Potential drug interactions with antibacterials in long-term care facilities analyzed by two interaction checkers
Background Residents in long-term care facilities take many medications concomitantly, including antibacterials, which increases the risk of drug–drug interactions. Objectives The aims of the study were to investigate the prevalence of severe potential interactions between antibacterials and other medications in Slovenian long-term care facilities and to compare the performance of two different drug–drug interaction checkers in these settings. Setting Residents in long-term care facilities in Slovenia. Method A point-prevalence study was conducted from April 2016 to June 2016. Residents’ characteristics, antibacterial treatment, and concomitant medications were obtained from their medical charts. Potential drug–drug interactions were determined using Lexicomp Online™ 3.0.2 and the online Drugs.com Drug Interactions Checker. The study only included potential drug–drug interactions categorized as type MA (major interactions) by the Drugs.com checker and as type X (should be avoided) by Lexicomp Online™. The study calculated the differences in the number of type X and MA potential drug–drug interactions between different antibacterial classes and between the two drug–drug interactions checkers. Main outcome measure Number of medications per patient, number of potential drug–drug interactions with antibacterial, and differences between two drug–drug interactions checkers. Results Eighty (68.4%) of Slovenian general long-term care facilities with 13,032 residents responded to the invitation. 317 (2.4%) of the residents received antibacterial treatment and 212 residents were included in the analysis. On average, they received 10.9 medications (SD = 3.9). Antibacterials were involved in 24.1% type MA potential drug–drug interactions and 26.4% type X potential drug–drug interactions. A significant difference in the total number of potential drug–drug interaction between the two checkers was found for all antibacterials, co-trimoxazole and fluoroquinolones (p < 0.005). Type X and MA potential drug–drug interactions were more common with fluoroquinolones than with beta-lactams or co-trimoxazole (p < 0.005). Conclusion Potential interactions between antibacterials, especially fluoroquinolones and other drugs, were common in long-term care facility residents treated with antibacterials. Differences in the number of potential drug–drug interactions between the two checkers indicate that if available the use of several sources of information is recommended in clinical practice. The results call for a collaborative approach to address the risks of drug–drug interactions.
KeywordsAntibacterials Drug–drug interactions Interactions checkers Elderly Long-term care Slovenia
Conflicts of interest
The authors declare that they have no conflict of interest.
- 13.The Association of Social Institutions in Slovenia. (2016) Highlights from analyzes. http://www.ssz-slo.si/wp-content/uploads/Poudarki-iz-komulativnega-stati%C4%8Dnega-poro%C4%8Dila-za-leto-2016.pdf. Accessed 10 Oct 2017.
- 14.European Centre for Disease Prevention and Control (ECDC) Point prevalence survey of healthcare-associated infections and antimicrobial use in European long-term care facilities. April–May 2013. Stockholm: ECDC. 2014. https://ecdc.europa.eu/sites/portal/files/media/en/publications/Publications/healthcare-associated-infections-point-prevalence-survey-long-term-care-facilities-2013.pdf. Accessed 10 Oct 2017.
- 15.Stepan D, Ušaj L, Petek Šter M, Smolinger Galun M, Smole H, Beović B. Antimicrobial prescribing in long-term care facilities: a nationwide point-prevalence study, Slovenia 2016. Euro Surveill. 2018;1:11. https://doi.org/10.2807/1560-7917.ES.2018.23.46.1800100.Google Scholar
- 16.Lexicomp-Clinical Drug Information. 2018. https://online.lexi.com/lco/action/home. Accessed 10 Oct 2017.
- 17.Drug Interactions Checker. 2018. https://www.drugs.com/drug_interactions.html. Accessed 10 Oct 2017.
- 22.Bonkat G, Bartoletti RR, Bruyère F, Cai T, Geerlings SE, Köves B, et al. Urological infections. Eur Assoc Urol. 2019. https://uroweb.org/guideline/urological-infections/#1. Accessed 15 May 2019.
- 24.European Medicines Agency. Disabling and potentially permanent side effects lead to suspension or restrictions of quinolone and fluoroquinolone antibiotics. European Medicines Agency. 2019. https://www.ema.europa.eu/en/medicines/human/referrals/quinolone-fluoroquinolone-containing-medicinal-products. Accessed 15 May 2019.
- 25.Holt S, Schimedel S, Thürmann AP. Potentially inappropriate medications in the elderly: the PRISCUS list. Dtsch Arztebl Int. 2010;107:543–51.Google Scholar
- 28.Gorup EC, Šter MP, Klančič D. Polypharmacy and inappropriate drug prescribing in elderly nursing home residents. Zdrav vestn. 2009;78:231–40.Google Scholar