Izloženost potencijalnim lek-antimikrobni agens interakcijama u primarnoj zdravstvenoj zaštiti
Sažetak
Uvod/Cilj. Interakcije antimikrobnih lekova predstavljaju važne i često neprepoznate komplikacije farmakoterapije koje mogu biti prevenirane. Cilj prezentovane studije bio je da se identifikuje frekvencija i tip potencijalnih interakcija antiinfektivnih lekova kod ambulantnih pacijenata, i da se definišu preporuke za kontrolu istih. Metode. Sprovedena je studija preseka koristeći bazu podataka o propisanoj terapiji. U analizu je randomizacijom uključeno 823 pacijenta (propisana ≥ 2 leka a najmanje jedan lek bio je antimikrobni agens za sistemsku upotrebu) koji su posetili Dom zdravlja Novi Sad tokom jedno-mesečnog perioda (1-30. novembar 2011). Sve interakcijske kombinacije antimikrobnih lekova su identifikovane saglasno Drug Interaction Facts. Dodatno, bazirano na kompedijumu, potencijalne interakcije su klasifikovane u kategorije: farmakološki mehanizmi, potencijalni klinički ishodi, i preporuke za kontrolu. Rezultati. Ukupno, 88 klinički značajnih potencijalnih lek-antimikrobni agens interakcija je identifikovano kod 69 (8.4%) izloženih pacijenata (prosečna starost 61.7 godina (SD ± 15.4); prosečan broj propisanih lekova 7.5 (SD ± 2.9); 56.5% su bile žene). Najzastupljeniji potencijalni interakcijski parovi su bili benzodiazepini koji se metabolizuju oksidacijom i klaritromicin ili eritromicin, i aminofilin i ciprofloksacin. U 83% svih slučajeva u osnovi je bio isključivo farmakokinetski mehanizam uključujući primarno inhibiciju metaboličkih puteva posredovanu CYP3A4 i CYP1A2 izoenzimima. Izražena sedacija (22.7%), kardiotoksičnost (20.5%), različite neželjene reakcije na aminofilin (13.6%), krvarenje (10.2%) su bili najčešće implicirani potencijalni klinički ishodi. Rizik za neželjene interakcije mogao je biti kontrolisan pažljivimmonitoringom uporedne upotrebe lekova (37.5%), različitim strategijama za modifikaciju rizika (31.8%), i izbegavanjem kombinacija (30.7%). Zaključak. Kod ambulantnih pacijenata postojao je značajan potencijal za klinički važne interakcije antimikrobnih lekova. Informacije bazirane na rezultatima istraživanja mogle bi biti integrisane u postojeći sistem za elektronsko propisivanje kao vid kliničke podrške.
Reference
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