Journal
BRITISH JOURNAL OF CLINICAL PHARMACOLOGY
Volume 80, Issue 4, Pages 818-826Publisher
WILEY
DOI: 10.1111/bcp.12567
Keywords
adverse drug reaction; antiretroviral therapy; anti-tuberculosis therapy; in-hospital death; preventability; South Africa
Categories
Funding
- Centers for Disease Control and Prevention (CDC)
- President's Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control and Prevention (CDC) [GGH000371]
Ask authors/readers for more resources
AimsFatal adverse drug reactions (ADRs) are important causes of death, but data from resource-limited settings are scarce. We determined the proportion of deaths in South African medical inpatients attributable to ADRs, and their preventability, stratified by human immunodeficiency virus (HIV) status. MethodsWe reviewed the folders of all patients who died over a 30 day period in the medical wards of four hospitals. We identified ADR-related deaths (deaths where an ADR was possible', probable' or certain' using WHO-UMC criteria and where the ADR contributed to death). We determined preventability according to previously published criteria. ResultsADRs contributed to the death of 2.9% of medical admissions and 56 of 357 deaths (16%) were ADR-related. Tenofovir, rifampicin and co-trimoxazole were the most commonly implicated drugs. 43% of ADRs were considered preventable. The following factors were independently associated with ADR-related death: HIV-infected patients on antiretroviral therapy (adjusted odds ratio (aOR) 4.4, 95% confidence interval (CI) 1.6, 12), exposure to more than seven drugs (aOR 2.5, 95% CI 1.3, 4.8) and increasing comorbidity score (aOR 1.3, 95% CI 1.1, 1.7). ConclusionsIn our setting, where HIV and tuberculosis are highly prevalent, fatal in-hospital ADRs were more common than reported in high income settings. Most deaths were attributed to drugs used in managing HIV and tuberculosis. A large proportion of the ADRs were preventable, highlighting the need to strengthen systems for health care worker training and support.
Authors
I am an author on this paper
Click your name to claim this paper and add it to your profile.
Reviews
Recommended
No Data Available