ObjectiveTo systematically review the adverse drug reactions (ADRs) caused by piperacillin. MethodsPubMed, EMbase, Web of Science, CNKI, WanFang Data and VIP databases were electronically searched to collect case reports on ADRs caused by piperacillin from inception to December 31, 2021. Two reviewers independently screened literature, extracted data and then a qualitative systematic review was performed. ResultsA total of 168 case reports involving 170 patients were included. The male to female ratio was 1.06∶1, and the median age was 54 year old. The statistical results showed that ADRs caused by piperacillin mostly involved the whole body (n=55), followed by the blood system (n=48), skin and soft tissue system (n=39) and nervous system (n=18). The most frequently reported cases were anaphylactic shock (n=29), followed by drug fever (n=19), rash (n=17) and thrombocytopenia (n=15). The most serious ADRs were anaphylactic shock (n=29) and bullous epidermal necrolysis (n=6). ConclusionCurrent evidence shows that ADRs caused by piperacillin mostly involved the whole body and the most serious ADRs are toxic epidermal necrolysis and anaphylactic shock.
Objective To provide the China Essential Drugs List with evidence-based data for selecting the antihypertensive drugs in ARBs category. Methods With following search terms such as losartan, atenolol and clinical trial, the relevant clinical trials on losartan and atenolol for treating hypertension in both Chinese and English languages were collected from the EMbase, PubMed, The Cochrane Library, website of clinicaltrials.gov, CNKI, VIP and CBM. Results A total of 52 studies were pooled in this systematic review, of which most focused on the losartan intervention for endpoint reduction in hypertension (LIFE) study. The main results were that: a) With the same effects in lowering blood pressure, losartan was superior to atenolol in toleration and reducing left ventricular hypertrophy; b) Losartan was more effective than atenolol in preventing cardiovascular and cerebrovascular events, especially better in preventing new-onset stroke; c) Losartan was superior to atenolol in the patients complicated with or without diabetes mellitus, with or without atrial fibrillation, and with low hemoglobin or high blood uric acid, as well as in the patients co-treated by aspirin or hydrochlorothiazide; d) No matter either losartan or atenolol used in the aggressive antihypertensive therapy, the risk of sudden cardiac death got increased in hypertensive patients with prolonged QRS duration; e) Losartan was superior to atenolol in treating patients with smoking and drinking habits; and f) There were no significant differences between losartan and atenolol in hypertensive patients of black people, different genders, as well as the patients with mutant angiotensin-converting enzyme (ACE) gene. Conclusion Losartan has the same antihypertensive effects as atenolol dose, but it is more effective in reducing left ventricular hypertrophy, and has more benefits to hypertensive patients beyond lowering blood pressure, such as, reducing urine protein and uric acid rather than high density lipoprotein.
Objective To analyze literatures reported allele frequencies of CYP2C191,2,3 for healthy Asian populations, and to provide evidence-based data for further personalized drug therapy and pharmacogenomics research. Methods Relevant articles were electronically retrieved from digital databases of PubMed, EMbase, The Cochran Library, CNKI, WanFang Data, VIP and CBM, and the articles reporting the allele frequencies of CYP2C19 were included. According to the inclusion and exclusion criteria, the data of the allele frequencies of the gene were extracted, pooled, and analyzed. Results A total of 41 articles were included, involving 9 841 healthy Asians from 17 countries. Analyses were conducted according to regional features, based on China, East Asia (China, Korea and Japan), Southeast Asia (Vietnam, Thailand, Malaysia, Singapore, Myanmar, Indonesia and Philippines), South Asia (India), and West Asia (Palestine, Lebanon, Saudi Arabia, Turkey, Iranian and Jordan). The major results showed that the allele frequencies of CYP2C191,2,3 were 61.3%, 32.1% and 6.6% (Chinese, n=4170); 61.0%, 31.2% and 7.8% (East Asians, n=5879); 67.6%, 28.8% and 3.7% (East South Asians, n=1985); 64.0%, 35.2% and 0.8% (South Asians, n=679); and 87.3%, 12.1% and 0.6% (West Asians, n=1298), respectively. Based on the included 9841 healthy Asians from 17 countries, the total allele frequencies of CYP2C191,2,3 were 66.0%, 28.4% and 5.5%, respectively. Conclusion The allele frequencies of CYP2C191,2,3 2 fairly differ in ethnic groups in China, as well as in regions in Asia. Besides, genetic variation is impacted by geographical factors such as regions and environment.
Objective To systematically evaluate anti-platelet effect of clopidogrel influenced by CYP2C192,3 polymorphism in patients with cardiovascular diseases, in order to provide references for its safe medication. Methods Literature was retrieved in electronic databases covering EMbase, PubMed, The Cochrane Library, CBM and CNKI from establishment dates to November, 2011. Observational studies and clinical trials were included, cross-checked, assessed and pooled for meta-analysis. meta-analysis was performed using the software RevMan 5.1. Results A total of 13 articles including 14 trials (n=36 855) were included. The results of meta-analysis showed that: a) there was no significant difference in the incidences of cardiovascular events between CYP2C192,3 carriers and CYP2C191 carriers; b) the risk of stent thrombosis in CYP2C192,3 carriers was significantly higher than that in CYP2C191 carriers (Plt;0.000 1), and the relative risk of CYP2C192,3 carriers increased 92% within one month (Plt;0.000 1); c) as for bleeding events, there were no significant differences between CYP2C192,3 carriers and CYP2C191 carriers. Conclusion Compared with CYP2C191 carriers, CYP2C192,3 carriers have a higher risk of stent thrombosis in clopidogrel-treated patients, but there are few differences in cardiovascular and bleeding events between the two carriers. Therefore, CYP2C192,3 carriers with cardiovascular diseases and ready to receive PCT are suggested to pay more attention to stent thrombosis when using clopidogrel. We propose that patients with cardiovascular diseases and ready to receive PCT should have CYP2C19 tests to determine the use of antiplatelet drug (clopidogrel) to avoid thrombus.
ObjectiveTo evaluate anti-platelet effect of clopidogrel influenced by CYP2C19*17 polymorphism in patients with cardiovascular disease. MethodsWe electronically searched EMbase, PubMed, The Cochrane Library, ClinicalTrials.gov, CNKI, CBM, WanFang Data and VIP databases for cohort studies about the anti-platelet effect of clopidogrel influenced by CYP2C19*17 polymorphism in patients with cardiovascular disease from inception to October 2012. Two reviewers independently screened studies according to the inclusion and exclusion criteria, extracted data and evaluated the methodological quality of the included studies. Then meta-analysis was performed using the software Rev-Man 5.2. ResultsA total of seven studies involving 12 116 patients were finally included. Three were 5 579 CYP2C19*17 carriers and 6 538 non-carriers. The results of meta-analyses showed that, compared with the CYP2C19*17 non-carriers, lower rate of cardiovascular events (OR=0.85, 95%CI 0.73 to 0.99, P=0.03) and higher bleeding events (OR=1.25, 95%CI 1.05 to 1.50, P=0.01) were found in the CYP2C19*17 carriers. ConclusionCYP2C19*17 carriers is with lower cardiovascular events and higher bleeding events than the CYP2C19*17 non-carriers.
ObjectivesTo compare different formula calculated dosages with the actual doses of warfarin from patients in Beijing Hospital so as to investigate suitable warfarin dosing models for Chinese patients.MethodsOne hundred and three Chinese patients with long-term prescription of warfarin were randomly selected from Beijing Hospital from July 2012 to May 2013. The CYP2C9 and VKROC1 genotypes and basic statistical information were collected. SPSS 18.0 software was used to compare the differences between different formula calculated dosages and the actual dosages of warfarin.ResultsFive genotypes were found in 103 patients, including: CYP2C9 AA genotype + VKORC1 AA genotype (n=72, 69.9%), CYP2C9 AA genotype + VKORC1 AG genotype (n=17, 16.5%), CYP2C9 AC genotype + VKORC1 AA genotype (n=10, 9.7%), CYP2C9 AC genotype + VKORC1 AG genotype (n=3, 2.9%) and CYP2C9 AA genotype + VKORC1 GG genotype (n=1, 1%). Compared with the actual dosages of warfarin, the degree of coincidence was highest for dosages calculated by Jeffrey’s formula.Conclusions Using Jeffrey’s formula to calculate warfarin dosages may be more suitable for Chinese patients with using long-term warfarin. Due to limited sample size, prospective and large sample size studies are required to verify the above conclusion.
ObjectiveTo evaluate the rationality of antibiotics use by analyzing the prescription reviewing results.MethodsThe review data of antibiotic prescriptions in Beijing Hospital was randomly selected from 2016 to 2019, from which unreasonable prescriptions and the antimicrobial agents were analyzed, and the use of antibiotics and unreasonable prescriptions annually were compared.ResultsThe evaluation of rational use of antibiotics involved 79 701 outpatient prescriptions from 2016 to 2019. There were 10 drugs in the top five irrational rates of outpatient antibiotics, primarily cephalosporin and quinolones, accounting for 50% and 30%, respectively. The primarily unreasonable problems were over prescription (common in gastroenterology and dermatology), unsuitable indications (common in otolaryngology), inappropriate usage and dosage (common in urology, dermatology and gastroenterology), and failure to write clinical diagnosis or incomplete clinical diagnosis (common in obstetrics and gynecology and general surgery). During the four years, the proportion of antibiotics prescriptions and the irrational rate decreased annually.ConclusionsThe use of antibiotics in outpatient department of Beijing Hospital has achieved initial results, however, there are still some problems. We should further strengthen the management of antibiotics usage, strengthen training and learning, and increase medical cooperation to promote rational drug use in clinic.
ObjectiveTo analyze genotype frequencies of CYP2C19 in healthy Asian population, and to provide evidence-based data for further personalized drug therapy and pharmacogenomics research. MethodsLiterature was retrieved from digital databases of PubMed, EMbase, The Cochrane Library (Issue 2, 2013), CNKI, WanFang Data, VIP and CBM from their established dates to August, 2013. According to the inclusion and exclusion criteria, the data of the allele frequencies of the gene were extracted, pooled, and analyzed. ResultsA total of 36 articles were included, involving 15 countries and 9 693 healthy populations. Analysis was conducted on regional features, by regions as China, East Asia (China, Korea and Japan), Southeast Asia (Vietnam, Thailand, Malaysia, Singapore, Myanmar and Indonesia), South Asia (India) and West Asia (Palestine, Lebanon, Iran, Turkey and Jordan). The results showed that the genotype frequencies of *1/*1, *1/*2, *1/*3, *2/*2, *2/*3 and *3/*3 were 37.2%, 41.4%, 6.7%, 9.9%, 4.1% and 0.7% (Chinese, n=4 105); 36.4%, 39.1%, 8.8%, 9.5%, 4.9% and 1.3% (East Asian, n=6 198); 44.9%, 41.1%, 4.7%, 7.0%, 1.8% and 0.6% (Southeast Asian, n=1 933); 43.5%, 42.9%, 0.3%, 12.7%, 0.6% and 0.0% (South Asian, n=361); 77.8%, 18.9%, 0.3%, 2.6%, 0.1% and 0.3% (West Asia, n=1 201); and 43.5%, 37.1%, 6.6%, 8.3%, 3.5% and 1.0% (Asian, n=9 693). ConclusionThe present study suggests that there is a great difference on the genotype frequencies of CYP2C19 for different ethnic groups in China, and at different regions in Asia. Besides, genetic variation is impacted by geographical factors such as region and environment.