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Mortality from adverse drug reactions in adult medical inpatients at four hospitals in South Africa: a cross‐sectional survey
Author(s) -
Mouton Johannes P.,
Mehta Ushma,
Parrish Andy G.,
Wilson Douglas P. K.,
Stewart Annemie,
Njuguna Christine W.,
Kramer Nicole,
Maartens Gary,
Blockman Marc,
Cohen Karen
Publication year - 2015
Publication title -
british journal of clinical pharmacology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.216
H-Index - 146
eISSN - 1365-2125
pISSN - 0306-5251
DOI - 10.1111/bcp.12567
Subject(s) - medicine , odds ratio , tuberculosis , cross sectional study , confidence interval , cause of death , adverse effect , pediatrics , emergency medicine , disease , pathology
Aims Fatal 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. Methods We 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. Results ADRs 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). Conclusions In 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.