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Author: Alexandra Farag, University of Western
Ontario, Class of 2013
Introduction: Antibiotics are frequently
misprescribed in patients with chronic kidney disease (CKD) and are
implicated in over one third of preventable adverse drug events in
these patients. To improve the safety of CKD patients, in January
2006, outpatient laboratories in Ontario, Canada began reporting
estimated glomerular filtration rate (eGFR) with adult laboratory
serum creatinine tests. We sought to describe the rate of
ambulatory antibiotic dosing errors in Southwestern Ontario and
examine the impact of eGFR reporting on these errors.
Methods: We linked health administrative data
for ambulatory residents in Southwestern Ontario from January 2003
to April 2010. Patients had non-dialytic stage 4 or 5 CKD (eGFR
< 30 ml/min/1.73 m2 ) and were 66 years of age or older. We
conducted a population-based intervention analysis with time-series
modeling on the monthly rate of dosing errors in these
Results: Of the total 1464 prescriptions filled
for study antibiotics throughout the study period, 970 (66%) were
dosed in excess of guidelines. Nitrofurantoin was prescribed 169
times, despite being contraindicated in patients with creatinine
clearance < 60 ml/min. The initiation of eGFR reporting was not
associated with a decline in the rate of antibiotic dosing errors.
Prior to eGFR reporting the average rate of dosing errors was 636
per 1000 antibiotic prescriptions; after eGFR reporting, the rate
of dosing errors was 680 per 1000 antibiotic prescriptions.
Conclusion: Our findings demonstrate that
ambulatory antibiotic dosing errors are exceedingly common among
non-dialytic stage 4 and 5 CKD patients. Moreover, eGFR reporting
has not impacted the rate of these errors at the population level.
Further interventions to reduce medication errors in CKD patients
may therefore be warranted.
November 2012 Issue of IMpact