RESUMEN
We report the case of an 83-year-old female patient who developed diclofenac-associated liver injury nine days after therapy had started. Diclofenac was used to treat back pain associated with an acute exacerbation of a chronic lumbovertebral symptoms reversed. We discuss the adverse reaction profile of diclofenac, particularly diclofenac-induced liver injury. We also discuss the epidemiology, clinical presentation and mechanisms of NSAID-induced liver injury, as well as risk factors and preventive measures.
Asunto(s)
Antiinflamatorios no Esteroideos/efectos adversos , Enfermedad Hepática Inducida por Sustancias y Drogas/etiología , Diclofenaco/efectos adversos , Espondilosis/tratamiento farmacológico , Anciano de 80 o más Años , Antiinflamatorios no Esteroideos/uso terapéutico , Enfermedad Hepática Inducida por Sustancias y Drogas/diagnóstico , Enfermedad Hepática Inducida por Sustancias y Drogas/epidemiología , Enfermedad Hepática Inducida por Sustancias y Drogas/prevención & control , Estudios Transversales , Diagnóstico Diferencial , Diclofenaco/uso terapéutico , Interacciones Farmacológicas , Quimioterapia Combinada , Femenino , Humanos , Pruebas de Función Hepática , Factores de Riesgo , SuizaRESUMEN
Using ATC/DDD methodology, we analyzed antibiotic utilization in the Clinical Centre of Banja Luka, one of the largest clinical centres in Bosnia and Herzegovina, during the war and postwar period (1994-2000), as well as the role of drug donations on doctors' prescribing decisions. The retrospective analysis of antibiotic utilization (group J according to the Anatomical Therapeutical Chemical - ATC classification) was based upon the data provided from the hospital computer centre and calculated as the number of defined daily doses (DDD) per 100 bed days. The pharmacoepidemiological analysis showed that the total use of antibiotics changed markedly; in the war year of 1994, as well as in 1998, antibiotics were the second most frequently used group of drugs (19.7% and 14.1% of total drug utilization respectively), while in the following years antibiotics were considerably less used. These dynamics were significantly influenced by drug donations, the percentage of which in the overall antibiotic supply in 1996 was 91.5%, while in 1999 and in 2000 it decreased considerably to 46.8% and 45.6%, respectively. The most widely prescribed antibiotics were penicillins, aminoglycosides, sulphonamides and tetracyclines. Among these, the aminopenicillins, co-trimoxazole, gentamicin and tetracyclines were mainly (70-100%) supplied as a drug donations. However, macrolides, cephalosporins and quinolones were less used due to fact that they were considerably less often delivered through drug donations. It can be concluded that the drug donations had a significant impact on prescribing practice and the rational use of antibiotics in the Clinical Centre studied.