Prevalence and nature of potential drug-drug interactions among hospitalized HIV patients presenting with suspected meningitis in Uganda

Autor: Daniel Kiiza, Prosperity C. Eneh, Katherine Huppler Hullsiek, David B. Meya, David R. Boulware, Joshua Rhein, Melanie R. Nicol
Rok vydání: 2020
Předmět:
Male
0301 basic medicine
Antifungal Agents
Acute care
Meningitis
Cryptococcal
chemistry.chemical_compound
0302 clinical medicine
Risk Factors
Prevalence
Drug Interactions
Uganda
030212 general & internal medicine
media_common
education.field_of_study
DDIs
medicine.diagnostic_test
Coinfection
Middle Aged
Hospitalization
Suspected meningitis
Treatment Outcome
Infectious Diseases
Anti-Retroviral Agents
Cohort studies
Female
Drug Monitoring
Meningitis
Research Article
medicine.drug
Cohort study
Adult
Drug
medicine.medical_specialty
Efavirenz
Adolescent
media_common.quotation_subject
030106 microbiology
Population
Tuberculous meningitis
lcsh:Infectious and parasitic diseases
Young Adult
03 medical and health sciences
Internal medicine
medicine
Humans
Drug-drug interactions
lcsh:RC109-216
education
Retrospective Studies
AIDS-Related Opportunistic Infections
business.industry
HIV
medicine.disease
chemistry
Therapeutic drug monitoring
Cryptococcus neoformans
HIV-1
business
Fluconazole
Zdroj: BMC Infectious Diseases, Vol 20, Iss 1, Pp 1-11 (2020)
BMC INFECTIOUS DISEASES
BMC Infectious Diseases
ISSN: 1471-2334
Popis: Background Management of co-infections including cryptococcal meningitis, tuberculosis and other opportunistic infections in persons living with HIV can lead to complex polypharmacotherapy and increased susceptibility to drug-drug interactions (DDIs). Here we characterize the frequency and types of potential DDIs (pDDIs) in hospitalized HIV patients presenting with suspected cryptococcal or tuberculous meningitis. Methods In a retrospective review of three cryptococcal meningitis trials between 2010 and 2017 in Kampala, Uganda, medications received over hospitalization were documented and pDDI events were assessed. IBM Micromedex DRUGDEX® online drug reference system was used to identify and describe potential interactions as either contraindicated, major, moderate or minor. For antiretroviral DDIs, the Liverpool Drug Interactions Checker from the University of Liverpool was also used to further describe interactions observed. Results In 1074 patients with suspected meningitis, pDDIs were present in 959 (overall prevalence = 89.3%) during the analyzed 30 day window. In total, 278 unique interacting drug pairs were identified resulting in 4582 pDDI events. Of all patients included in this study there was a mean frequency of 4.27 pDDIs per patient. Of the 4582 pDDI events, 11.3% contraindicated, 66.4% major, 17.4% moderate and 5% minor pDDIs were observed. Among all pDDIs identified, the most prevalent drugs implicated were fluconazole (58.4%), co-trimoxazole (25.7%), efavirenz (15.6%) and rifampin (10.2%). Twenty-one percent of the contraindicated pDDIs and 27% of the major ones involved an antiretroviral drug. Increased likelihood of QT interval prolongation was the most frequent potential clinical outcome. Dissonance in drug interaction checkers was noted requiring clinicians to consult more than one database in making clinical decisions about drug combinations. Conclusions The overall prevalence of pDDIs in this population is high. An understanding of drug combinations likely to result in undesired clinical outcomes, such as QT interval prolongation, is paramount. This is especially important in resource limited settings where availability of therapeutic drug monitoring and laboratory follow-up are inconsistent. Adequate quantification of the increased likelihood of adverse clinical outcomes from multiple drug-drug interactions of the same kind in a single patient is needed to aid clinical decisions in this setting.
Databáze: OpenAIRE
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