Adverse Reactions to Antimicrobial Therapy

Adverse reactions to antimicrobial agents consist of toxic effects mediated through chemical changes in tissue cells, sensitivity reactions produced by antigen-antibody reactions, and biological effects caused by alteration of the bacterial flora in the body. Patients vary in their susceptibility to these because of genetically determined differences in enzyme and protein make-up, differences in immunologic reactivity, differences in environment, or because of the effects of disease. Some antibiotics are capable of producing almost invariable damage to certain tissues if given long enough in sufficient dosage, whereas others produce disturbances in only occasional patients. Almost any organ in the body may be involved, indicating that the metabolic processes affected by these agents are represented to a varying degree in the cells of the host. Little is known of the specific mechanisms involved, but as information is acquired, it should be possible to reduce the incidence of reactions.     

Adverse Reactions to Radiographic Contrast Material

Major adverse reactions to radiographic contrast media will occur more often as contrast material is now also administered during computerized tomographic (CT) scanning. Differentiation of the two major contrast reactions, the vagus reaction and the anaphylactoid reaction, is essential. Bradycardia is the key finding for identifying the vagus reaction. The vagus reaction involving hypotension and bradycardia requires treatment with large doses of atropine given intravenously. The immediate generalized reaction or anaphylactoid reaction should be treated as anaphylaxis with administration of vasopressors, fluids, steroids and antihistamines. Steroids and antihistamines given before the examination may offer protection to those high-risk patients who have had previous anaphylactoid reactions to contrast material.     

Predisposing Factors in Adverse Reactions to Drugs

Predisposing factors were sought in 118 patients who developed adverse drug reactions in hospital. Significantly more patients of 60 years and over, and more women than men, developed adverse drug reactions. Patients with reactions had more drugs before the development of the reaction than patients who did not develop reactions. A previous adverse drug reaction and a history of allergic disease were significant factors, while a history of jaundice or the presence of diabetes mellitus and renal disease was not.     

Intensive Hospital Monitoring of Adverse Reactions to Drugs

A total of 1,268 patients admitted to hospital wards were kept under surveillance by one observer throughout their stay in hospital. All drugs given to them and the occurrence of adverse reactions were recorded.Drug reactions were found in 10·2% of the 1,160 patients who received drug therapy. Most reactions were due to known pharmacological actions of the drugs. Though only four reactions were of life-threatening seriousness, 80% of the 129 reactions observed were of moderate severity. Digitalis preparations, bronchodilator drugs, and ampicillin had the highest reaction rates. It is suggested that larger surveys of adverse reactions in relation to drug usage would make a useful contribution to the problem.     

Evaluation of Spontaneous Reports of Adverse Reactions to Drugs

An adverse drug-reaction monitoring system based on spontaneous reporting to a central register of adverse reactions has been in operation for eight years. As a test of the validity of the reports and of the probability of causal relationship between drug and reaction a random sample of 82 cases were followed up in detail. The sample included 17 deaths, 26 serious reactions, and 39 reactions of moderate or only minor severity. Altogether 78% of the reactions were considered to be “probably” drug related and 13% “possibly” drug related. It is concluded that the reports are of value in the detection and evaluation of drug safety.     

Differences between Drug-Induced and Contrast Media-Induced Adverse Reactions Based on Spontaneously Reported Adverse Drug Reactions

Objective

We analyzed differences between spontaneously reported drug-induced (not including contrast media) and contrast media-induced adverse reactions.

Methods

Adverse drug reactions reported by an in-hospital pharmacovigilance center (St. Mary’s teaching hospital, Daejeon, Korea) from 2010–2012 were classified as drug-induced or contrast media-induced. Clinical patterns, frequency, causality, severity, Schumock and Thornton’s preventability, and type A/B reactions were recorded. The trends among causality tools measuring drug and contrast-induced adverse reactions were analyzed.

Results

Of 1,335 reports, 636 drug-induced and contrast media-induced adverse reactions were identified. The prevalence of spontaneously reported adverse drug reaction-related admissions revealed a suspected adverse drug reaction-reporting rate of 20.9/100,000 (inpatient, 0.021%) and 3.9/100,000 (outpatients, 0.004%). The most common adverse drug reaction-associated drug classes included nervous system agents and anti-infectives. Dermatological and gastrointestinal adverse drug reactions were most frequently and similarly reported between drug and contrast media-induced adverse reactions. Compared to contrast media-induced adverse reactions, drug-induced adverse reactions were milder, more likely to be preventable (9.8% vs. 1.1%, p < 0.001), and more likely to be type A reactions (73.5% vs. 18.8%, p < 0.001). Females were over-represented among drug-induced adverse reactions (68.1%, p < 0.001) but not among contrast media-induced adverse reactions (56.6%, p = 0.066). Causality patterns differed between the two adverse reaction classes. The World Health Organization–Uppsala Monitoring Centre causality evaluation and Naranjo algorithm results significantly differed from those of the Korean algorithm version II (p < 0.001).

Conclusions

We found differences in sex, preventability, severity, and type A/B reactions between spontaneously reported drug and contrast media-induced adverse reactions. The World Health Organization–Uppsala Monitoring Centre and Naranjo algorithm causality evaluation afforded similar results.     

培门冬酶治疗儿童急性淋巴细胞性白血病的不良反应观察

目的:观察左旋门冬酰胺酶两种常用剂型在急性淋巴细胞性白血病患儿联合化疗中的治疗反应.方法:本院2010-3-2010.12行长春新碱+吡柔比星+门冬酰胺酶+强的松方案化疗的急性淋巴细胞白血病患儿,使用含有聚乙二醇化的左旋门冬酰胺酶剂型培门冬酶即VDPAP者作为A组(40例)与既往使用含大肠杆菌剂型即VDLP者B组(60例)对比,观察不良反应.化疗前后检测血象,肝功能,凝血功能,观察过敏情况等,记录化疗后第28天的各项指标.结果:A组过敏发生2例(5%)而B组过敏发生13例(21.67%),P值0.045,有统计学意义.既往对大肠杆菌剂型发生过敏的13例患儿首剂使用PEG-Asp均无过敏,2例于第二剂时出现皮试阳性.A组(＞2级)白细胞减少16例,中性粒细胞减少26例,血红蛋白降低0例,血小板减少5例,纤维蛋白原降低1例,部分凝血活酶时间延长0例;B组(＞2级)白细胞减少28例,中性粒细胞减少46例,血红蛋白降低2例,血小板减少16例,纤维蛋白原降低2例,部分凝血活酶时间延长0例.A组(未分级)抗凝血酶Ⅱ降低23例,D二聚体升高4例,谷丙转氨酶升高5例:B组(未分级)抗凝血酶Ⅱ降低33例,D二聚体升高8例,谷丙转氨酶升高5例..血液学不良反应差异无统计学意义.A组平均住院日11.14天.B组平均住院日18.47天.结论:左旋门冬酰胺酶两种剂型不良反应相当,但培门冬酶具有使用次数少,使用方便,过敏率低,缩短住院目的优点.     

尼美舒利的临床应用及其不良反应

尼美舒利具有强大的抗炎、镇痛和解热作用。临床主要用于急慢性疼痛、关节炎、月经痛、癌症疼痛和解热。其作用机理主要是通过选择性抑制COX-2而抑制前列腺素的合成。尼美舒利的不良反应与其他NSAIDs相似,但对胃肠道副作用较少。本文总结了尼美舒利的主要临床应用及不良反应。     

培门冬酶治疗儿童急性淋巴细胞性白血病的不良反应观察

目的：观察左旋门冬酰胺酶两种常用剂型在急性淋巴细胞性白血病患儿联合化疗中的治疗反应。方法：本院2010.3-2010.12行长春新碱＋吡柔比星＋门冬酰胺酶＋强的松方案化疗的急性淋巴细胞白血病患儿,使用含有聚乙二醇化的左旋门冬酰胺酶剂型培门冬酶即VDPAP者作为A组（40例）与既往使用含大肠杆菌剂型即VDLP者B组（60例）对比,观察不良反应。化疗前后检测血象,肝功能,凝血功能,观察过敏情况等,记录化疗后第28天的各项指标。结果：A组过敏发生2例（5%）而B组过敏发生13例（21.67%）,P值0.045,有统计学意义。既往对大肠杆菌剂型发生过敏的13例患儿首剂使用PEG-Asp均无过敏,2例于第二剂时出现皮试阳性。A组（〉2级）白细胞减少16例,中性粒细胞减少26例,血红蛋白降低0例,血小板减少5例,纤维蛋白原降低1例,部分凝血活酶时间延长0例;B组（〉2级）白细胞减少28例,中性粒细胞减少46例,血红蛋白降低2例,血小板减少16例,纤维蛋白原降低2例,部分凝血活酶时间延长0例。A组（未分级）抗凝血酶Ⅲ降低23例,D二聚体升高4例,谷丙转氨酶升高5例;B组（未分级）抗凝血酶Ⅲ降低33例,D二聚体升高8例,谷丙转氨酶升高5例。.血液学不良反应差异无统计学意义。A组平均住院日11.14天。B组平均住院日18.47天。结论：左旋门冬酰胺酶两种剂型不良反应相当,但培门冬酶具有使用次数少,使用方便,过敏率低,缩短住院日的优点。     

217例药物不良反应报告分析

目的:了解我院药物不良反应(ADR)发生的特点,促进临床合理用药.方法:对我院收集到的217例ADR报告,按患者年龄、性别、给药途径、ADR程度、药物类型、ADR涉及器官或系统及临床表现等进行分类统计与分析.结果:涉及ADR的药物共有217种,抗微生物类药物居首位,其次为中成药;静脉注射引发的ADR为151例(占69.59%);ADR可发生于人体各个系统,但主要为变态反应,以皮肤及其附件损害最为严重,皮肤反应的ADR为总报告例数的67.74%.结论:临床应重视ADR的报告和监测工作,以减少或避免ADR的发生.     

Adverse Reactions to Daily and Intermittent Rifampicin Regimens for Pulmonary Tuberculosis in Hong Kong

This paper reports the nature, incidence, and severity of adverse reactions to regimens of rifampicin and ethambutol given once weekly, twice weekly, or daily and to a standard reserve regimen in a total of 330 Chinese failure patients who completed at least six months'' chemotherapy in a therapeutic comparison in Hong Kong.The adverse reactions which occurred on the regimens of intermittent rifampicin were termed cutaneous, abdominal, “flu”, and respiratory; in addition, purpura and abnormal liver function tests were encountered. There was an association of adverse reactions with the interval between doses and with the dose size of rifampicin, the highest incidence occurring with once-weekly rifampicin in high dosage. A procedure was developed for managing adverse reactions to intermittent rifampicin. Of 202 patients treated with intermittent rifampicin 60 developed adverse reactions, but in only 7 (3%) was it necessary to terminate the drug, though a further 10 (5%) were changed to daily rifampicin. On daily rifampicin, generalized hypersensitivity, cutaneous reactions, (one with purpura), and impaired liver function were encountered. Adverse reactions on the standard ethionamide, pyrazinamide, and cycloserine regimen were frequent and some were serious.     

药物不良反应造成急性肾损害的临床分析

目的：研究药物不良反应（ADR）所致急性肾损伤的相关因素并探讨其诊疗思路。,方法：对56例ADR造成急性肾损害的病例进行归类统计和分析评价。结果：56例病例中,男性略多于女性,男女之比为1．24：1,平均年龄53．1岁;抗生素发生率居首位,其次为中成药;途径以静脉注射为主。结论：合理用药,早期干预治疗,预防药源性急性肾损害的发生。     

Bias in Spontaneous Reporting of Adverse Drug Reactions in Japan

Background

Attitudes of healthcare professionals regarding spontaneous reporting of adverse drug reactions (ADRs) in Japan are not well known, and Japan’s unique system of surveillance, called early post-marketing phase vigilance (EPPV), may affect these reporting attitudes. Our objectives were to describe potential effects of EPPV and to test whether ADR seriousness, prominence, and frequency are related to changes in reporting over time.

Methods

A manufacturer’s database of spontaneous ADR reports was used to extract data from individual case safety reports for 5 drugs subject to EPPV. The trend of reporting and the time lag between ADR onset and reporting to the manufacturer were examined. The following indices for ADRs occurring with each drug were calculated and analyzed to assess reporting trends: Serious:Non-serious ratio, High prominence:Low prominence ratio, and High frequency:Low frequency ratio.

Results

For all 5 drugs, the time lag between ADR onset and reporting to the manufacturer was shorter in the EPPV period than in the post-EPPV period. All drugs showed higher Serious:Non-serious ratios in the post-EPPV period. No specific patterns were observed for the High prominence:Low prominence ratio. The High frequency:Low frequency ratio for peginterferon alpha-2a and sevelamer hydrochloride decreased steadily throughout the study period.

Conclusions

Healthcare professionals may be more likely to report serious ADRs than to report non-serious ADRs, but the effect of event prominence on reporting trends is still unclear. Factors associated with ADR reporting attitude in Japan might be different from those in other countries because of EPPV and the involvement of medical representatives in the spontaneous reporting process. Pharmacovigilance specialists should therefore be cautious when comparing data between different time periods or different countries. Further studies are needed to elucidate the underlying mechanism of spontaneous ADR reporting in Japan.     

A Structure-Based Approach for Mapping Adverse Drug Reactions to the Perturbation of Underlying Biological Pathways

Adverse drug reactions (ADR), also known as side-effects, are complex undesired physiologic phenomena observed secondary to the administration of pharmaceuticals. Several phenomena underlie the emergence of each ADR; however, a dominant factor is the drug''s ability to modulate one or more biological pathways. Understanding the biological processes behind the occurrence of ADRs would lead to the development of safer and more effective drugs. At present, no method exists to discover these ADR-pathway associations. In this paper we introduce a computational framework for identifying a subset of these associations based on the assumption that drugs capable of modulating the same pathway may induce similar ADRs. Our model exploits multiple information resources. First, we utilize a publicly available dataset pairing drugs with their observed ADRs. Second, we identify putative protein targets for each drug using the protein structure database and in-silico virtual docking. Third, we label each protein target with its known involvement in one or more biological pathways. Finally, the relationships among these information sources are mined using multiple stages of logistic-regression while controlling for over-fitting and multiple-hypothesis testing. As proof-of-concept, we examined a dataset of 506 ADRs, 730 drugs, and 830 human protein targets. Our method yielded 185 ADR-pathway associations of which 45 were selected to undergo a manual literature review. We found 32 associations to be supported by the scientific literature.     

双膦酸盐类药物致不良反应回顾性分析

目的:分析双膦酸盐类药物所致不良反应情况。方法:检索中国期刊全文数据库(CNKI)、万方数据库(Wan Fang)、中文科技期刊数据库(VIP)2004年1月至2013年8月国内有关双膦酸盐致不良反应的个案报道,按年龄、性别、原发病、药物名称、给药途径、不良反应发生时间、临床表现症状、治疗与转归等进行分类统计分析。结果:48例不良反应包括运动系统、消化系统、感官系统、循环系统、神经系统及全身性损害,高年龄段与女性发生率较高。结论:临床上应重视双膦酸盐类药物所致不良反应,坚持合理用药。     

Caveolin-1 Provides Palliation for Adverse Hepatic Reactions in Hypercholesterolemic Rabbits

Caveolins are an essential component of cholesterol-rich invaginations of the plasma membrane known as caveolae. These flask-shaped, invaginated structures participate in a number of important cellular processes, including vesicular transport, cholesterol homeostasis, and signal transduction. We investigated the effects of CAV-1 on mitochondrial biogenesis and antioxidant enzymes in hypercholesterolemia-affected target organs. A total of eighteen male New Zealand white rabbits were divided into three groups: a normal-diet group, an untreated hypercholesterolemia-induced group, and a hypercholesterolemia-induced group that received intravenous administration of antennapedia-CAV-1 (AP-CAV-1) peptide every 2 days for 2 weeks. Serum biochemistry, CAV-1 distribution, neutral lipid distribution, mitochondrial morphology, biogenesis-mediated protein content, oxidative stress balance, antioxidant enzyme levels, and apoptotic cell death of liver tissue were analysed. Hepatic and circulating cholesterol and low-density lipoprotein cholesterol (LDL-C) levels differed significantly between the three groups (P<0.05). Immunohistochemical staining intensity of CAV-1 was greater in AP-CAV-1-treated rabbits than in untreated rabbits, especially in the vicinity of the liver vasculature. The high levels of neutral lipids, malondialdehyde, peroxisome proliferator-activated receptor-γ coactive 1α (PGC-1α), and nuclear respiratory factor-1 (NRF-1) seen in untreated hypercholesteremic animals were attenuated by administration of AP-CAV-1 (P<0.05). In addition, mitochondria in animals that received treatment exhibited darker electron-dense matrix and integrated cristae. Furthermore, the levels of ROS modulator 1 (Romo1) and superoxide dismutase (SOD)-2, as well as catalase activity were significantly lower in CAV-1-treated hypercholesterolemic rabbits (P<0.05). AP-CAV-1 treatment also restored mitochondrial respiratory chain subunit protein content (OXPHOS complexes I–V), thereby preserving mitochondrial function (P<0.05). Furthermore, AP-CAV-1 treatment significantly suppressed apoptotic cell death, as evidenced by a reduction in the number of TUNEL-positive cells. Our results indirectly indicate that CAV-1 mediates the negative effects of PGC-1α on hepatic mitochondrial respiratory chain function, promotes the antioxidant enzyme defence system, and maintains mitochondrial biogenesis.