Chloroquine poisoning in Zimbabwe: a toxicoepidemiological study

Chloroquine is commonly implicated in pharmaceutical poisonings in Zimbabwe. A retrospective hospital record review was performed to describe the epidemiology of chloroquine poisoning compared with that of other medicines. All records of admissions to eight referral hospitals in Zimbabwe due to poisoning with single pharmaceutical agents were collated and separated into those involving either chloroquine or other medicines. Case characteristics were compared and a retrospective cohort study performed to investigate the association of pregnancy with chloroquine overdose. Of 544 cases, antimalarials accounted for the largest proportion of admissions (53.1%), with chloroquine accounting for 96.2% (279 cases) of these. The latter were compared with the remaining 265 cases. The median length of hospital stay for the chloroquine group was significantly lower (1 vs 2 days; P = 0.001) and a greater proportion of patients took chloroquine deliberately (80.3% vs 68.7%; P < 0.05). The mortality rate due to chloroquine poisoning was significantly higher than that of poisoning due to other drugs (5.7% vs 0.7%; P < 0.0001). There was no significant gender bias in mortality. Women of childbearing age admitted with chloroquine poisoning (188 cases) were twice as likely to be found pregnant (relative risk = 2.3, 95% CI = 1.2-4.5) than similar women admitted due to other medicines (157 cases). In conclusion, chloroquine is the most common cause of pharmaceutical poisoning admission at referral hospitals in Zimbabwe. It is normally taken deliberately with significant mortality. In women of childbearing age admitted with chloroquine poisoning, pregnancy should be suspected.     

Poisoning in Zimbabwe: a survey of eight major referral hospitals

A retrospective study of the pattern of poisoning cases admitted to eight major urban referral hospitals in Zimbabwe over a 2-year period (1998-1999 inclusive) was conducted to describe the pattern of poisoning at these centres. There were a total of 2764 hospital admissions due to poisoning, involving a total of 2846 toxic agents. Accidental poisoning (AP) and deliberate self-poisoning (DSP) accounted for 48.9% (1352 cases) and 41.3% (1142 cases), respectively. With AP, the highest number of cases (45.9%) occurred in children below the age of 5 years, with half of these due to chemicals, mainly paraffin. In the DSP group, however, more than 60% of all cases occurred in the 16-25-year age group. In addition, twice as many females as males were admitted for DSP compared with an overall male/female ratio of 1 : 1.2. Pesticides (31.4%) and pharmaceuticals (30.4%) were the most common groups of toxic agents responsible for the hospital admissions. Unknown toxins, natural toxins and pesticides showed the highest mortality rates (15.4%, 8.3% and 6.7%, respectively). Compared with the last major survey of poisoning in Zimbabwe, the pattern of poisoning at referral hospitals has changed over the last decade, with an increase in pesticide and pharmaceutical cases and a marked fall in cases of traditional medicine poisoning. Educational and legislative interventions may be required to address these changes. There is the need also to investigate further the high mortality rates associated with traditional medicine poisoning.     

49例阿司匹林致不良反应报告分析

目的探讨阿司匹林致不良反应（ADR）的特点及相关因素。方法收集医院2008年至2013年发生的阿司匹林ADR报告49份,利用Excel软件统计并分析。结果阿司匹林致ADR以70岁以上的老年人居多（48．98％）;以严重的ADR为主;多有长期用药史;ADR累及器官／系统主要为消化系统;联合用药主要为阿司匹林和硫酸氢氯吡格雷片联用;ADR经治疗后均好转;ADR来源主要为医生上报。结论临床应高度重视阿司匹林引起的ADR,尤其是消化道出血等严重ADR,以确保安全用药。     

2007年至2009年我院中药注射剂不良反应报告分析

目的了解医院使用中药注射剂的药品不良反应情况,为临床安全用药提供参考。方法采用回顾性调查分析方法,对医院2007年至2009年收集的121例中药注射剂所致不良反应报告进行统计分析。结果 121例药品不良反应涉及17种中药注射剂;0～9岁年龄组患者35例,比例最高(30.58%);临床表现以皮肤及其附件损害多见,其次为全身性损害及用药部位损害,较严重的有呼吸困难、过敏性休克等。结论应加强中药注射剂不良反应的监控工作,避免和预防不良反应的发生。     

104 例儿童中药注射剂不良反应分析

目的:分析儿童中药注射剂不良反应(ADR)发生情况,为临床合理用药提供参考。方法:从国家药品ADR 监测系统中 收集2006-2021 年中成药不良反应案例1 356 例,筛选出中药注射剂在儿童中发生的ADR 共104 例。从患儿因素、药物因素及 临床因素3 个角度对ADR 的特点及原因进行分析。结果:男65 例(62. 50%),女39 例(37. 50%);≤5 岁59 例(56. 73%);复方 制剂63 例(60. 58%),单一组分制剂41 例(39. 42%);用药后30 min 内发生ADR 86 例(82. 69%)。结论:儿童尚处于生长发育 阶段,需要重视中药注射剂在儿童中的应用,谨慎用药,加强监测,以减少或避免ADR 的发生。     

Drug related hospital admissions

Summary As part of a high-intensity monitoring study of drug events as the cause of admission to departments of internal medicine, the effect of an educational intervention programme was studied. Two departments were included, one specialising in geriatrics and one that received patients by non-selected referral. The series consisted of 607 consecutive admissions studied before and 703 after the intervention. The drug events considered were adverse drug reactions and dose-related therapeutic failures, mainly due to non-compliance.A modest, statistically non-significant decrease in drug related hospital admissions (DRH) was seen, from 14% before to 13% after the intervention period. However, DRHs classified as definitely avoidable showed the significant decrease of 83%.There was no apparent relationship between the topics selected for the intervention programme and changes in the pattern of DRHs. No relationship between alterations in sales data and hospital admissions caused by a given drug could be demonstrated. A blinded external evaluation of case abstracts did not disclose any significant shift in the investigators' assessments.The intervention may have had an non-specific effect on avoidable DRHs.     

我院2011年66例中药注射剂不良反应报告分析

目的了解中药注射剂在我院发生药品不良反应的情况,为临床用药提供参考。方法采用回顾性分析方法,对2011年该院收集到的66例中药注射剂不良反应报告进行统计分析。结果66例中药注射剂不良反应报告中女性43例（占65．15％）,男性23例（占34．85％）,且40岁以上中老年患者占绝大多数,有58例（约占87．87％）。引起不良反应的的药物中多为生脉注射液（13例）,参麦注射液（13例）,注射用双黄连（12例）,痰热清注射液（6例）等。药物引起的不良反应率最高的为全身性损害,有31例,约占38．75％,其次为心血管系统损害,有12例,约占15．00％。结论辩证看待中药注射剂不良反应,提倡合理使用中药注射剂,加强中药注射剂用药监护,减少和避免ADR的发生。     

喹诺酮类药物的合理用药及不良反应分析

目的 探讨喹诺酮类药物在临床使用中的不良反应,为临床科学合理用药提供相应对策.方法 选择2008年2月-2010年2月间有喹诺酮类药物不良反应的117例患者进行回顾性调查与分析.结果 117例喹诺酮类药物不良反应患者主要由6种喹诺酮类药物引起,分别为：诺氟沙星、左氧氟沙星、环丙沙星、加替沙星、氧氟沙星、莫西沙星,其中诺氟沙星和左氧氟沙星分别占的41例和38例;不良反应的主要临床表现为皮疹、瘙痒、恶心、呕吐、腹痛、头晕、头痛、静脉炎等.结论 喹诺酮类药物是目前应用广泛的一类抗感染药物,但不良反应症状多;临床应用时要注意不良反应的监测,科学合理地用药,提高用药的安全性与疗效性.     

Drug-induced upper gastrointestinal disorders requiring hospitalization: a five-year study in a South Indian hospital

PURPOSE: To study the clinical spectrum of drug induced upper gastrointestinal tract (GIT) disorders requiring hospitalization and establish the causal relation between drug and disorder using WHO causality definitions. METHODS: Case-records of patients in the Department of Gastroenterology (from January 1998 to December 2002) hospitalized with diagnoses of drug induced upper GIT disorders were analyzed retrospectively. The causality assessment of each disorder was done based on WHO causality definitions. RESULTS: Out of 101 cases identified over the study period, 8 were categorized as certain, 87 as probable and 6 cases as possible. The certain and probable cases (95) were analyzed. Of these, 13 were in 1998, 14 in 1999, 18 in 2000, 20 in 2001 and 30 in 2002. The drug class most commonly implicated with adverse drug reactions was non-steroidal anti-inflammatory drugs (NSAIDs) (76.8%). Among individual drugs, aspirin was most commonly involved (32.6%). Results of endoscopy revealed gastric erosions (40.2%), combination of gastric ulcer and gastric erosions (16.1%), gastric ulcer (15.0%), duodenal ulcer (13.8%), normal (13.8%) and duodenal erosions (1.1%). Risk factors noticed were chronic smoking (16.8%), alcohol consumption (13.7%), smoking and alcohol use (21.1%), history of peptic ulcer (10.5%) and chronic steroid use (1.1%). CONCLUSION: NSAIDs especially aspirin were implicated in maximum number of patients. An increase in occurrence over 5 years, a wide spectrum of disorders and various risk factors were noticed.     

Drug information in Zimbabwe: 1990–1999

Objective To assess the utilisation and development of the Zimbabwe Drug And Toxicology Information Service (DATIS) Setting The national drug and poisons information centre in Harare, Zimbabwe. Method A survey of records at the Zimbabwe national Drug and Toxicology Information Service (DaTIS) for the period January 1990 to December 1999 was conducted and compared to a previous review. Main outcome measures Average annual reporting rate, distribution of service users and report categories Results The mean (SD) reporting rate was 142.9 (81.6) p.a. with an increasing trend. Most contacts came from the capital city (67%). Pharmacists (40%) predominated in requests for drug information (DI), which comprised about three-quarters of reports, whereas toxicological enquiries mostly came from physicians (49%). Therapeutic categories mentioned most in DI reports were systemic anti-infective (24%) and nervous system agents (20.4%). Pesticides (28%) predominated in toxicology requests followed by pharmaceuticals (21%), largely nervous system (36%) and antiparasitic agents (23%). Conclusion Compared to the previous decade, use of DaTIS had not grown significantly due to perceived resource constraints, lack of local political and institutional support and divided loyalty of staff. The drug and poison information components serves two distinct user populations with separate needs. Development plans for both DaTIS and other drug information services in Africa need to be realistic taking into account the resource constraints and local political and institutional support.     

我院286例老年患者药品不良反应回顾性分析

目的了解医院老年患者用药发生药品不良反应（ADR）的特点。方法回顾性分析2005年至2009年的286例老年患者ADR报告。结果总计1 175例ADR中,老年患者ADR发生率为24.34%,男性略少于女性,静脉给药方式导致ADR最多（83.92%）,引发ADR最多的为抗感染药物（45.80%）,ADR临床表现以皮肤及其附件损害最常见（30.42%）。结论老年患者因身体机能减退,同时患有多种疾病等原因,服药种类多,潜在的不良反应发生率较高。因此,医务工作者要有以患者为中心的服务意识,充分利用处方审查系统提供的用药指南指导患者用药,确保用药安全。     

A prospective study of adverse drug reactions as a cause of admission to a paediatric hospital

1 A total of 512 consecutive paediatric hospital admissions of children 2 years old or less were evaluated to assess the extent and pattern of admission caused by suspected adverse drug reactions (ADRs). The proportion of suspected ADRs related to hospital admissions was 4.3%.
2 The organ-systems most commonly implicated were the central nervous system (40.5%), digestive system (16.7%), and skin and appendages (14.3%). Together, they accounted for 71.5% of admissions attributed to ADRs. The most common clinical manifestations inducing admission were convulsions (4 cases), dizziness (4), vomiting (3), and tremor, fever, itching and apnoea (2 cases each).
3 The four classes of drugs most frequently suspected in admissions due to ADRs were respiratory drugs (35%), anti-infective agents (25%), drugs active on the central nervous system (15%) and drugs used in dermatology (10%). The most common drugs related to ADRs were a combination of chlorpheniramine, diphenhydramine, phenylephrine, guaiphenesin and salicylic acid (4 cases), followed by fenoterol, adrenaline, paracetamol, DTP vaccine and antipolio vaccine (2 cases each).
4 There were no significant differences between children older and younger than 1 year (odds ratio 0.89; 95% CI 0.37–2.17) or between the sexes as regards hospital admittance due to suspected ADRs (odds ratio 1.94; 95% CI 0.72–5.42).
5 The results of this kind of study may be influenced by patterns of drug utilization. Nevertheless, the lack of specific studies of drug effects in young children makes it desirable to carry out pharmacoepidemiological studies in this age group.     

抗感染药物不良反应159例分析

目的分析我院近几年来抗感染药物不良反应（ADR）的发生情况,为临床安全、合理用药提供参考。方法对我院1999年1月～2007年10月ADR监测小组收集的159例抗感染药物ADR报告进行回顾性分类统计分析。结果159例ADR报告涉及药物12类41个品种,其中喹诺酮类药物报告例数为首位,其次为林可霉素类及青霉素类药物等。ADR的临床表现主要为皮肤及其附件损害最为多见,其次为消化系统损害和神经系统损害等。结论合理使用抗感染药物,重视ADR的监测工作,减少ADR发生。     

某院活血化瘀类中药注射剂不合理联用情况与分析

目的：分析临床常见活血化瘀类中药注射剂不合理联用情况。方法：汇总某院2015年全年活血化瘀类中药注射剂联用导致的不良反应,具体分析不合理联用的原因。结果与讨论：活血化瘀类中药注射剂应在中医药理论指导下单独使用,谨慎联用,避免不良反应的发生。     

Emergency re-admissions to hospital due to adverse drug reactions within 1 year of the index admission

AIM

The proportion of re-admissions to hospital caused by ADRs is poorly documented in the UK. The aim of this study was to evaluate the impact of ADRs on re-admission to hospital after a period as an inpatient.

METHODS

One thousand patients consecutively admitted to 12 wards were included. All subsequent admissions for this cohort within 1 year of discharge from the index admission were retrospectively reviewed.

RESULTS

Of the 1000 patients included, 403 (40.3%, 95% CI 39.1, 45.4%) were re-admitted within 1 year. Complete data were available for 290 (70.2%) re-admitted patients, with an ADR contributing to admission in 60 (20.8%, 95% CI 16.4, 25.6%) patients. Presence of an ADR in the index admission did not predict for an ADR-related re-admission (10.5% vs. 7.2%, P = 0.25), or re-admission overall (47.2% vs. 41.2%, P = 0.15). The implicated drug was commenced in the index admission in 33/148 (22.3%) instances, with 37/148 (25%) commenced elsewhere since the index admission. Increasing age and an index admission in a medical ward were associated with a higher incidence of re-admission ADR. The most frequent causative drugs were anti-platelets and loop diuretics, with bleeding and renal impairment the most frequent ADRs. Over half (52/91, 57.1%) of the ADRs were judged to be definitely or possibly avoidable.

CONCLUSIONS

One fifth of patients re-admitted to hospital within 1 year of discharge from their index admission are re-admitted due to an ADR. Our data highlight drug and patient groups where interventions are needed to reduce the incidence of ADRs leading to re-admission.     

短期使用氯喹/羟氯喹引起不良反应的病例报道分析及合理应用建议

目的检索与分析短期应用氯喹/羟氯喹(CQ/HCQ)可能导致的药品不良反应(ADR)及分析相关影响因素,为临床合理应用提供参考。方法通过检索PubMed、中国期刊全文数据库(CNKI)、万方数据库从建库至今CQ/HCQ引起的药品相关不良反应的个案报道的相关文献,设定单次服药至服药3个月内出现的ADR情况,分析CQ/HCQ可能引起的ADR及容易诱发ADR的相关因素,进行分析总结。结果共检索到文献1280篇,最终纳入42篇。其中心脏ADR共7篇10例,主要为心律失常,包括房室传导阻滞4例、Q-T间期延长4例;其中3例死亡,7例停药后恢复,服药1 g/d以上出现心脏毒性更快。视觉相关ADR文献4篇5例,其中应用CQ的1例,为单次用药后出现视力下降。HCQ的4例,出现黄斑病变1例,视物模糊1例,结膜充血2例。出现视物模糊与黄斑病变的患者停药后未恢复。皮肤ADR纳入21篇,严重的可引起Stevens-Johnson综合征2例,急性或泛发性脓疱病10例。其他严重ADR共10篇,主要表现为神经精神系统ADR。结论CQ/HCQ可引起严重ADR,对既往有心脏疾病、合并使用有相互作用的药物应进行严密监测,制定新型冠状病毒肺炎治疗的合理剂量,还应考虑患者疾病严重程度、肝肾功能情况,选择不同的药物与给药方案。     

磷酸氯喹治疗新型冠状病毒肺炎的药品不良反应/事件分析及风险管理建议

目的通过分析磷酸氯喹治疗新型冠状病毒肺炎(简称新冠肺炎)出现的药品不良反应/事件(ADR/AE)报告,为新冠肺炎临床用药安全提供参考。方法对深圳市2020年1月1日至3月6日期间上报的磷酸氯喹治疗新冠肺炎不良反应病例报告进行统计分析。结果根据追踪获知共有32位患者使用了磷酸氯喹治疗新冠肺炎,对收到的21例怀疑药品为磷酸氯喹的新冠肺炎ADR/AE进行了统计分析:其ADR/AE发生率为65.62%,男女比例1∶1.1;30~39岁及50~59岁年龄段发生的ADR/AE比例较高,分别为38.10%、23.81%;发生率较高依次为:消化系统、循环系统(含心脏)、神经肌肉系统、眼睛损害;心律失常是磷酸氯喹可致命的ADR/AE类型;肝损周期较短,平均3.5天;联合有潜在肝损伤的中药汤剂时可能增加肝损伤风险;ADR/AE最短当天发生,最长用药后9天发生,多发生在用药后2~7天。结论临床在使用磷酸氯喹治疗新冠肺炎的过程中,应避免联用禁忌的药物,尽量减少不必要的联合用药,密切观察ADR/AE,一旦发现应积极处理,从而保障患者的用药安全。     

β-内酰胺类抗生素致176例不良反应分析

目的：监测分析上海市长宁区β-内酰胺类抗生素所致不良反应及其相关因素。方法：采用回顾性调查方法对2003年1～12月发生在我区β-内酰胺类抗生素所致176例不良反应报告进行统计分析。结果：不良反应涉及药品16种，排前3位的是青霉素、头孢拉定和头孢唑林。不良反应累及人体的9个系统，比例最高的不良反应为变态反应。结论：应关注β-内酰胺类抗生素的不良反应，提高合理用药水平。     

Prevalence and characteristics of adverse drug reactions at admission to hospital: a prospective observational study

AimsAdverse drug reactions (ADRs) contribute to poorer patient outcomes and additional burden to the healthcare system. However, data on the true burden, relevant types and drugs causing ADRs are lacking. The aim of this study was to determine the prevalence of ADR‐related hospitalization in the general adult population in Singapore and to investigate their characteristics.MethodsWe prospectively recruited 1000 adult patients with unplanned admission to a large tertiary‐care hospital. Two independent reviewers evaluated all suspected ADRs for causality, type, severity and avoidability. The prevalence of ADR‐related hospitalization was calculated based on ‘definite’ and ‘probable’ ADRs. Logistic regression was used to evaluate predictors for having an ADR at admission.ResultsThe prevalence of all ADRs at admission was 12.4% (95% CI: 10.5–14.6%) and ADRs causing admission was 8.1% (95% CI: 6.5–10.0%). The most common ADRs were gastrointestinal‐related. The most common drug category causing ADRs were cardiovascular drugs. Patients with ADRs had a longer length of stay than those who did not (median 4 vs. 3 days, P = 1.70 × 10⁻³). About 30% of ADRs at admission were caused by at least one drug with a clinical annotation in the Pharmacogenomics KnowledgeBase (PharmGKB), suggesting that some of these ADRs may have been predicted by pharmacogenetic testing.ConclusionsWe have quantified the burden and characteristics of clinically impactful ADRs in the Singaporean general adult population. Our results will provide vital information for efforts in reducing ADRs through targeted vigilance, patient education and pharmacogenomics in Singapore.     

不溶性微粒引发中药注射剂不良反应的原因及分析

中药注射剂因其疗效显著、作用靶点多等优势,现已被广泛应用于临床,而不溶性微粒是中药注射剂发生不良反应的重要因素之一,探讨了不溶性微粒引起的危害和产生的原因,并提出解决对策和相关建议,以期为临床应用提供理论支持。