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Objective: To characterize the patterns and determinants of acid suppressive medications use among adult medical inpatients of Kenyatta National Hospital. Design: Cross-sectional study. Setting: Medical wards in the hospital. Participants: Inpatients aged ≥18 years. Interventions: Demographic, clinical characteristics and details of acid suppressant use were examined both by records review and patient interview Main outcome measures: Demographic characteristics: age, gender; Acid suppressant use: prevalence, types, indication; Factors associated with inappropriate prescribing of acid suppressants. Results: 272 patients were included in the study. The mean age was 45.4 ± 16.6 years. 55.9% of the participants were on acid suppressive medications, majority (57.0%) being females. Proton pump inhibitors were the most frequently (95.2%) used acid suppressants. Acid suppressive medications were inappropriately prescribed in 178 (65.4%) patients. Internationally recognized indications of acid suppressive therapies accounted for 27 (28.7%) while stress ulcer prophylaxis was indicated in 55 (58.5%) of the patient in whom it was justified. Logistic regression revealed that use of cardiovascular drugs (P = 0.020), corticosteroids (P = 0.001) and anti-cancers (P = 0.012) as well as a diagnosis of pneumonia (P = 0.016) were significantly associated with inappropriate prescription of acid suppressive therapies. Conclusion: Acid suppressive medication use is high and generally unjustified among the medical inpatients of the Kenyatta National Hospital. Measures aimed at controlling their use by intensifying the evaluation of patients' in need for appropriate prescribing should be encouraged. Future studies should assess prescribers and hospital contextual factors associated with appropriate use of acid suppressive medications. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to compare renal function in diabetic hypertensive chronic kidney disease patients receiving enalapril or losartan., Design: This was a retrospective analytic cohort study., Setting: Kenyatta National Hospital, Nairobi, Kenya., Subjects: Two hundred adult patients with hypertension and diabetic nephropathy., Interventions: One hundred and sixteen participants received an enalapril regimen while 84 were on a losartan regimen., Main Outcome Measures: Time to doubling of serum creatinine and changes in the levels of proteinuria., Results: There was a higher risk of doubling of serum creatinine with losartan (Adjusted HR = 1.572; [95% CI: 1.015-2.434]; p = 0.043) than enalapril. There was a significant difference in time to doubling between the two arms--losartan 18 months, enalapril 36 month (p = 0.046). The changes in the levels of proteinuria between the two arms were not statistically significant for most of the follow up period except at the 15th month from treatment initiation (p = 0.05)., Conclusions: Enalapril was found to be more reno-protective compared to losartan. Where feasible, we suggest local use of enalapril as opposed to losartan for diabetic hypertensive chronic kidney disease patients.

Background: Antiretrovirals have been associated with serious adverse drug reactions. Several factors have been suggested as independent risk factors for their development. Identification of these factors may help in prevention and management of the adverse drug reactions., Objective: To describe the factors associated with adverse drug reactions, their management, and the clinical outcomes., Design: A retrospective cohort study., Setting: Kenyatta National Hospital, Comprehensive Care Centre., Subjects: Adult patients receiving antiretrovirals from 2003 to 2006., Main Outcome Measures: The primary outcomes were the risk-factors, interventions and outcomes of documented adverse drug reaction after exposure to antiretrovirals., Results: Systematic random sampling was used to pick 350 patients' files. The risk factors for experiencing at least one adverse drug reaction were: having a baseline CD4 count less than 123 (odds ratio [OR] = 1.82, 95% confidence interval [CI: 1.18 to 2.79; p = 0.006); treatment with antiretrovirals for more than 32 months (OR = 1.76, CI: 1.15 to 2.71; p = 0.010), using didanosine containing regimens (OR = 3.7, CI: 1.40 to 9.70; p = 0.008) or being on stavudine containing regimens (OR = 4.4, CI: 2.53 to 7.71; p = 0.001). The most common intervention was addition of a non-antiretroviral while 41% of events resulted in a change of anti-retroviral therapy., Conclusions: Current standard regimens in resource-limited countries are associated with an increased risk of adverse drug reactions. Almost half of adverse reactions are managed by addition of a non-anti-retroviral drug alone but 41% necessitated a change of anti-retrovirals.