Antibiotic allergy as a cause of hospitalization in adults: a hospital-based study in Ukraine
Background: Antibiotic allergy is an important clinical and social-economical issue.
Objective: The main objectives of this study were to determine the incidence, causative drugs, and risk groups of antibiotic allergy as a reason for hospitalization. The secondary objective was to evaluate the treatment of antibiotic allergy through the identification of drug related problems (DRPs).
Methods: This retrospective hospital-based study was carried out in one of Lviv city hospitals (Ukraine) from January 2015 to December 2017. Patients with antibiotic allergy as a cause for hospitalization were included in this study.
Results: In this study the incidence of antibiotic allergy was 2.0% (95%СI 1.6:2.4) of all admissions to the Unit that provides special medical care for adult inpatients with allergy diseases and allergy reactions. The mean age of patients was 48.5 years (SD=17.0; range 18-83 years) with female predominance (78.2%; 95%СI 68.9:85.2). Antibiotic hypersensitivity reactions manifested as urticaria with angioedema (52.5%; 95%СI 42.3:62.5), urticaria (36.6%; 95%СI 27.8:46.8) or angioedema (10.9%; 95%СI 5.6:18.7). Beta-lactams (48.5%; 95%СI 38.5:58.7), fluoroquinolones (13.9%; 95%СI 7.8%:22.2%) and macrolides (7.9%; 95%СI 3.5:15.0) were specified as the main causative drugs. All patients during hospitalization (a mean of 8.2 days; SD=2.2; range 2-13 days) took at least 3 medicines (a mean of 5.4 medicines per patient; SD=1.2; range 3-12 medicines). The total number of identified DRPs was 400, a mean of 4.0 DRPs per patient (SD=1.8). The most frequently identified type of DRPs was inappropriate route of drug administration (25.0%; 95%СI 20.8:29.5). This was followed by duplicate prescriptions (23.5%; 95%СI 19.4:28.0) and insufficient frequency of drug administration (19.0%; 95%СI 15.3:23.2). Potential drug-drug interactions and inappropriate drug prescriptions each accounted for 16.0% (95% СI 12.6:20.0) of all DRPs. Comparing all above items in 2015, 2016 and 2017 showed no statistically significant changes (p˃0.05).
Conclusions: Antibiotic allergy is a common reason for admissions. The treatment of antibiotic allergy is associated with numerous DRPs. Our results could be useful for development of strategies for improving the safety and quality of pharmacotherapy.
Jourdan A, Sangha B, Kim E, et al. Antibiotic hypersensitivity and adverse reactions: management and implications in clinical practice. Allergy Asthma Clin Immunol. 2020;16:6. https://doi.org/10.1186/s13223-020-0402-x
Lovegrove MC, Geller AI, Fleming-Dutra KE, Shehab N, Sapiano MRP, Budnitz DS. US Emergency Department Visits for Adverse Drug Events From Antibiotics in Children, 2011-2015. J Pediatric Infect Dis Soc. 2019;8(5):384-391. https://doi.org/10.1093/jpids/piy066
Geller AI, Lovegrove MC, Shehab N, Hicks LA, Sapiano MRP, Budnitz DS. National Estimates of Emergency Department Visits for Antibiotic Adverse Events Among Adults-United States, 2011-2015. J Gen Intern Med. 2018;33(7):1060-1068. https://doi.org/10.1007/s11606-018-4430-x
Bielen C, Bielen L, Likić R. Incidence, etiology, predictors and outcomes of suspected drug hypersensitivity reactions in a tertiary care university hospital's emergency department : A retrospective study. Wien Klin Wochenschr. 2019;131(13-14):329-336. https://doi.org/10.1007/s00508-019-1499-0
Macy E, Poon K-Y T. Self-reported antibiotic allergy incidence and prevalence: age and sex effects. Am J Med. 2009;122(8):778.e1-778.e7787. https://doi.org/10.1016/j.amjmed.2009.01.034
Bhattacharya S. The facts about penicillin allergy: a review. J Adv Pharm Technol Res. 2010;1(1):11-17.
Blumenthal KG, Peter JG, Trubiano JA, Phillips EJ. Antibiotic allergy. Lancet. 2019;393(10167):183-198. https://doi.org/10.1016/s0140-6736(18)32218-9
Sousa-Pinto B, Cardoso-Fernandes A, Araújo L, Fonseca JA, Freitas A, Delgado L. Clinical and economic burden of hospitalizations with registration of penicillin allergy. Ann Allergy Asthma Immunol. 2018;120(2):190-194.e2. https://doi.org/10.1016/j.anai.2017.11.022
MacFadden DR, LaDelfa A, Leen J, et al. Impact of Reported Beta-Lactam Allergy on Inpatient Outcomes: A Multicenter Prospective Cohort Study. Clin Infect Dis. 2016;63(7):904-910. https://doi.org/10.1093/cid/ciw462
Shehab N, Lovegrove MC, Geller AI, Rose KO, Weidle NJ, Budnitz DS. US Emergency Department Visits for Outpatient Adverse Drug Events, 2013-2014. JAMA. 2016;316(20):2115-2125. https://doi.org/10.1001/jama.2016.16201
Wu TY, Jen MH, Bottle A, et al. Ten-year trends in hospital admissions for adverse drug reactions in England 1999-2009. J R Soc Med. 2010;103(6):239-250. https://doi.org/10.1258/jrsm.2010.100113
Baran K, Pałgan K, Szortyka M, Bitner A, Bartuzi Z, Klawe JJ. Anaphylaxis as a cause of hospitalization--a single academic centre experience. Pneumonol Alergol Pol. 2015;83(3):188-192. https://doi.org/10.5603/piap.2015.0030
Olivier P, Bertrand L, Tubery M, Lauque D, Montastruc JL, Lapeyre-Mestre M. Hospitalizations because of adverse drug reactions in elderly patients admitted through the emergency department: a prospective survey. Drugs Aging. 2009;26(6):475-482. https://doi.org/10.2165/00002512-200926060-00004
van der Hooft CS, Dieleman JP, Siemes C, et al. Adverse drug reaction-related hospitalisations: a population-based cohort study. Pharmacoepidemiol Drug Saf. 2008;17(4):365-371. https://doi.org/10.1002/pds.1565
Oscanoa TJ, Lizaraso F, Carvajal A. Hospital admissions due to adverse drug reactions in the elderly. A meta-analysis. Eur J Clin Pharmacol. 2017;73(6):759-770. https://doi.org/10.1007/s00228-017-2225-3
Alexopoulou A, Dourakis SP, Mantzoukis D, et al. Adverse drug reactions as a cause of hospital admissions: a 6-month experience in a single center in Greece. Eur J Intern Med. 2008;19(7):505-510. https://doi.org/10.1016/j.ejim.2007.06.030
Lo Giudice I, Mocciaro E, Giardina C, et al. Characterization and preventability of adverse drug events as cause of emergency department visits: a prospective 1-year observational study. BMC Pharmacol Toxicol. 2019;20(1):21. https://doi.org/10.1186/s40360-019-0297-7
Turner PJ, Gowland MH, Sharma V, et al. Increase in anaphylaxis-related hospitalizations but no increase in fatalities: an analysis of United Kingdom national anaphylaxis data, 1992-2012. J Allergy Clin Immunol. 2015;135(4):956-963. https://doi.org/10.1016/j.jaci.2014.10.021
Farha RA, Saleh A, Aburuz S. The impact of drug related problems on health-related quality of life among hypertensive patients in Jordan. Pharm Pract (Granada). 2017;15(3):995. https://doi.org/10.18549/pharmpract.2017.03.995
Fijn R, Van den Bemt PM, Chow M, De Blaey CJ, De Jong-Van den Berg LT, Brouwers JR. Hospital prescribing errors: epidemiological assessment of predictors. Br J Clin Pharmacol. 2002;53(3):326-331. https://doi.org/10.1046/j.0306-5251.2001.bjcp1558.doc.x
Birarra MK, Heye TB, Shibeshi W. Assessment of drug-related problems in pediatric ward of Zewditu Memorial Referral Hospital, Addis Ababa, Ethiopia. Int J Clin Pharm. 2017;39(5):1039-1046. https://doi.org/10.1007/s11096-017-0504-9
Nivya K, Sri Sai Kiran V, Ragoo N, Jayaprakash B, Sonal Sekhar M. Systemic review on drug related hospital admissions - A pubmed based search. Saudi Pharm J. 2015;23(1):1-8. https://doi.org/10.1016/j.jsps.2013.05.006
Singh H, Kumar BN, Sinha T, Dulhani N. The incidence and nature of drug-related hospital admission: A 6-month observational study in a tertiary health care hospital. J Pharmacol Pharmacother. 2011;2(1):17-20. https://doi.org/10.4103/0976-500x.77095
Nebeker JR, Barach P, Samore MH. Clarifying adverse drug events: a clinician's guide to terminology, documentation, and reporting. Ann Intern Med. 2004;140(10):795-801. https://doi.org/10.7326/0003-4819-140-10-200405180-00009
Linkens AEMJH, Milosevic V, van der Kuy PHM, Damen-Hendriks VH, Mestres Gonzalvo C, Hurkens KPGM. Medication-related hospital admissions and readmissions in older patients: an overview of literature. Int J Clin Pharm. 2020;42(5):1243-1251. https://doi.org/10.1007/s11096-020-01040-1
Aronson JK, Ferner RE. Clarification of terminology in drug safety. Drug Saf. 2005;28(10):851-870. https://doi.org/10.2165/00002018-200528100-00003
PCNE classification for drug related problems [Internet]. Pharmaceutical Care Network Europe (PCNE) classification for drug related problems V5.01, https://studylib.net/doc/18191674/pcne-classification-scheme-for-drug-related-problems (accessed Mar 1, 2020).
ICD-10 Version: 2016 [Internet]. International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10)-WHO. https://icd.who.int/browse10/2016/en#/XIX (accessed Mar 1, 2020).
[Unified clinical protocol of emergency, primary, secondary (specialized) and tertiary (highly specialized) medical care: drug allergy, including anaphylaxis, 2015]. https://moz.gov.ua/uploads/1/5052-dn_20180510_868_dod_2.pdf (accessed Mar 1, 2020).
Medscape. https://reference.medscape.com (accessed Mar 1, 2020).
Sousa-Pinto B, Fonseca JA, Gomes ER. Frequency of self-reported drug allergy: A systematic review and meta-analysis with meta-regression. Ann Allergy Asthma Immunol. 2017;119(4):362-373.e2. https://doi.org/10.1016/j.anai.2017.07.009
Zhou L, Dhopeshwarkar N, Blumenthal KG, et al. Drug allergies documented in electronic health records of a large healthcare system. Allergy. 2016;71(9):1305-1313. https://doi.org/10.1111/all.12881
Costa MJ, Herdeiro MT, Polónia JJ, et al. Type B adverse drug reactions reported by an immunoallergology department. Pharm Pract (Granada). 2018;16(1):1070. https://doi.org/10.18549/pharmpract.2018.01.1070
Macy E, Ho NJ. Multiple drug intolerance syndrome: prevalence, clinical characteristics, and management. Ann Allergy Asthma Immunol. 2012;108(2):88-93. https://doi.org/10.1016/j.anai.2011.11.006
Thong BY, Tan TC. Epidemiology and risk factors for drug allergy. Br J Clin Pharmacol. 2011;71(5):684-700. https://doi.org/10.1111/j.1365-2125.2010.03774.x
Warrington R, Silviu-Dan F, Wong T. Drug allergy. Allergy Asthma Clin Immunol. 2018;14(Suppl 2):60. https://doi.org/10.1186/s13223-018-0289-y
Gomes E, Cardoso MF, Praça F, Gomes L, Mariño E, Demoly P. Self-reported drug allergy in a general adult Portuguese population. Clin Exp Allergy. 2004;34(10):1597-1601. https://doi.org/10.1111/j.1365-2222.2004.02070.x
[Unified clinical protocol of emergency, primary, secondary (specialized) and tertiary (highly specialized) medical care: drug allergy, including anaphylaxis, 2015] https://dec.gov.ua/wp-content/uploads/images/dodatki/2015_916_MA/2015_916_YKPMD_MA.pdf (accessed Mar 20, 2020).
van den Bemt PM, Egberts AC, Lenderink AW, et al. Risk factors for the development of adverse drug events in hospitalized patients. Pharm World Sci. 2000;22(2):62-66. https://doi.org/10.1023/a:1008721321016
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):180-186. https://doi.org/10.4103/picr.picr_132_16
Zakharov S, Tomas N, Pelclova D. Medication errors--an enduring problem for children and elderly patients. Ups J Med Sci. 2012;117(3):309-317. https://doi.org/10.3109/03009734.2012.659771
Wu HY, Chiang CW, Li L. Text mining for drug-drug interaction. Methods Mol Biol. 2014;1159:47-75. https://doi.org/10.1007/978-1-4939-0709-0_4
Schmiedl S, Rottenkolber M, Szymanski J, et al. Preventable ADRs leading to hospitalization - results of a long-term prospective safety study with 6,427 ADR cases focusing on elderly patients. Expert Opin Drug Saf. 2018;17(2):125-137. https://doi.org/10.1080/14740338.2018.1415322
Fernández-Regueiro R, Fonseca-Aizpuru E, López-Colina G, Alvarez-Uría A, Rodríguez-Ávila E, Morís-De-La-Tassa J. Prescripción inadecuada y efectos adversos a medicamentos en pacientes de edad avanzada [Inappropriate drug prescription and adverse drug effects in elderly patients]. Rev Clin Esp. 2011;211(8):400-406. https://doi.org/10.1016/j.rce.2011.05.004
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