Battle of polymyxin induced nephrotoxicity: Polymyxin B versus colistin.

OBJECTIVES: Nephrotoxicity is the most serious and common adverse effect that limits the use of polymyxins. This study compared polymyxin E (colistin) and polymyxin B regarding drug-related nephrotoxicity. METHODS: This study was conducted as a retrospective cohort study in a university hospital between January 2020 and July 2022. Patients older than 18 years and who received colistin or polymyxin B were identified using electronic hospital records. Kidney disease improving global outcome criteria were used for assessing nephrotoxicity. RESULTS: A total of 190 patients, 95 in both groups, were evaluated. The incidence of acute kidney injury during the treatment was higher in the colistin group [52.6% (n = 50) and 34.7% (n = 33), P = 0.013]. In patients who were exposed to high-dose, the rate of nephrotoxicity was higher in patients receiving colistin [25% (n = 3) vs. 76.9% (n = 10); P = 0.017]. Nephrotoxicity was reversible in 64.4% (n = 38) of patients and the reversibility rate was similar (70% and 52.6% for colistin and polymyxin; P = 0.248). In the multivariable analysis, colistin treatment [odds ratio (OR): 3.882, 95% confidence interval (95% CI) = (1.829-8.241)], concomitant vasopressor use (OR = 2.08, CI: 1.036-4.179), and age (OR=1.036, CI: 1.014-1.058) were found to be independent markers of nephrotoxicity. CONCLUSION: Nephrotoxicity was more common in patients receiving high-dose colistin than polymyxin B. Therefore, the use of appropriate doses of colistin is important in terms of preventing nephrotoxicity. In addition, advancing age and concomitant use of vasopressors contribute to polymyxin-related nephrotoxicity.

A retrospective study: Can dual ART mitigate the risk of potential drug-drug interactions among PLWH under stable ART?

Background/aim: People living with human immunodeficiency virus (PLWH) are getting older. Age-related comorbidities in PLWH result in polypharmacy and increase the risk for potential drug-drug interactions (pDDIs). This study aimed to evaluate how the rate of pDDIs would change if the treatment of patients receiving different combined antiretroviral therapies (ARTs) were theoretically changed with dolutegravir/lamivudine (DTG+3TC) or cabotegravir/rilpivirine (CAB+RPV). Materials and methods: This study was conducted at the infectious disease outpatient clinic of a university hospital as a follow-up of a previous study. The data of PLWH receiving at least 1 comedication other than antiretrovirals (ARVs) were retrospectively reviewed and analyzed. The Drugs.com/Drug Interactions Checker and University of Liverpool HIV Drug Interactions Checker databases were used to identify pDDIs and their severities. Results: A total of 75 PLWH, of whom 83% were male, with a mean age (± standard deviation) of 46.5 (±12.98) years were included. Polypharmacy was observed in 59 (79%) of the participants; however, with dual ARV options, the probability of polypharmacy was 35 (47%) (p < 0.001). In the Drugs.com database, no significant difference was found in terms of pDDIs between the treatment of current ARTs (64%) and DTG/3TC (%44) (p = 0.06) or CAB/RPV (%64) (p = 0.521). However, in the University of Liverpool database, the current rate of pDDIs (55%) was significantly higher compared to the theoretical treatment of DTG/3TC (40%) (p = 0.029), oral CAB/RPV (48%) (p = 0.003), and injectable CAB/RPV (31%) use (p = 0.006). Conclusion: The results suggest that dual treatment regimens can reduce pDDIs, resulting in better tolerance and probably higher quality of life among PLWH.

Effect of clinical pharmacists' interventions on dementia treatment adherence and caregivers' knowledge.

AIM: Poor adherence with dementia medications is common among patients and caregivers, owing to the absence of perceived effect, polypharmacy, and adverse effects. The aim of this study was to evaluate the effect of clinical pharmacists' interventions on the adherence to dementia treatment and the caregivers' knowledge of dementia. METHODS: This study was conducted at a geriatric outpatient clinic of the university hospital between October 2018 and April 2019. The Morisky Green Levine Adherence Scale (MGLS) to patients or caregivers and the Dementia Knowledge Assessment Tool Version Two (DKAT2) to caregivers were applied at the beginning of the study and 4 months later by a clinical pharmacist. After the scales were applied in the first interview, verbal information about the importance of adherence to dementia treatment, and incorrect answers of caregivers in DKAT2 were provided by the clinical pharmacist. RESULTS: A total of 94 patients and 91 caregivers were included in the study. High adherence to treatment was determined in 70.2% of the patients in the first interview and in 95.7% in the second interview (P < 0.001). The mean score of DKAT2 was 15.53 ± 2.44 in the first interview, while the median score of DKAT2 in the second interview was 19.11 ± 1.25 (P < 0.001). CONCLUSION: The intervention of clinical pharmacists significantly increased the adherence to dementia treatment and the caregivers' knowledge of dementia. Close monitoring of dementia patients and caregivers by clinical pharmacists and collaboration with a multidisciplinary team play an important role in dementia care. Geriatr Gerontol Int 2021; 21: 506-511.