Abstract
Introduction: Drug-drug interactions (DDIs) are an important concern for patients admitted to intensive care units (ICUs). Since anti-infective agents are commonly prescribed for critically ill patients with respiratory disorders, the DDIs related to these agents should be considered by the physicians.
Aims: We aimed to identify anti-infective drug interactions with clinically important consequences in ICU-admitted patients in order to improve treatment outcomes and patient safety.
Methods: A prospective study was carried out in a respiratory referral hospital. The medication records of ICU-admitted patients receiving antibiotics were reviewed twice a week. The presence, mechanism, severity, reliability, outcome, and management of potential DDIs were determined by a clinical pharmacologist.
Results: During the 6 months, 184 patients were included in the study. From 398 prescribed anti-infective agents, 124 lead to major and contraindicated interactions. The inhibition/induction of drug metabolizer enzymes (61.32%), synergistic effect (21.69%), and altered absorption (13.2%) were the most frequent mechanisms of potential interactions. The inhibition of tacrolimus and cyclosporine metabolism by azole antifungal agents (9.43%) and QTc prolongation by co-administration of quinolones and macrolides with other torsadogenic drugs (17.92%) were the most frequent clinically significant DDIs.
Conclusions: Critically ill patients with respiratory disorders are predisposed to clinically significant anti-infective drug interactions. Monitoring therapeutic and adverse effects, dose adjustment, and considering an alternative drug are recommended for clinical management.
- Copyright ©the authors 2016
