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Vojnosanitetski pregled
2018, vol. 75, br. 8, str. 795-802
jezik rada: engleski
vrsta rada: izvorni naučni članak
objavljeno: 30/08/2018
doi: 10.2298/VSP160930383N
Creative Commons License 4.0
Izloženost potencijalnim lek-antimikrobni agens interakcijama u primarnoj zdravstvenoj zaštiti
aHealth Center Novi Sad, Novi Sad + Univerzitet u Novom Sadu, Medicinski fakultet, Katedra za farmaciju
bUniverzitet u Novom Sadu, Medicinski fakultet, Katedra za farmakologiju i toksikologiju
cUniverzitet u Novom Sadu, Medicinski fakultet, Katedra za farmaciju
dHealth Center Novi Sad, Novi Sad + Univerzitet u Novom Sadu, Medicinski fakultet

e-adresa: bozana.nikolic@mf.uns.ac.rs

Projekat

The work was supported by the Provincial Secretariatfor Science and Technological Development, AutonomousProvince of Vojvodina, the Republic of Serbia (Project No.142-451-2413/2018)

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 učestalost i tip potencijalnih interakcija antimikrobnih lekova kod ambulantnih bolesnika, 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 bolesnika (propisana ≥ 2 leka a najmanje jedan lek bio je antimikrobni agens za sistemsku upotrebu) koji su posetili Dom zdravlja Novi Sad tokom jednomesečnog perioda (1-30. novembar 2011). Sve interakcije 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 potencijalnih, klinički značajnih lek-antimikrobni agens interakcija identifikovano je kod 69 (8,4%) izloženih bolesnika [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 bili su benzodiazepini koji se metabolizuju oksidacijom i klaritromicin ili eritromicin kao i aminofilin i ciprofloksacin. U 83% svih slučajeva u osnovi je bio farmakokinetski mehanizam interakcija uključujući primarno inhibiciju metaboličkih puteva posredovanu izoenzimima CYP3A4 i CYP1A2. Izražena sedacija (22,7%), kardiotoksičnost (20,5%), različite neželjene reakcije na aminofilin (13,6%), krvarenje (10,2%) bili su najčešće implicirani potencijalni klinički ishodi. Rizik za neželjene interakcije mogao je biti kontrolisan pažljivim monitoringom uporedne upotrebe lekova (37,5%), različitim strategijama za modifikaciju rizika (31,8%), i izbegavanjem kombinacija (30,7%). Zaključak. Kod ambulantnih bolesnika 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.

Ključne reči

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