Antimicrobial use-related drug therapy problems and associated factors among patients in the medical ward of Wachemo University Nigist Eleni Mohammed Memorial Comprehensive Specialized Hospital, Southwest Ethiopia

Objective: This study assessed the antimicrobial use-related drug therapy problems (DTPs) among patients admitted to the medical ward of Wachemo University Nigist Eleni Mohammed Memorial Comprehensive Specialized Hospital (WCUNEMMCSH), Southwest Ethiopia. Methods: A hospital-based prospective observational study design was used to assess antimicrobial use-related DTPs among patients admitted to the medical ward of WCUNEMMCSH from June to August 2021. Data were collected using a structured data abstraction format. Results: In all, 128 patients admitted to the medical ward were enrolled. Among the study participants, at least one form of antimicrobial DTP occurred in 98 (76.6%) of them. The most prevalent DTPs were unnecessary drug treatment in 42 (32.8%), the need for additional drug treatment in 36 (28.1%), and non-adherence in 30 (23.4%) of the patients. There were a total of 288 antimicrobial drug orders. Ceftriaxone 120 (41.7%) and azithromycin 69 (24.0%) were the most commonly prescribed antimicrobial drugs. In multivariate logistic analysis, the length of hospital stay (adjusted odds ratio (AOR) = 2.97, 95% confidence interval (CI): 1.06–8.32; p  = 0.04) and the number of diagnosed diseases (AOR = 3.10, 95% CI: 1.12–8.15, p  = 0.02) were predictors of antimicrobial use-related DTPs. Conclusion: Antimicrobial use-related DTPs are common among patients admitted to the medical ward of WCUNEMMCSH. Health professionals should work together to reduce the high prevalence of DTPs among medical ward admitted patients in this hospital

Comparison on incidence, type and severity grade of antiretroviral and/or antituberculosis DILI stratified by type of disease and treatment groups.

<p>Arm1  =  HIV patients treated with efavirenz based HAART only.</p><p>Arm2  =  TB-HIV patients with baseline CD4<200 cells/μL, treated with efavirenz based HAART and rifampicin based anti-tuberculosis drugs.</p><p>Arm3  =  TB-HIV patients with baseline CD4>200 cells/μL, treated with rifampicin based anti-tuberculosis drugs only,</p><p>Arm4  =  TB patients treated with rifampicin based anti-tuberculosis drugs only.</p

Socio demographic, type of HAART, baseline clinical and laboratory characteristics of study participants stratified by treatment groups.

<p>Arm1  =  HIV patients treated with efavirenz based HAART only.</p><p>Arm2  =  TB-HIV patients with baseline CD4<200 cells/μL, treated with efavirenz based HAART and rifampicin based anti-tuberculosis drugs.</p><p>Arm3  =  TB-HIV patients with baseline CD4>200 cells/μL, treated with rifampicin based anti-tuberculosis drugs only,</p><p>Arm4  =  TB patients treated with rifampicin based anti-tuberculosis drugs only.</p

Univariate and Multivariate Cox proportional regression analysis to show the risk factors for developing DILI. HR = hazard ratio.

<p>Univariate and Multivariate Cox proportional regression analysis to show the risk factors for developing DILI. HR  =  hazard ratio.</p

Comparison of incidence (Figure 1A) and severity grade of DILI in study participants stratified by treatment groups: HIV patients without TB co-infection (Arm-1) treated with efavirenz based HAART alone, TB-HIV co-infected patients with CD4 count ≤ 200 cells/μL treated with concomitant anti-TB and HAART therapy (Arm-2), TB-HIV co-infected patients with CD4 count >200 cells/μL treated with anti-TB therapy alone (Arm-3) and TB patients without HIV co-infection treated anti-TB therapy alone (Arm-4).

<p>Figure 1B indicates severity grade distribution among the total 159 DILI cases.</p

Distribution of the different types of liver injuries (hepatocellular, cholestatic and mixed type) that were observed in each treatment group (Figure 2A) and stratified by severity grade (Figure 2B): HIV patients without TB co-infection (Arm-1) treated with efavirenz based HAART alone, TB-HIV co-infected patients with CD4 count ≤ 200 cells/μL treated with concomitant anti-TB and HAART therapy (Arm-2), TB-HIV co-infected patients with CD4 count >200 cells/μL treated with anti-TB therapy alone (Arm-3) and TB patients without HIV co-infection treated anti-TB therapy alone (Arm-4).

<p>Distribution of the different types of liver injuries (hepatocellular, cholestatic and mixed type) that were observed in each treatment group (Figure 2A) and stratified by severity grade (Figure 2B): HIV patients without TB co-infection (Arm-1) treated with efavirenz based HAART alone, TB-HIV co-infected patients with CD4 count ≤ 200 cells/μL treated with concomitant anti-TB and HAART therapy (Arm-2), TB-HIV co-infected patients with CD4 count >200 cells/μL treated with anti-TB therapy alone (Arm-3) and TB patients without HIV co-infection treated anti-TB therapy alone (Arm-4).</p

Additional file 1: Table S1. of Genome-wide association and replication study of anti-tuberculosis drugs-induced liver toxicity

Top fifteen SNPs in the GWAS of ATDILI. Table S2. Top fifteen SNPs in the replication study of ATDILI. Table S3. Top SNPs in the GWAS of the pattern of ATDILI. Table S4. Top SNPs for GWAS of ATDILI in genes related to autoimmune diseases, oxidative stress, pharmacokinetic, and HLA region. (PDF 57 kb