Emre KARA, Kamer TECEN YÜCEL, Nesligül ÖZDEMİR, Ahmet Çağkan İNKAYA, Aygin BAYRAKTAR EKİNCİOĞLU, Kutay DEMİRKAN, Serhat ÜNAL

Yoğun Bakım Hastalarında Antibiyotiklerin Diğer İlaçlarla Etkileşimlerinin Değerlendirilmesi

Amaç: Bu çalışmanın amacı, yoğun bakım hastalarında antibiyotiklerin diğer ilaçlarla olan etkileşimlerini, hastanelerde sıklıkla başvurulan 3 farklı online ilaç-ilaç etkileşim veri tabanı ile saptamak, bu veri tabanlarını karşılaştırmak ve ilaç etkileşimlerinin klinik önemini klinik eczacı tarafından değerlendirmektir. Yöntem: Kasım-Aralık 2015 tarihleri arasında bir üniversite hastanesi Dahiliye Yoğun Bakım Ünitesi’nde yatmakta olan ve en az bir antibiyotik kullanan hastalar çalışmaya dahil edilmiştir. Hastaların kullandığı ilaçlar arasındaki etkileşimler; Micromedex®, Medscape® ve Drugs.com® online veri tabanlarının ilaç-ilaç etkileşim bölümleri ile analiz edilmiş ve antibiyotiklerle olan potansiyel ilaç-ilaç etkileşimleri belirlenmiştir. Veri tabanlarında gözlenen potansiyel ilaç-ilaç etkileşimlerinin sayısı ve derecesi arasındaki farklar tespit edilmiştir. Saptanan etkileşimlerin klinik açıdan önemi bir klinik eczacı tarafından değerlendirilmiştir. Bulgular: Altmış iki hastada toplam 42, 112 ve 91 ilaç etkileşimi Micromedex®, Medscape® ve Drugs.com® tarafından sırasıyla belirlenmiştir. Saptanan bu etkileşimlerin klinik önemi değerlendirildiğinde, en fazla Micromedex® veri tabanı ile saptanan ilaç etkileşimleri 15’i (%35,7) klinik olarak anlamlı bulunmuştur. Sonuç: Etkileşimlerin değerlendirilmesinde yalnızca veri tabanları ile saptanmayıp aynı zamanda klinik eczacı ve klinisyenlerin klinik anlamlılığı göz önünde bulundurduğu bir yaklaşım izlenmelidir.

The Evaluation of Interactions of Antibiotics with Other Drugs in Intensive Care Patients

Objective: The aim of this study was to identify the interactions of antibiotics with other drugs in intensive care patients by means of 3 different online drug-drug interaction databases frequently used in hospitals, to compare these databases and to evaluate the clinical significance of drug interactions through the interpretation by a clinical pharmacist. Method: The patients who were hospitalized at the Internal Medicine Intensive Care Unit of a university hospital during November and December 2015 and using at least one antibiotic were included in the study. The interactions between drugs used by patients were analysed through drug-drug interactions sections of Micromedex, Medscape® and Drugs.com online databases and potential drugdrug interactions with antibiotics were identified. The differences between the databases in the numbers and severity of potential drug interactions were recorded. The clinical significance of identified drug interactions was evaluated by a clinical pharmacist. Findings: In 62 patients, a total of 42, 112 and 91 drug-drug interactions were identified through the Micromedex®, Medscape® and Drugs.com®, respectively. When the clinical significance of these interactions was evaluated, 15 (35,7%) of the drug interactions detected mostly through the Medscape® database were found to be clinically significant. Conclusion: An evaluation of drug interaction should not be based solely on the databases; it should include the interpretation of a clinical pharmacist or clinician considering its clinical significance.

___

1. Khandeparkar A, Rataboli PV. A study of harmful drug-drug interactions due to polypharmacy in hospitalized patients in Goa Medical College. Perspect Clin Res 2017;8(4):180-6.
2. Jain S, Jain P, Sharma K, Saraswat P. A Prospective Analysis of Drug Interactions in Patients of Intensive Cardiac Care Unit. J Clin Diagn Res 2017;11(3):FC01-FC4.
3. Zheng WY, Richardson LC, Li L, Day RO, Westbrook JI, Baysari MT. Drug-drug interactions and their harmful effects in hospitalised patients: a systematic review and meta-analysis. Eur J Clin Pharmacol 2018;74(1):15-27.
4. Yeh ML, Chang YJ, Wang PY, Li YC, Hsu CY. Physicians' responses to computerized drug-drug interaction alerts for outpatients. Comput Methods Programs Biomed 2013;111(1):17-25.
5. Rosas-Carrasco O, Garcia-Pena C, Sanchez-Garcia S, Vargas-Alarcon G, Gutierrez-Robledo LM, Juarez-Cedillo T. The relationship between potential drug-drug interactions and mortality rate of elderly hospitalized patients. Rev Invest Clin 2011;63(6):564-73.
6. Halkin H, Katzir I, Kurman I, Jan J, Malkin BB. Preventing drug interactions by online prescription screening in community pharmacies and medical practices. Clin Pharmacol Ther 2001;69(4):260-5.
7. Reis AM, Cassiani SH. Evaluation of three brands of drug interaction software for use in intensive care units. Pharm World Sci 2010;32(6):822-8.
8. Al-Ramahi R, Raddad AR, Rashed AO, Bsharat A, Abu-Ghazaleh D, Yasin E, et al. Evaluation of potential drug- drug interactions among Palestinian hemodialysis patients. BMC Nephrol 2016;17:96.
9. Palatini P, De Martin S. Pharmacokinetic drug interactions in liver disease: An update. World J Gastroenterol 2016;22(3):1260-78.
10. Van der Sijs H, Lammers L, van den Tweel A, Aarts J, Berg M, Vulto A, et al. Time-dependent drugdrug interaction alerts in care provider order entry: software may inhibit medication error reductions. J Am Med Inform Assoc 2009;16(6):864-8.
11. Vanham D, Spinewine A, Hantson P, Wittebole X, Wouters D, Sneyers B. Drug-drug interactions in the intensive care unit: Do they really matter? J Crit Care 2017;38:97-103.
12. Moura C, Prado N, Acurcio F. Potential drug-drug interactions associated with prolonged stays in the intensive care unit: a retrospective cohort study. Clin Drug Investig 2011;31(5):309-16.
13. Reis AM, Cassiani SH. Prevalence of potential drug interactions in patients in an intensive care unit of a university hospital in Brazil. Clinics (Sao Paulo) 2011;66(1):9-15.
14. Jankovic SM, Pejcic AV, Milosavljevic MN, Opancina VD, Pesic NV, Nedeljkovic TT, et al. Risk factors for potential drug-drug interactions in intensive care unit patients. J Crit Care 2018;43:1- 6.
15. Vonbach P, Dubied A, Krahenbuhl S, Beer JH. Prevalence of drug-drug interactions at hospital entry and during hospital stay of patients in internal medicine. Eur J Intern Med 2008;19(6):413-20.
16. Seymour RM, Routledge PA. Important drug-drug interactions in the elderly. Drugs & aging 1998;12(6):485-94.
17. Magnus D, Rodgers S, Avery AJ. GPs' views on computerized drug interaction alerts: questionnaire survey. J Clin Pharm Ther 2002;27(5):377-82.
18. Payne TH, Nichol WP, Hoey P, Savarino J. Characteristics and override rates of order checks in a practitioner order entry system. Proc AMIA Symp 2002:602-6.
19. Weingart SN, Toth M, Sands DZ, Aronson MD, Davis RB, Phillips RS. Physicians' decisions to override computerized drug alerts in primary care. Arch Intern Med 2003;163(21):2625-31.
20. Kheshti R, Aalipour M, Namazi S. A comparison of five common drug-drug interaction software programs regarding accuracy and comprehensiveness. J Res Pharm Pract 2016;5(4):257-63.
21. Smithburger PL, Kane-Gill SL, Benedict NJ, Falcione BA, Seybert AL. Grading the severity of drug-drug interactions in the intensive care unit: a comparison between clinician assessment and proprietary database severity rankings. Ann Pharmacother 2010;44(11):1718-24.
22. Tecen-Yucel K, Bayraktar-Ekincioglu A, Kilickap S, Erman M. Clinical Pharmacy Practices in Oncology Patients Treated with Tyrosine Kinase Inhibitors. International Journal of Hematology and Oncology 2018;28(4):053-060
23. Kara E, Inkaya AC, Aydin Hakli D, Demirkan K, Unal S. Polypharmacy and drug-related problems among people living with HIV/AIDS: a singlecenter experience. Turk J Med Sci. 2019 Feb 11;49(1):222-229.