Potential drug-drug interactions in paediatric outpatient prescriptions in Nigeria and implications for the future.

Question

1. What are other ways of promoting rational medicine for children?

2. What drugs were commonly implicated in the DDIs?

3. What is the role of the pharmacist in promoting rational medicine for children?

4. What did the researchers require of the patients to come for follow-up every week?

Accepted Answer

Careful consideration of medicines contraindicated or without indications in specific age-groups, for instance the use of promethazine in children under the age of two years, and the use of a handbook of medicines for children are other potential means of promoting rational medicine for children that should be embraced by the prescribers in Nigeria.

Accepted Answer

Among the seven classes of drugs implicated, antimalarials, predominantly the Artemisinin-based Combination Therapies (ACTs), were the most implicated (179; 37.3%), followed by antiemetics/antihistamines (126; 26.3%), and antimicrobials (103; 21.5%).

Accepted Answer

Collaboration between prescribers and pharmacists could further promote rational medicine use for children and reduce potential DDIs and any consequent ADEs.

Accepted Answer

During the study, adolescents and parents or caregivers of young children were required to come for follow-up every week for 6 weeks and to take note of any untoward events that may occur while their child/ward took the prescribed medicines at home.

Accepted Answer

some of the interacting drug pairs are unavoidable because of their high therapeutic benefit versus minor consequences of the interactions.

Accepted Answer

For those interacting drug pairs (promethazine and artemether/lumefantrine; ciprofloxacin and artemether/lumefantrine; and promethazine and metoclopramide) that resulted in reported adverse events, the authors believe chlorpheniramine, diphenhydramine, cetirizine, and metoclopramide are good substitutes for promethazine co-prescribed with artemether/lumenfantrine since these combinations would not produce adverse interactions.

Accepted Answer

29 Within the confines of their study, only a single drug pair (phenobarbital and artemether/amodiaquine) were implicated in the contraindicated potential DDI, whilst 10 different drug pairs (ibuprofen and ketorolac, fluconazole and ondansetron, calcium chloride and ceftriaxone, aspirin and ketorolac, glycopyrrolate and potassium chloride, calcium gluconate and ceftriaxone, metoclopramide and promethazine, ketorolac and naproxen, epinephrine and linezolid, and atropine and potassium chloride) were implicated in the larger American cohort.

Accepted Answer

Only adverse events associated with contraindicated, major and moderate interactions reported in the interaction checkers are listed in this study.

Accepted Answer

Among 520 adult medical patients, Fokter and his colleagues observed potential DDIs in the prescriptions for 51% of patients on admission and 63% on discharge, of which 13% and 18%, respectively were identified as major.

Accepted Answer

The nurses reviewed the case file of each patient prospectively during follow-up visit, weekly for six weeks to specifically look for documentation of any potential adverse event known to be associated with the interactions that was documented by the attending physicians.

Accepted Answer

Four registered nurses, trained for this research, one per study center, reviewed each case file on a daily basis, and - using a standardized form purposively designed for the study - extracted data on age and gender of the patient, prescribed medicines and their route of administration.

Accepted Answer

The ACTs (artemether/lumenfantrine and artemether/amodiaquine) (179; 37.3%) and promethazine (118; 24.6%) were the two specific drugs most commonly implicated in the potential DDIs.

Accepted Answer

In addition, the authors identified potential DDIs from the BNF for Children, Stockley’s Drug Interaction reference book, free online Medscape interaction and drugs.com databases, while Micromedex Drug-Reax® or INFOPHARM Drug Interactions Compendium®

Accepted Answer

These hospitals were chosen for the study since they are all situated in densely populated Local Government Areas and are likely to experience a very high patient load during clinic days.

Accepted Answer

Insert Figure 1Among the cohort of pediatric outpatients treated in Nigeria, less than a quarter (16.9%) were exposed to at least one potential DDI.

Potential drug-drug interactions in paediatric outpatient prescriptions in Nigeria and implications for the future.

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Most frequently asked questions

1. What are other ways of promoting rational medicine for children?

2. What drugs were commonly implicated in the DDIs?

3. What is the role of the pharmacist in promoting rational medicine for children?

4. What did the researchers require of the patients to come for follow-up every week?

5. Why are some of the interacting drug pairs unavoidable?

6. What are the common drug pairs that resulted in adverse events?

7. What drug pairs were implicated in the larger American cohort?

8. What are the main categories of interactions in the study?

9. How many potential DDIs were observed in the prescriptions of 520 adult patients?

10. How long did the nurses look for evidence of the potential adverse event?

11. How many registered nurses were trained for this study?

12. What drugs were commonly implicated in the potential DDIs?

13. What other databases were widely used for identifying potential DDIs?

14. What are the main reasons why the hospitals were chosen?

15. How many potential DDIs were reported in Nigeria?

Figures

Citations

Stockley’s Drug Interactions

Prevalence of potential drug-drug interactions in Swedish pediatric outpatients.

Potential drug-drug interactions in hospitalized pediatric patients with respiratory disorders: a retrospective review of clinically important interactions.

Reported needs of information resources, research tools, connectivity and infrastructure among African Pharmacological Scientists to improve future patient care and health

An Assessment of Medication Errors Among Pediatric Patients in Three Hospitals in Freetown Sierra Leone: Findings and Implications for a Low-Income Country

References

Adverse drug reactions as cause of admission to hospital: prospective analysis of 18 820 patients

Interventions to improve the appropriate use of polypharmacy for older people

iACP: a sequence-based tool for identifying anticancer peptides

Glucuronidation in humans. Pharmacogenetic and developmental aspects

Adverse Drug Events in the Outpatient Setting: An 11-Year National Analysis

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