine and Hydroxychloroquine in Patients with and without COVID-19: A Systematic Review

et al. 2022

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Chloroquine (CQ) and hydroxychloroquine (HCQ) have recently become the focus of global attention as possible treatments for Coronavirus Disease 2019 (COVID-19). The current systematic review aims to assess their safety in short treatments (≤14 days), whether used alone or in combination with other drugs. Following the PRISMA and SWiM recommendations, a search was conducted using four health databases for all relevant English-, Chinese-, and Spanish-language studies from inception through 30 July 2021. Patients treated for any condition and with any comparator were included. The outcomes of interest were early drug adverse effects and their frequency. A total of 254 articles met the inclusion criteria, including case and case-control reports as well as cross-sectional, cohort, and randomised studies. The results were summarised either qualitatively in table or narrative form or, when possible (99 studies), quantitatively in terms of adverse event frequencies. Quality evaluation was conducted using the CARE, STROBE, and JADAD tools. This systematic review showed that safety depended on drug indication. In COVID-19 patients, cardiac adverse effects, such as corrected QT interval prolongation, were relatively frequent (0–27.3% and up to 33% if combined with azithromycin), though the risk of torsade de pointes was low. Compared to non-COVID-19 patients, COVID-19 patients experienced a higher frequency of cardiac adverse effects regardless of the regimen used. Dermatological adverse effects affected 0–10% of patients with autoimmune diseases and COVID-19. A broad spectrum of neuropsychiatric adverse effects affected patients treated with CQ for malaria with variable frequencies and some cases were reported in COVID-19 patients. Gastrointestinal adverse effects occurred regardless of drug indication affecting 0–50% of patients. In conclusion, CQ and HCQ are two safe drugs widely used in the treatment of malaria and autoimmune diseases. However, recent findings on their cardiac and neuropsychiatric adverse effects should be considered if these drugs were to be proposed as antivirals again.

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Section: Discussionmentioning

confidence: 99%

Safety of Short-Term Treatments with Oral Chloroquine and Hydroxychloroquine in Patients with and without COVID-19: A Systematic Review

et al. 2022

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“…This was also the primary DRP reported in a study wherein the objective was to compare pharmaceutical interventions in patients with and without .6%, respectively) (Perez et al, 2020). However, a separate study observed that only 10.2% of the 59 pharmaceutical interventions performed in patients with COVID-19 treated with lopinavir/ritonavir, hydroxychloroquine or azithromycin were related with an incorrect dosage; wrong duration of treatment (54.2%) and the presence of interactions (23.7%) comprised the main DRPs (Gourieux et al, 2021). Frontiers in Pharmacology frontiersin.org…”

Section: Discussionmentioning

confidence: 99%

“…In one study done in a French university hospital, 28.8% of patients with COVID-19 presented at least one DRP during a 1-month study period ( Perez et al, 2021 ). Another study noted that 19.1% of patients with COVID-19 treated with lopinavir/ritonavir, hydroxychloroquine or azithromycin presented at least one DRP in relation to those drugs ( Gourieux et al, 2021 ). The rate of DRP observed in patients with COVID-19 was higher than in other previous studies carried out in patients without COVID-19 ( Ferrández et al, 2019 ) ( Ferrández et al, 2018 ) ( Krähenb et al, 2007 ).…”

Section: Discussionmentioning

confidence: 99%

“…One study did evaluate DRP in relation to antivirals administered for this type of infection ( Gourieux et al, 2021 ). Nevertheless, in the present study, no DRP with specific COVID-19 antivirals such as remdesivir was identified.…”

Section: Discussionmentioning

confidence: 99%

“…Currently, there is a lack of evidence regarding DRP in patients with COVID-19 ( Perez et al, 2021 ) ( Gourieux et al, 2021 ). The aim of the present study is to describe reported cases of DRP and drugs administered in patients with COVID-19 during the first wave, and evaluate associated risk factors.…”

Section: Introductionmentioning

confidence: 99%

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Drug-related problems in patients admitted for SARS-CoV-2 infection during the COVID-19 pandemic

Barceló-Vidal

Echeverría-Esnal²,

Carballo³

et al. 2022

Front. Pharmacol.

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Introduction: Drug-related problems (DRP) are events or circumstances in which drug therapy does or could interfere with desired health outcomes. In December 2019, a new coronavirus, SARS-CoV-2, appeared. Little knowledge about this type of infection resulted in the administration of various drugs with limited use in other pathologies. Evidence about DRP in patients with COVID-19 is lacking.Objective: The aim of the present study is to describe identified cases of DRP and those drugs involved in the first wave of patients with COVID-19, and evaluate associated risk factors.Material and methods: Observational, retrospective study performed in a tertiary university hospital between 14th March 2020 and 31 May 2020 (corresponding to the first COVID-19 wave). We recruited patients admitted during the study period. Exclusion criteria included age < 18 years; admission to critically ill units; and care received either in the emergency room, at-home hospitalization or a healthcare center.Results: A total of 817 patients were included. The mean age was 62.5 years (SD 16.4) (range 18–97), and 453 (55.4%) were male. A total of 516 DRP were detected. Among the patients, 271 (33.2%) presented at least one DRP. The mean DRP per patient with an identified case was 1.9. The prevailing DRPs among those observed were: incorrect dosage (over or underdosage) in 145 patients (28.2%); wrong drug combination in 131 (25.5%); prescriptions not in adherence to the then COVID-19 treatment protocol in 73 (14.1%); prescription errors due to the wrong use of the computerized physician order entry in 47 (9.2%); and incorrect dosage due to renal function in 36 (7%). The logistic regression analysis showed that patients who received only prescriptions of antibacterials for systemic use (J01 ATC group) faced a higher likelihood of experiencing a DRP (OR 2.408 (1.071–5.411), p = 0.033).Conclusion: We identified several factors associated with an increased risk of DRPs, similar to those reported in other pre-pandemic studies, including a prolonged length of stay, higher number of prescribed drugs and antimicrobial administration. The relevance of pharmacists and tools like pharmacy warning systems can help prevent, identify and resolve DRP efficiently.

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Pharmacist-driven antimicrobial stewardship interventions in patients with COVID-19: a scoping review

et al. 2023

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Background Coronavirus Disease 2019 (COVID-19) is a highly infectious disease that can be treated with antivirals in addition to other antimicrobials in cases of secondary or concomitant infections. This creates potential for antimicrobials misuse, which increases antimicrobial resistance (AMR). Pharmacists are known to undertake prominent roles in combatting AMR. Aim The aim of this review was to characterize pharmacist-driven interventions that have been performed in patients with COVID-19 globally and describe their impact on antimicrobial use. Method We followed the Joanna Briggs Institutes manual framework for scoping reviews in our study. Studies that reported antimicrobial stewardship (AMS) interventions performed by pharmacists in COVID-19 patients were included. Articles that did not report outcomes or did not mention pharmacists in the intervention were excluded. Restrictions included English-only articles from inception date until June 2022. Articles were searched from four databases. Results Eleven publications were included in the review. The most common AMS intervention was pharmacist-driven interventions reported in 63.2% of all studies, followed by guideline development and application (26.3%), and medication supply coordination (10.5%), respectively. The outcomes of the interventions were difficult to compare but showed a reduction in antimicrobial use and prevention of adverse drug reactions with a relatively high acceptance rate from physicians. Conclusion Pharmacists played an important role in performing AMS-related interventions in COVID-19 patients and helped in the fight against the worsening of AMR during the pandemic. The impact of pharmacist-driven AMS interventions in patients with COVID-19 seemed to be positive and improved outcomes related to antimicrobial use.

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Prescribing practices of lopinavir/ritonavir, hydroxychloroquine and azithromycin during the COVID-19 epidemic crisis and pharmaceutical interventions in a French teaching hospital

Cited by 5 publications

References 17 publications

Safety of Short-Term Treatments with Oral Chloroquine and Hydroxychloroquine in Patients with and without COVID-19: A Systematic Review

Safety of Short-Term Treatments with Oral Chloroquine and Hydroxychloroquine in Patients with and without COVID-19: A Systematic Review

Drug-related problems in patients admitted for SARS-CoV-2 infection during the COVID-19 pandemic

Pharmacist-driven antimicrobial stewardship interventions in patients with COVID-19: a scoping review

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