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Analysis of levofloxacin-related medication errors and prevention suggestions in the elderly in China

Published on May. 30, 2023Total Views: 640 times Total Downloads: 218 times Download Mobile

Author: Liu-Jun ZHOU 1, 2 Xiao-Ling LI 1 Yu-Qin WANG 1 [WL 7322681@sina.com]Qing-Xia ZHANG, 1

Affiliation: 1. Department of Pharmacy, Xuanwu Hospital of Capital Medical University, National Gerontic Disease Clinical Research Center, Beijing 100053, China 2. Department of Clinical Pharmacy, School of Pharmacy, Capital Medical University, Beijing 100069, China

Keywords: Levofloxacin Elderly Medication safety Medication errors

DOI: 10.19960/j.issn.1005-0698.202305001

Reference: Liu-Jun ZHOU, Xiao-Ling LI, Yu-Qin WANG, Qing-Xia ZHANG.Analysis of levofloxacin-related medication errors and prevention suggestions in the elderly in China[J].Yaowu Liuxingbingxue Zazhi,2023, 32(5): 481-488.DOI: 10.19960/j.issn.1005-0698.202305001.[Article in Chinese]

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Abstract

Objective  To investigate the incidence and causes of medication errors (MEs) related to levofloxacin in the elderly (≥60 years old) in China so as to put forward suggestions for targeted precau-tions.

Methods  Reports about levofloxacin-related MEs (excluding topical preparations) in the elderly were extracted from the National Monitoring Network for Clinical Safe Drug Medication between Sep-tember 22, 2012 and September 22, 2021. The severity of errors, content of errors, where errors were made, the personnel who made these errors, and causes of errors were retrospectively analyzed statis-tically.

Results  A total of 286 MEs reports were extracted, including 164 males and 122 females, with a median age of 70 (60-98) years old. When it came to severity of MEs, errors of class B were dominating (194 cases, 67.83%). As for the severe MEs (10 cases, 3.50%), 3 patients with adverse drug reation did not quitted medication promptly, 2 patients with severe renal insufficiency did not undergo dose ad-justment, 2 patients with a history of allergy were prescripted with levofloxacin, 2 patients with levofloxacin were treated with doxofylline, 1 patient had phlebitis due to rapid infusion. The personnel who triggered ME were mainly physicians (220 cases,76.92%), and the first three errors contents were frequency, dosage and variety. Most of these MEs were due to lack of knowledge or training and fatigue. Followed by pharmacists (41 cases, 14.34%), and the first three errors contents were variety, quantity and specification, and most of them were caused by LASA drugs. 234 cases (81.82%) of errors were identified by pharmacists.

Conclusion The use of levofloxacin in elderly patients should pay attention to prescription, dispensing and medication errors. Variety selection and dose adjustment in patients with renal insufficiency, the contraindications and caution of levofloxacin, the frequency of levofloxacin ad-ministration and drug interaction should be focused on. It is recommended that information construc-tion be fortified to decrease the ME of the prescription link, drug selection be taken seriously, clinicians be better informed of rational drug use.

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References

1.Shtaniuk E, Kovalenko T, Krasnikova L, et al. Characteristics of levofloxacin and its clinical application (review)[J]. Georgian Med News, 2020(307): 173-180. https://pubmed.ncbi.nlm.nih.gov/33270600/.

2.彭佳, 陈志宏, 刘丽华, 等. 2015—2020年长沙市2478例左氧氟沙星致药品不良反应的报告分析[J]. 中国医院用药评价与分析, 2021, 21(10): 1269-1272. [Peng J, Chen ZH, Liu LH, et al. Analysis of 2478 cases of adverse drug reactions in-duced by levofloxacin in Changsha from 2015 to 2020[J]. Evaluation and Analysis of Drug-Use in Hos-pitals of China, 2021, 21(10): 1269-1272.] DOI: 10.14009/j.issn.1672-2124.2021.10.027.

3.张青霞, 王雅葳, 李晓玲, 等. 全国临床安全用药监测网年度报告(2021)[J]. 药物不良反应杂志, 2022, 24(5): 225-232. [Zhang QX, Wang YW, Li XL, et al. Annual report of National Monitoring Network for Clinical Safe Medication (2021)[J]. Adverse Drug Reactions Journal, 2022, 24(5): 225-232.] DOI: 10.3760/cma.j.cn114015-20220421-00346.

4.张青霞, 王雅崴, 李晓玲, 等. 全国临床安全用药监测网临床安全用药年度报告(2018)[J]. 药物不良反应杂志, 2019, 21(1): 2-8. [Zhang QX, Wang YW, Li XL, et al. Annual report on clinical medication safety of National Monitoring Network for Clinical Safe Medication (2018)[J]. Adverse Drug Reactions Journal, 2019, 21(1): 2-8.] DOI: 10.3760/cma.j.issn.1008-5734.2019.01.002.

5.张青霞, 张益志, 曾艳, 等. 基于全国临床安全用药监测网的高尿酸血症/痛风患者用药错误分析[J]. 中国药房, 2021, 32(15): 1894-1898. [Zhang QX, Zhang YZ, Zeng Y, et al. Analysis of medication errors in patients with Hyperuricemia/Gout based on National Monitoring Network for Clinical Safe Drug Use[J]. China Pharmacy, 2021, 32(15): 1894-1898.] DOI: 10.6039/j.issn.1001-0408.2021.15.17.

6.合理用药国际网络中国中心组临床安全用药组, 中国药理学会药源性疾病学专业委员会, 中国药学会医院药学委员会, 等. 中国用药错误管理专家共识[J]. 药物不良反应杂志, 2014(6): 321-326. DOI: 10.3760/cma.j.issn.1008-5734.2014.06.001.

7.Adviser UC. Common terminology criteria for adverse events[EB/OL]. (2022-06-27)[2022-07-05]. https://www.uptodate.com/contents/common-terminology-criteria-for-adverse-events.

8.中国医师协会急诊医师分会, 中华医学会急诊医学分会, 中国急诊专科医联体, 等. 喹诺酮类抗菌药物急诊临床应用指导意见[J]. 中国急救医学, 2020, 40(11): 1047-1056. DOI: 10.3969/j.issn.1002-1949.2020.11.004.

9.第一三共制药有限公司. 左氧氟沙星氯化钠注射液说明书[EB/OL]. (2022-01-21)[2022-07-09]. https://zy.yaozh.com/instruct/sms20220121/3.pdf.

10.McGee EU, Samuel E, Boronea B, et al. Quinolone allergy[J]. Pharmacy (Basel), 2019, 7(3): 97. DOI: 10.3390/pharmacy7030097.

11.Doña I, Blanca-López N, Boteanu C, et al. Clinical practice guidelines for diagnosis and management of hypersensitivity reactions to quinolones[J]. J Investig Allergol Clin Immunol, 2021, 31(4): 292-307. DOI: 10.18176/jiaci.0669.

12.国家药品监督管理局. 药品不良反应信息通报(第56期) 警惕左氧氟沙星注射剂的严重不良反应[EB/OL]. (2013-08-30)[2022-07-09]. https://www.nmpa.gov.cn/xxgk/yjjsh/ypblfytb/20130802184601656.html.

13.Tandan M, Cormican M, Vellinga A. Adverse events of fluoroquinolones vs. other antimicrobials pre-scribed in primary care: a systematic review and meta-analysis of randomized controlled trials[J]. Int J Antimicrob Agents, 2018, 52(5): 529-540. DOI: 10.1016/j.ijantimicag.2018.04.014.

14.Bennett AC, Bennett CL, Witherspoon BJ, et al. An evaluation of reports of ciprofloxacin, levofloxacin, and moxi-floxacin-association neuropsychiatric toxicities, long-term disability, and aortic aneurysms/dissections disseminated by the Food and Drug Administration and the European Medicines Agency[J]. Expert Opin Drug Saf, 2019, 18(11): 1055-1063. DOI: 10.1080/14740338.2019.1665022.

15.管玉瑶, 刘雪梅, 杨静, 等. 某院氟喹诺酮类注射液高风险因素人群用药安全性分析[J]. 药物流行病学杂志, 2020, 29(10): 666-669, 704. [Guan YY, Liu XM, Yang J, et al. Analysis of drug safety in patients with high risk factors of fluoroquinolones injection in a hospital[J]. Chinese Journal of Pharmacoepidemiology, 2020, 29(10): 666-669,704.] DOI: 10.19960/j.cnki.issn1005-0698.2020.10.003.

16.国家药品监督管理局. 药物警戒快讯第1期(总第213期)[EB/OL]. (2021-02-28)[2022-07-09]. https://www.nmpa.gov.cn/directory/web/nmpa/xxgk/yjjsh/ywjjkx/20210203152540178.html.

17.Gorelik E, Masarwa R, Perlman A, et al. Fluoroquinolones and cardiovascular risk: a systematic review, meta-analysis and network meta-analysis[J]. Drug Saf, 2019, 42(4): 529-538. DOI: 10.1007/s40264-018-0751-2.

18.Tsai LH, Weng YM, Lin CC, et al. Risk screening for long QT prior to prescribing levofloxacin[J]. Am J Emerg Med, 2014, 32(9): 1151-1153. DOI: 10.1016/j.ajem.2014.02.032.

19.Tisdale JE, Jaynes HA, Kingery JR, et al. Development and validation of a risk score to predict QT in-terval prolongation in hospitalized patients[J]. Circ Cardiovasc Qual Outcomes, 2013, 6(4): 479-487. DOI: 10.1161/CIRCOUTCOMES.113.000152.

20.Shojaei L, Ruzbahani M, Khajavian S, et al. Analysis of QTc interval during levofloxacin prescription in cardiac patients with pneumonia[J]. Curr Drug Saf, 2020, 15(2): 111-116. DOI: 10.2174/1574886315666200213112702.

21.国家卫生和计划生育委员会. 抗菌药物临床应用指导原则(2015年版)[EB/OL]. (2015-08-27)[2023-02-07]. http://www.gov.cn/foot/site1/20150827/9021440664034848.pdf.

22.李桂丹, 何心. 原研与国产仿制左氧氟沙星注射液说明书的对比分析[J]. 中国药房, 2016, 27(25): 3598-3600. [Li GD, He X. Comparative analysis of the nstructions of original and domestic generic levofloxacin ilnjec-tions[J]. China Pharmacy, 2016, 27(25): 3598-3600.]DOI: 10.6039/j.issn.1001-0408.2016.25.43.

23.李朵璐, 阚全程, 张琨. 左氧氟沙星对COPD患者体内多索茶碱药动学的影响[J]. 中国药学杂志, 2008, 43(23): 1807-1810. [Li DL, Kan QC, Zhang K. Effect of levofloxacin on pharmacokinetics of doxofylline in chronic obstructive pulmonary disease patients[J]. Chinese Pharmaceutical Journal, 2008, 43(23): 1807-1810.] DOI: 10.3321/j.issn:1001-2494.2008.23.012.

24.周鹏, 姜赛平, 张幸国. 药师参与1例多索茶碱与左氧氟沙星联用致心律失常的治疗[J]. 药品评价, 2012, 9(23): 42-44. [Zhou P, Jiang SP, Zhang XG. Pharmacist's participation in the therapy of one case of arrhythmia induced by combination of doxofylline and levofloxacin[J]. Drug Evaluation, 2012, 9(23): 42-44.] DOI: 10.3969/j.issn.1672-2809.2012.23.012.

25.赵梁艳, 张珠间, 范兰珍. 1例左氧氟沙星与茶碱类药物联用致患者癫痫发作的临床分析及其治疗对策[J]. 抗感染药学, 2021, 18(5): 734-736. [Zhao LY, Zhang ZJ, Fan LZ. Clinical analysis and treatment of a case of epileptic seizure caused by levofloxacin combined with theophylline[J]. Anti-Infection Pharmacy, 2021, 18(5): 734-736.] DOI: 10.13493/j.issn.1672-7878.2021.05-030.

26.侯金华. 联用多索茶碱和左氧氟沙星治疗支气管哮喘的效果分析[J]. 当代医药论丛, 2019, 17(22): 138-139. [Hou JH. Effect of doxophylline combined with levofloxacin in the treatment of bronchial asthma[J]. Con-temporary Medicine Forum, 2019, 17(22): 138-139.] DOI:10.3969/j.issn.2095-7629.2019.22.097.

27.庄红玲, 谭娜, 李红玲. 左氧氟沙星与多索茶碱致肌肉震颤1例[J]. 中南药学, 2019, 17(1): 155-156.[Zhuang HL, Tan N, Li HL. A case of muscle tremor induced by levofloxacin and doxofylline[J]. Central South Phar-macy, 2019, 17(1): 155-156.] DOI: 10.7539/j.issn.1672-2981.2019.01.038.

28.何锦妍, 李海珊, 蔡艳芳. 多索茶碱与喹诺酮类药物联合应用的药动学与不良反应分析[J]. 临床合理用药杂志, 2019, 12(1): 87-88. [He JY, Li HS, Cai YF. Pharmacokinetics and adverse reactions of doxofylline combined with quin-olones[J]. Chinese Journal of Clinical Rational Drug Use, 2019, 12(1): 87-88.] DOI: CNKI:SUN:PLHY.0.2019-01-049.

29.Brunetti L, Lee SM, Nahass RG, et al. The risk of cardiac events in patients who received concomitant levofloxacin and  amiodarone[J]. Int J Infect Dis, 2019, 78: 50-56. DOI: 10.1016/j.ijid.2018.10.017.

30.Hosono M, Yokoyama H, Takayanagi R, et al. Interactions between new quinolone antibacterials and diagnostic drug containing  manganese[J]. Eur J Drug Metab Pharmacokinet, 2013, 38(4): 255-259. DOI: 10.1007/s13318-013-0120-6.

31.Bryan R, Aronson JK, Williams A, et al. The problem of look-alike, sound-alike name errors: drivers and solutions[J]. Br J Clin Pharmacol, 2021, 87(2): 386-394.DOI: 10.1111/bcp.14285.

32.Becherucci F, Landini S, Cirillo L, et al. Look alike, sound alike: phenocopies in steroid-resistant ne-phrotic syndrome[J]. Int J Environ Res Public Health, 2020, 17(22): 8363. DOI: 10.3390/ijerph17228363.

33.朱幸仪, 卢妤, 林沛茹. 不同静脉滴注速度对甲磺酸左氧氟沙星氯化钠注射液致皮肤血管不良反应的影响研究[J]. 中国医院用药评价与分析, 2018, 18(8): 1050-1052. [Zhu XY, Lu Y,  Lin PR. Research on rffects of intravenous drip of  levofloxacin mesylate sodium chloride iniection at different speeds on cutaneous vascular adverse reactions[J]. Evaluation and Analysis of Drug-Use in Hospitals of China, 2018, 18(8): 1050-1052.] DOI:10.14009/j.issn.1672-2124.2018.08.014.

34.成艳, 邱宁, 罗豫招, 等. 盐酸左氧氟沙星氯化钠注射液不同滴注速度对患者发生不良反应的影响[J]. 抗感染药学, 2016, 13(3): 541-543. [Cheng Y, Qiu N, Luo YZ, et al. Influence of different infusion speeds of levofloxa-cin hydrochloride and sodium chloride injection on ADRs occurrence[J].Anti-Infection Pharmacy, 2016, 13(3): 541-543.] DOI: 10.13493/j.issn.1672-7878.2016.03-019.

35.李婷, 郭丽梅, 詹文元, 等. 不同输液速度对静脉输注盐酸左氧氟沙星所致静脉炎的预防护理效果探讨[J]. 海峡药学, 2020, 32(9): 165-166. [Li T, Guo LM, Zhan WY, et al. Effect of different intravenous infusion rates on skin vascular adverse reactions induced by levofloxacin mesylate and sodium chloride injection[J]. Strait Pharmaceutical Journal, 2020, 32(9): 165-166.] DOI: 10.3969/j.issn.1006-3765.2020.09.065.

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