Risk assessment of drug interactions in polypharmasy in children

Abstract

This study was carried out on the basis of the department for children of the first year of life (infants department) of the Odessa Regional Children Clinical Hospital (ORCCH) and is devoted to the study of polypharmacy (PP) in pediatric practice. This issue is relatively well studied in the therapy of the adult population with an increased background of comorbid diseases, severe cardiovascular, metabolic and mental disorders. A narrower direction in the study of PP is the analysis of the effect of drug-drug interactions on the functions of a number of organs. For example, the computer program "Drug Interactions Checker" reports that 303 interactions have been identified for the widely used drug Ceftriaxone/lidocaine Interactions alone. Of these, 60 are strong, 179 are of medium strength and 64 are of low strength. In pediatrics, such issues are considered much less frequently, and the cause of PP is explained by the following reasons: an unreasonable combination of drugs of different classes, thermoregulation disorders, severe congenital systemic diseases, and increased prescription of antibiotics for acute respiratory infections. Unfortunately, with a general negative attitude towards PP, numerous articles devoted to the study of this medical phenomenon reveal a number of conflicting factors. By 2017, there were up to 138 definitions of polypharmacy and related terms. The most common definition of PP was found to be the numerical definition of five or more drugs per day with definitions ranging from two or more to 11 or more drugs. A wide variety of subjective interpretations of (PP) have been found to exist, such as moderate, major, elevated, excessive, severe, rational, persistent, chronic, and pseudo-polypharmacy. Interest in the problem of polypharmacy increased after the publication in 2017 of the English scientists M.Molokhia and A.Majeed who, as a result of analyzing trends in the field of PP, concluded that clinicians can maximize the benefits of prescribing multiple drugs and at the same time minimize the associated with this complication. In order to prevent unreasonable PP, in recent years, applications for smartphones have been increasingly developed to personalize treatment: “Hemolog”, “AsthmaTrack”, “Diabetes Diary”, “iheadache” and others. Purpose of the study: To identify the frequency and nature of polypharmacy at treatment of acute diseases in children less than one year of age (infants), admitted to the ORCCH in 2021 and its relationship with the clinical characteristics of diseases. Substantiation of the expediency of grouping prescribed drugs on the pharmacokinetic platform of induction or inhibition of cytochrome P450 (CYP450) activity.