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首页> 外文期刊>British Journal of Clinical Pharmacology >Adverse drug reactions in adult medical inpatients in a South African hospital serving a community with a high HIV/AIDS prevalence: prospective observational study.
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Adverse drug reactions in adult medical inpatients in a South African hospital serving a community with a high HIV/AIDS prevalence: prospective observational study.

机译：服务于艾滋病毒/艾滋病感染率高的社区的南非医院的成年住院患者的药物不良反应：前瞻性观察研究。

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What is already known about this subject. Studies conducted primarily in developed countries have shown that adverse drug reactions (ADRs) are a significant cause of hospital admission, prolong hospital stay and consequently increase the cost of disease management in patients. Cardiovascular medicines, hypoglycaemic agents, nonsteroidal anti-inflammatory drugs and antibiotics are the most frequently implicated medicines in these studies. A large proportion of these ADRs have been shown to be preventable through improved drug prescribing, administration and monitoring for adverse effects. What this paper adds. This is the first Sub-Saharan African study in the HIV/AIDS era that describes the contribution of ADRs to patient morbidity, hospitalisation and mortality. Cardiovascular medicines and antiretroviral therapy contributed the most to community-acquired ADRs at the time of hospital admission while medicines used for opportunistic infections (such as antifungals, antibiotics and antituberculosis medicines were most frequently implicated in hospital acquired ADRs. ADRs in HIV-infected patients were less likely to be preventable. AIMS: To describe the frequency, nature and preventability of community-acquired and hospital-acquired adverse drug reactions (ADRs) in a South African hospital serving a community with a high prevalence of human immunodeficiency virus (HIV)/ acquired immunodeficiency syndrome. METHODS: A 3-month prospective observational study of 665 adults admitted to two medical wards. RESULTS: Forty-one (6.3%) patients were admitted as a result of an ADR and 41 (6.3%) developed an ADR in hospital. Many of the ADRs (46.2%) were considered preventable, although less likely to be preventable in HIV-infected patients than in those with negative or unknown HIV status (community-acquired ADRs 2/24 vs. 35/42; P < 0.0001; hospital-acquired ADRs 3/25 vs. 14/26; P = 0.003). Patients admitted with ADRs were older than patients not admitted with an ADR (median 53 vs. 42 years, P = 0.003), but 60% of community-acquired ADRs at hospital admission were in patients <60 years old. Among patients <60 years old, those HIV infected were more likely to be admitted with an ADR [odds ratio (OR) 2.32, 95% confidence interval (CI) 1.17, 4.61; P = 0.017]. Among HIV-infected patients, those receiving antiretroviral therapy (ART) were more likely to be admitted with an ADR than those not receiving ART (OR 10.34, 95% CI 4.50, 23.77; P < 0.0001). No ART-related ADRs were fatal. Antibiotics and drugs used for opportunistic infections were implicated in two-thirds of hospital-acquired ADRs. CONCLUSIONS: ADRs are an important, often preventable cause of hospitalizations and inpatient morbidity in South Africa, particularly among the elderly and HIV-infected. Although ART-related injury contributed to hospital admissions, many HIV-related admissions were among patients not receiving ART, and many ADRs were associated with medicines used for managing opportunistic infections.
机译：关于此主题的已知信息。主要在发达国家进行的研究表明，药物不良反应（ADR）是医院入院，延长住院时间并因此增加患者疾病管理成本的重要原因。在这些研究中，心血管药物，降糖药，非甾体抗炎药和抗生素是最常见的药物。通过改善药物处方，给药和不良反应监测，已证明这些ADR中的大部分是可以预防的。本文增加了什么。这是艾滋病毒/艾滋病时代撒哈拉以南非洲地区的第一项研究，描述了ADR对患者发病率，住院和死亡率的影响。在医院入院时，心血管药物和抗逆转录病毒疗法对社区获得的ADR贡献最大，而机会感染的药物（例如抗真菌药，抗生素和抗结核药则最常与医院获得的ADR发生牵连）。目的：描述在为人类免疫缺陷病毒（HIV）/艾滋病高发病率社区服务的南非医院中社区获得性和医院获得性药物不良反应（ADR）的发生频率，性质和可预防性方法：为期三个月的前瞻性观察性研究，对665名成年人在两个医疗病房中的治疗结果：41名（6.3％）患者因ADR而入院，其中41名（6.3％）在ADR中发展为ADR许多ADR（46.2％）被认为是可以预防的，尽管与那些患有HIV的患者相比，可预防的可能性更低阴性或未知的HIV状况（社区获得的ADR 2/24与35/42; P <0.0001;医院获得的ADR 3/25与14/26; P = 0.003）。接受ADR的患者比未接受ADR的患者年龄大（中位年龄53岁vs. 42岁，P = 0.003），但是住院时社区获得的ADR的60％是60岁以下的患者。在60岁以下的患者中，那些感染了HIV的患者更有可能接受ADR [优势比（OR）2.32、95％置信区间（CI）1.17、4.61; P ＝ 0.017]。在感染HIV的患者中，接受抗逆转录病毒疗法（ART）的患者比未接受ART的患者更有可能接受ADR（OR 10.34，95％CI 4.50，23.77; P <0.0001）。没有与ART相关的ADR致命。三分之二的医院获得的ADR涉及用于机会感染的抗生素和药物。结论：在南非，尤其是在老年人和艾滋病毒感染者中，ADR是住院和住院发病率的重要且通常可预防的原因。尽管与ART相关的伤害导致住院治疗，但许多与HIV相关的住院治疗属于未接受ART的患者，并且许多ADR与用于控制机会性感染的药物有关。

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