scholarly journals A Five-Year Review of Adverse Cutaneous Drug Reaction in a Tertiary Care Hospital in Yogyakarta, Indonesia

2021 ◽  
Vol 33 (3) ◽  
pp. 150
Author(s):  
Dyah Ayu Mira Oktarina ◽  
Maria Sophiati ◽  
Erinda Maharani Rambu Moha ◽  
Fajar Waskito ◽  
Haryanto Soebono
Keyword(s):  
Drug Reaction ◽  
Mortality Rate ◽  
Hypersensitivity Reaction ◽  
Past History ◽  
Tertiary Care ◽  
Stevens Johnson Syndrome ◽  
Care Hospital ◽  
Type Iv ◽  
Causative Agents ◽  
Cutaneous Drug Reaction

Background: The prevalence of adverse drug reactions is likely to increase, and it is associated with increased usage of various drugs. Adverse Cutaneous Drug Reaction (ACDR) is the most frequent adverse drug reaction (30–45%). In Indonesia, the study on the prevalence of ACDR is still limited. Purpose: This study investigated the prevalence, clinical features, causative agents, and mortality rate of ACDR with a type-IV hypersensitivity reaction among patients attending the Department of Dermatology and Venereology in Dr. Sardjito Hospital, Yogyakarta. Methods: This retrospective study was conducted examining medical records undertaken for five years (2011–2015). Of 68,375 patients medicated in the Department of Dermatology and Venereology, 397 patients were diagnosed as ACDR with a type-IV hypersensitivity reaction. Detailed history, including age, sex, past history, and family history of drug reaction taken by the patient, were obtained. Patch testing was done wherever feasible. Result: Of 68,375 patients, 397 patients were included in ACDR with type-IV hypersensitivity (0.58%), giving a 5% of mortality rate. The mean age of the patients was 40.42 years (±16.30; range 18 to 89 years). The female to male ratio was 1.1: 1. The Maculopapular rash was the most common ACDR manifestation (50.88%), followed by Stevens-Johnson Syndrome (13.85%), Fixed Drug Eruption (12.85%), and Drug Reaction with Eosinophilia and Systemic Symptoms (10.08%). The most common causative agents were beta-lactam (16.55%), NSAIDs (12.18%), and acetaminophen (8.62%). Conclusion:  Prescription of those drugs should be considered carefully so the incidence of ACDR can be reduced.

scholarly journals A study of cutaneous morphological patterns of adverse drug reactions in tertiary care center, Chitradurga, Karnataka, India

2020 ◽  
Vol 6 (4) ◽  
pp. 499
Author(s):  
Nikitha Babu ◽  
Yogendra M. ◽  
Raghu M. T. ◽  
Virupakshappa H. E. ◽  
Ashwini S. ◽  
...  
Keyword(s):  
Drug Reaction ◽  
Drug Eruption ◽  
Tertiary Care Hospital ◽  
Past History ◽  
Care Center ◽  
Tertiary Care ◽  
Stevens Johnson Syndrome ◽  
Care Hospital ◽  
Female Ratio ◽  
Cutaneous Drug Reaction

<p class="abstract"><strong>Background:</strong> An adverse cutaneous drug reaction is an undesirable change in structure and function of skin, its appendages or mucous membrane due to drugs. The main aim of this study is to detect the pattern of adverse cutaneous drug reaction in a tertiary care hospital of Chitradurga district, Karnataka, India.</p><p class="abstract"><strong>Methods:</strong> A Hospital based cross sectional study was performed in a tertiary care hospital, Chitradurga for 6 months from January 2019 to June 2019. For each case, data regarding age, sex of the patient, clinical history, past history and comorbidities, name of suspected drugs, duration between drug intake and onset of reaction, morphology of drug eruption, associated mucosal or systemic involvement were analyzed.<strong></strong></p><p class="abstract"><strong>Results:</strong> During the 8 months study period, 30 patients have attended the dermatology outpatient department with cutaneous adverse drug reaction. Majority of the patients were in the age group 20-39 years and the male to female ratio was 1.1:1. The commonest drug reaction pattern observed was the maculopapular rash (40%), urticaria (20%), fixed drug eruption (5%), Stevens Johnson syndrome (10%), toxic epidermal necrolysis (6.7%) and exfoliative dermatitis (6.7%). Commonest drugs producing reactions were diclofenac (30%), amoxycillin (23.3%), carbamazepine (20%), anti-tubercular drugs (16.7%), phenytoin (6.7%) and dapsone (3.3%).</p><p class="abstract"><strong>Conclusions:</strong> Knowledge of the pattern and the offending drug helps in better management and reduced complications in these patients and also help in preventing recurrences.</p>

Cutaneous Drug Reactions in Children Attending a Tertiary Care Hospital

2020 ◽  
Vol 33 (2) ◽  
pp. 56-62
Author(s):  
Md Mostafizur Rahman ◽  
Md Azraf Hossain Khan ◽  
Pampa Chandra ◽  
Laila Shamima Sharmin ◽  
Fazlur Rahman ◽  
...  
Keyword(s):  
Drug Reaction ◽  
Adverse Drug Reactions ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Stevens Johnson Syndrome ◽  
Care Hospital ◽  
Drug Reactions ◽  
Johnson Syndrome ◽  
Cutaneous Drug Reactions ◽  
Cutaneous Drug Reaction

Background: Cutaneous drug reaction (CDR) is a growing health hazard in the world. Adverse drug reactions are common complications in drug therapy. About 3-8% of all hospital admissions are the results of adverse drug reactions, among them 2-3% are children and these can cause significant disability to patients. Early identification and management of adverse cutaneous drug reaction has both short term and long term prognostic significance.  Objective: To know the cutaneous reaction to drugs in children in a tertiary care hospital.  Study design: Hospital based descriptive, observational study. Subjects: 50 children with cutaneous drug reactions were studied in the department of Dermatology and Pediatric respectively in Rajshahi Medical College Hospital, Rajshahi. Methods: Data were collected by detailed history taking, physical examination and laboratory investigations in a prefixed data collection sheet and with the help of GOLD guideline after taken informed consent of the patient. Results: This study showed a significant male predominance. Male: female ratio was 1.08:1 .In this study prevalence was highest among 1-5 years age group. Cotrimoxazole, NSAIDs, anticonvulsant and quinolone were most offending medications. Maculopapular eruption, Stevens Johnson Syndrome, fixed drug eruption and urticaria were most common morphological types. Majority of CDRs were noted with oral route of administration. It was observed that almost all the CDRs that were reported involved mainly the skin. Majority of adverse cutaneous drug reactions reported were moderate in severity. Conclusion: Frequency distribution of the offending drugs and the adverse reactions revealed that adverse cutaneous drug reactions occurred mostly by cotrimoxazole, NSAIDs and quinolones. Maculopapular rash and Stevens Johnson Syndrome were the most common morphological types. A better understanding of the mechanisms underlying CRDs is important in drug development and in patient care. TAJ 2020; 33(2): 56-62

scholarly journals ANTIMICROBIAL-RELATED ADVERSE DRUG REACTION IN A TERTIARY CARE HOSPITAL

2017 ◽  
Vol 10 (8) ◽  
pp. 229
Author(s):  
Jindal M ◽  
Sharma Rk
Keyword(s):  
Adverse Drug Reaction ◽  
Drug Reaction ◽  
Spontaneous Reporting ◽  
Tertiary Care Hospital ◽  
Past History ◽  
Tertiary Care ◽  
Care Hospital ◽  
Beta Lactam ◽  
Active Monitoring ◽  
Beta Lactam Antibiotics

  Objective: The objective of the study was to evaluate the adverse drug reaction (ADR) related to commonly used antimicrobials in a tertiary care hospital.Methods: A prospective spontaneous reporting study involving, active methods (pharmacist actively looking for suspected ADRs) and passive methods (stimulating prescribers to report suspected ADRs) was carried out in all departments of a tertiary care hospital, for 1 year. Patients of all age groups were included in the study. The data for the study were taken from case sheets, investigation reports of patients who had experienced an ADR, personal interviews with reporting persons or clinicians, personal interviews with patient or patient’s attendant, past history of medication use, which were generally obtained from, prescriptions from the past, reports of medical and surgical interventions, referral letters, ADR reporting forms. Collected data were then analyze for causality assessment by Naranjo’s scale and severity assessment by Hartwig and Siegel’s scale.Result: During 1 year of study period, 75 ADRs related to antimicrobial were reported among 1354 patients who were given antibiotic for the treatment. The incidence rate of antibiotic was found to be 5.53%. The department that reported ADR was medicine (10.16%), ENT (4.6%), pediatric (8.12%), orthopedics (06.9%), surgery (06.9%), chest and tuberculosis (04.6%), obstetrics and gynecology (06.9%), dentistry (02.3%), and skin (10.16%). The most common ADRs were related to gastrointestinal tract; dermatological reactions were second in the list of antimicrobial drugs causing ADR. In this study, among antimicrobials, fluoroquinolones, and beta-lactam antibiotics were the most common drugs causing gastrointestinal and dermatological ADRs. There was no unknown ADR reported that may need to be further investigated through active monitoring. All patients recovered from ADRs without any complications. The causality was assessed by Naranjo’s scale and it revealed that out of 75 antibiotics related ADR 48 (64%) were possible, 27 (36%) were probable, 3 (4.00%) were definate, and 0% were unlikely. According to the Hartwig and Siegel’s scale, most of ADR were mild 45 (60%) and moderate 30 (40%) in nature.Conclusion: ADRs related to antimicrobials occurs frequently. Among antimicrobials, fluoroquinolones, and beta-lactam antibiotics were the most common drugs causing gastrointestinal and dermatological ADRs. The health-care system can promote the spontaneous reporting of antimicrobial ADR to pharmacovigilance center for ensuring safe drug use and patient care.

scholarly journals Pattern of adverse drug reaction to antiepileptic drugs in a tertiary care hospital

2017 ◽  
Vol 6 (9) ◽  
pp. 2219
Author(s):  
Suchitra D. Akalu ◽  
Niveditha G. Belavadi
Keyword(s):  
Adverse Drug Reaction ◽  
Drug Reaction ◽  
Antiepileptic Drugs ◽  
Vascular System ◽  
Tertiary Care ◽  
Stevens Johnson Syndrome ◽  
Care Hospital ◽  
Entire Study ◽  
Monitoring Centre ◽  
Post Marketing Surveillance

Background: Adverse drug reactions (ADRs) are a major cause of morbidity and mortality, and are the leading cause of hospital admission. The overall rate of ADRs is estimated to be 6.5% and 28% of these ADRs are preventable. Antiepileptic drugs (AEDs) are authorized for several therapeutic indications and are highly prescribed. ADRs due to AEDs range from minor maculopapular exanthem (MPE) to severe life-threatening reactions like Drug reaction eosinophilia and systemic symptoms (DRESS) and Stevens-Johnson syndrome (SJS). Objective of the study was to evaluate the pattern of ADRs reported with AEDs in an adverse drug reaction monitoring centre (AMC) of a tertiary care hospital.Methods: Retrospective analysis of the records was done for a period 48 months from January 2013 to December 2016. During this period, all the ADRs caused by AEDs reported to the AMC were included in the study. The study evaluated the pattern of ADRs due to AEDs. The study also assessed the gender-wise distribution, predilection for various systems, causality, severity, and preventability of ADRs. Data was analysed using descriptive statistics.Results: A total of 319 ADRs were reported by spontaneous reporting during the entire study period. Out of the total 319 ADR reports received, antiepileptic drugs related ADRs were 35 (11%). Antiepileptic drugs which caused the ADRs included phenytoin, carbamazepine, clobazam and lorazepam. The most common system affected was dermatological (60%), followed by gastrointestinal system (17.14%), vascular system (11.42%), blood (5.8%), respiratory system (5.8%) and central nervous system (2.9%). Among the dermatological ADRs, SJS accounted for 11 cases of which 10 cases were due to phenytoin and one case was due to carbamazepine. DRESS syndrome due to phenytoin was documented in one case.Conclusions: AEDs are the most commonly prescribed drugs for various indications. Uses of AEDs are accompanied by ADRs which vary from mild rashes and itching to SJS and DRESS/TEN. Post-marketing surveillance of the AEDs is important for compliance, therapeutic efficacy and ultimately safety of the patient.

scholarly journals A possible case of etoricoxib induced fixed drug eruption

2019 ◽  
Vol 8 (2) ◽  
pp. 343
Author(s):  
Apoorva . ◽  
Girish K. ◽  
Namrata C. Manjunath
Keyword(s):  
Drug Reaction ◽  
Side Effects ◽  
Drug Eruption ◽  
Past History ◽  
Tertiary Care ◽  
Lower Limbs ◽  
Care Hospital ◽  
Fixed Drug Eruption ◽  
Fixed Drug ◽  
History Of

Fixed drug eruption (FDE) is a most commonly with adverse drug reaction seen with use of Non-steroidalanti-inflammatory drugs (NSAIDs) in particular nimesulide followed by antibiotics and anticonvulsants. Etoricoxib is a selective cyclo-oxygenase isoenzyme-2 inhibitor which is superior to conventional NSAIDs and causes less side effects. Authors present a case of fixed drug eruption due to etoricoxib in a male patient. A 50-year-old patient presented to Outpatient Department (OPD) of Dermatology of a Tertiary Care Hospital with complains of skin rashes over lips, oral cavity, trunk, both the upper and lower limbs, palm, soles, scrotum and glans penis since a week. The detailed history of the patient revealed the use of etoricoxib a week back, prescribed for low back pain. It was suspected that the cutaneous drug reaction was due to the use of etoricoxib. The suspected drug etoricoxib was stopped, patient was admitted and managed symptomatically. The above reaction was assessed to be “possible” as per WHO-UMC and Naranjo causality scale, “moderate” on Hartwig’s scale and “Probably preventable” according to Schumock and Thornton criteria. This case reporting was done to sensitize the prescribers regarding rare side effects of the above drug and the need to confirm past history of drug reaction before prescription.

Rising Economic Impact of Clostridium difficile-Associated Disease in Adult Hospitalized Patient Population

2008 ◽  
Vol 29 (9) ◽  
pp. 823-828 ◽  
Author(s):  
Xiaoyan Song ◽  
John G Bartlett ◽  
Kathleen Speck ◽  
April Naegeli ◽  
Karen Carroll ◽  
...  
Keyword(s):  
At Risk ◽  
Mortality Rate ◽  
Clostridium Difficile ◽  
Economic Burden ◽  
Excess Mortality ◽  
Tertiary Care ◽  
Severity Of Illness ◽  
Adult Patients ◽  
Care Hospital ◽  
Course Of Illness

Background.Clostridium difficile-associated disease (CDAD) is responsible for increased morbidity and a substantial economic burden. Incidences of CDAD, including those with a severe course of illness, have been increasing rapidly.Objective.To evaluate the excess mortality, increased length of stay (LOS) in the hospital, and additional costs associated with CDAD.Design.A retrospective matched cohort study.Patients.Adult patients admitted to a large tertiary care hospital between January 2000 and October 2005.Methods.Adult patients were tested with a C. difficile laboratory assay at admission or 72 hours after admission. Infected patients had lor more positive assay results and were individually matched to 1 uninfected patient who had negative assay results, by exposure time, age, ward, and at least 2 measurements for comorbidity and severity of illness.Results.The incidence rate of CDAD among adult patients increased from 0.57 cases per 1,000 patient-days at risk before 2004 to 0.88 cases per 1,000 patient-days at risk after 2004 (P < .001). The 630 infected patients had a mortality rate of 11.9%; the 630 uninfected patients had a mortality rate of 15.1% (P = .02). After adjustment in the multivariate analysis, we found that the LOS for infected patients was 4 days longer than that for uninfected patients (P < .001). If CDAD occurred after 2004, the additional LOS increased to 5.5 days. The direct cost associated with CDAD was $306 per case; after year 2004, it increased to $6,326 per case.Conclusions.There may be no excess mortality among patients with CDAD, compared with patients without it, but the economic burden of CDAD is increasing. By 2004, CDAD-associated medical expenditures approached $1,000,000 per year at our institution alone.

scholarly journals Epidemiology, species distribution, and outcome of nosocomial Candida spp. bloodstream infection in Shanghai: an 11-year retrospective analysis in a tertiary care hospital

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Yan-Jun Zheng ◽  
Ting Xie ◽  
Lin Wu ◽  
Xiao-Ying Liu ◽  
Ling Zhu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mortality Rate ◽  
Antifungal Therapy ◽  
Species Distribution ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Clinical Severity ◽  
Severe Neutropenia ◽  
Care Hospital ◽  
The Impact

Abstract Background The incidence of Candida bloodstream infections (BSIs), has increased over time. In this study, we aimed to describe the current epidemiology of Candida BSI in a large tertiary care hospital in Shanghai and to determine the risk factors of 28-day mortality and the impact of antifungal therapy on clinical outcomes. Methods All consecutive adult inpatients with Candida BSI at Ruijin Hospital between January 1, 2008, and December 31, 2018, were enrolled. Underlying diseases, clinical severity, species distribution, antifungal therapy, and their impact on the outcomes were analyzed. Results Among the 370 inpatients with 393 consecutive episodes of Candida BSI, the incidence of nosocomial Candida BSI was 0.39 episodes/1000 hospitalized patients. Of the 393 cases, 299 (76.1%) were treated with antifungal therapy (247 and 52 were treated with early appropriate and targeted antifungal therapy, respectively). The overall 28-day mortality rate was 28.5%, which was significantly lower in those who received early appropriate (25.5%) or targeted (23.1%) antifungal therapy than in those who did not (39.4%; P = 0.012 and P = 0.046, respectively). In multivariate Cox regression analysis, age, chronic renal failure, mechanical ventilation, and severe neutropenia were found to be independent risk factors of the 28-day mortality rate. Patients who received antifungal therapy had a lower mortality risk than did those who did not. Conclusions The incidence of Candida BSI has increased steadily in the past 11 years at our tertiary care hospital in Shanghai. Antifungal therapy influenced short-term survival, but no significant difference in mortality was observed between patients who received early appropriate and targeted antifungal therapy.

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