Nursel SURMELİOGLU, Hatice Yağmur SOYSAL, İkbal TÜRKER, Faruk EKİNCİ, Ozden OZGUR HOROZ, Dinçer YILDIZDAŞ

Durumu kritik olan pediatrik hastalarda ilaç-ilaç etkileşimlerinin değerlendirilmesi

Amaç: Bu çalışmada, kritik çocuk hastalarda sıklıkla karşılaşılan ilaç-ilaç etkileşimlerinin ve bu etkileşimleri tahmin eden faktörlerin tespit edilmesi amaçlanmaktadır. Gereç ve Yöntem: Prospektif ve kesitsel olan bu çalışmaya bir üniversite hastanesinin çocuk yoğun bakım ünitesine yatışı yapılan ve tedavilerinde birden fazla ilaç kullanılan tüm hastalar dahil edilmiştir. Hastaların demografik özellikleri, laboratuvar bulguları ve tedavilerinde yer alan ilaçlar günlük olarak bir klinik eczacı tarafından değerlendirilmiştir. Potansiyel ilaç etkileşimlerinin tespit edilmesi için UpToDate® veri tabanından yararlanılmıştır. Bulgular: Çalışma boyunca takip edilen 66 hastanın 55’inde (%83.33) toplam 797 adet potansiyel ilaç-ilaç etkileşimi tespit edilmiştir. Tüm bu etkileşimler klinik eczacı tarafından değerlendirilmiş ve bu potansiyel etkileşimlere yönelik, tedaviyi takip eden hekimlere 114 öneride bulunulmuştur. Bu önerilerin 85’i (%74.56) hekimler tarafından kabul edilmiştir. Çalışma kapsamında her hasta ortanca 9 (2-63) gün takip edilmiş, bu sürede tespit edilen potansiyel ilaç etkileşimlerinin ortanca değeri 7 (1-89) olarak hesaplanmıştır. Sonuç: Kritik çocuk hastaların tedavilerinde potansiyel ilaç etkileşimi riski yüksektir. Bu riskin azaltılması adına, mümkün olduğu kadar polifarmasiden kaçınılması, tedavide bulunan indüktör ve inhibitör ilaçlara alternatifler sunulması önerilmektedir. Yoğun bakım ünitelerinde uzmanlaşmış eczacıların, multidisipliner ekibe dahil olmasının, potansiyel ilaç etkileşimlerinin yönetimini sağlayarak tedavinin optimizasyonuna katkı sağlayacağı düşünülmektedir.

Anahtar Kelimeler:

Kritik çocuk hasta, ilaç etkileşimleri, polifarmasi

Evaluation of drug-drug interactions in critically ill pediatric patients

Purpose: The aim of this study was to determine the drug-drug interactions that are frequently encountered in critically ill patients and the factors that predict these interactions. Materials and Methods: All patients who were admitted to the pediatric intensive care unit (13 bed) of a university hospital and used more than one drug in their treatment were included in this prospective and cross-sectional study. Patients' demographics, laboratory findings, and medications included in their treatment were evaluated daily by a clinical pharmacist. The UpToDate® database was used to detect potential drug interactions. Results: During the study, 797 potential drug-drug interactions were detected in 55 (83.33%) of 66 patients followed. All these interactions were evaluated by the clinical pharmacist and 114 recommendations were made to the physicians following the treatment regarding these potential interactions. Eighty-five (74.56%) of these recommendations were accepted by physicians. Within the scope of the study, each patient was followed up for a median of 9 (2-63) days, and the median value of potential drug interactions detected during this period was calculated as 7 (1-89). Conclusion: The existence of pDDIs was significantly associated with the number of prescribed medications. Exposure to pDDIs is frequent in critically ill pediatric patients and related to the number of medications. Daily and close cooperation between clinicians and clinical pharmacists is recommended to prevent harmful outcomes of DDIs. In order to minimize this risk, it is recommended to avoid polypharmacy as much as possible and to offer alternatives to inducer and inhibitor drugs in treatment.

Keywords:

drug interactions, polypharmacy, Critically ill pediatric patient,

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