Date of Award

Winter 1-4-2020

Document Type

Dissertation

Degree Name

PharmD

Department

Department of Pharmacy Practice

First Advisor

Dr. Kavitha Saravu

Abstract

Background: With advanced age, there is increased risk of various infections. Antimicrobial agents are majorly prescribed for management of these infections. Due to age-related physiological changes, many of the antimicrobial agents cause adverse mental health. Therefore, we evaluated the geriatric antimicrobial prescription to determine its potential to cause mental health issue. Objectives:  To prepare a checklist for antimicrobials which have the potential to cause adverse mental health.  Evaluate the geriatric antimicrobial prescription to determine its potential to cause mental health issue.  To determine antimicrobial-related mental health problems in geriatric patients. Methods: A prospective observational study was conducted in all the medicine departments of Kasturba Hospital (KH), Manipal. The geriatric patients prescribed with antimicrobial agents were recruited based on the inclusion and exclusion criteria. A checklist of antimicrobial agents with potential to develop adverse mental health was prepared by performing thorough literature review and hospital formulary of KH, Manipal. All the relevant data was collected in the case report form and the potential agents that could cause adverse mental health were identified using the checklist. The data was entered in IBM SPSS version 25.0 and suitable descriptive statistical analysis was carried out. Results: Out of the 115 geriatric patients, 89 (77.4%) were prescribed with a total of 178 antimicrobial agents with potential to develop adverse mental health. Average number of antimicrobials per prescription, which has the potential to cause mental health adverse effect is 1.5. These prescriptions comprised of 21 drugs from various classes of antimicrobial agents listed in the checklist prepared. Out of the 89 patients who received the antimicrobials with potential to cause the adverse mental health, 10 patients developed the adverse drug reactions such as insomnia, agitation, delirium, anxiety, nightmares, and seizures. Female geriatric patients have 3.5 times higher risk for developing the adverse mental health problems compared to male patients after the antimicrobial use (OR: 3.5; 95% CI:0.06-1.41). However, the risk for development of adverse mental health problems in patients with renal dysfunction are 28% times less likely than the patients with normal renal function (OR: 0.28; 95% CI:0.08-6.15). Conclusions: The major antimicrobial classes, which have adverse mental health issues in geriatrics are beta-lactams, tetracyclines, cephalosporins, fluoroquinolones, macrolides, sulfonamides, aminoglycosides, carbapenems, oxazolidines, other antibiotics, antifungals, antimalarial and antivirals. Risk estimation shows that women geriatric patients have higher risk for developing the adverse mental health problems compared to men after the antimicrobial use. However, unlike other studies renal dysfunction was not found to be a risk factor for developing the adverse mental health. Potential mechanism of toxicity differs among the agents and the etiology also remains unidentified in some cases. However, the incidences may be increased due to presence of co-morbidities, drug interaction and age-related changes.

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