Journal of Literature Pharmacy Sciences

Enfeksiyon Hastalıklarının Tedavisinde Deprescribing: Geleneksel Derleme
Deprescribing in the Treatment of Infectious Diseases: Traditional Review
Kübra Nur KARAKAYAa , Emre KARAb , Kutay DEMİRKANb
aHacettepe Üniversitesi Eczacılık Fakültesi, Eczacılık Bölümü, Ankara, Türkiye
bHacettepe Üniversitesi Eczacılık Fakültesi, Klinik Eczacılık AD, Ankara, Türkiye
J Lit Pharm Sci. 2024;13(2):124-32
doi: 10.5336/pharmsci.2023-100113
Article Language: TR
Full Text
ÖZET
 Günümüzde polifarmasiyi ifade etmek için birçok tanım kullanılıyor olsa da genel olarak polifarmasi hastanın ihtiyacı olan ilaç sayısından fazlasını kullanması olarak kabul edilmektedir ve olumsuz sağlık sonuçları ile ilişkilendirilmektedir. Reçete edilen ilaç sayısının fazla olması; ilaç-ilaç etkileşimlerinin, tedaviye uyumsuzluğun ve daha önemlisi advers ilaç olaylarının en önemli belirleyicileri olarak görülmektedir. Polifarmasinin neden olduğu sorunların çözümü ve iyi reçete yazma uygulamalarının bir parçası olan ''deprescribing'', ilaçla ilgili sorunları önlemek ve düzeltmek, tedavi sonuçlarını iyileştirmek ve maliyetleri azaltmak amacıyla ilaçların kesilmesi veya doz azaltılması sürecini ifade eden yeni bir kavramdır. Özellikle polifarmasi hastalarında antimikrobiyal ilaçların tedaviye eklenmesi veya tedavinin kesilmesi durumlarında yarar-risk oranı gözetilmesi önemlidir. Enfeksiyon hastalıklarının tedavisinde ''deprescribing'' uygulaması; hastanın ilaçları, klinik durumunun hekim ve eczacı tarafından bütüncül incelenmesini gerektirmektedir. Bu uygulama, potansiyel olarak uygunsuz ve akılcı olmayan antimikrobiyal ilaç kullanımını tespit edildiği takdirde ilaç tedavisinin kesilmesini, dozun azaltılmasını veya tedavi süresinin kısaltılmasını kapsamaktadır. Aynı zamanda enfeksiyon hastalığı için tedavi gören kişinin kronik hastalıkları sebebiyle düzenli kullandığı ilaçlar da detaylı olarak incelenerek ''deprescribing'' uygulamasının gerekliliği üzerine düşünülmelidir. ''Deprescribing'' uygulamasının faydalarından yararlanabilmek için hekim, klinik eczacı ve hasta iş birliği önemli ve gereklidir bunun yanında uygulamalarının sağlık alanında gereken öneme kavuşturulması, geliştirilmesi ve yaygınlaştırılması adına klinik eczacılara önemli rol düşmektedir. Bu derleme kapsamında enfeksiyon hastalıklarının tedavisinde ''deprescribing'' uygulamalarına dair mevcut veriler incelenerek uygulamaların ve faydalarının değerlendirilmesi amaçlanmıştır.

Anahtar Kelimeler: Polifarmasi; deprescribing; enfeksiyon hastalıkları; ilaç etkileşimi; advers etki
ABSTRACT
 Polypharmacy is generally recognized as the use of more than the number of medications needed by the patient and is associated with negative health outcomes. The excessive number of prescribed medications is considered the most significant determinant of drug-drug interactions, treatment non-adherence, and, more importantly, adverse drug events. Deprescribing, which is part of the solution to the problems caused by polypharmacy and good prescription practices, is a new concept that involves discontinuing or reducing the dosage of medications to prevent and correct medication-related issues, improve treatment outcomes, and reduce costs. Especially in patients with polypharmacy, the benefit-risk ratio should be considered in the addition and discontinuation of antimicrobial agents. Deprescribing in the treatment of infectious diseases requires a comprehensive examination of the patient medications and clinical condition by the physician and pharmacist. This practice requires interruption of drug treatment, dose reduction or shortening the duration of treatment if potentially inappropriate and nonrational antimicrobial drug use is detected. It is essential to carefully evaluate the ongoing medications of patients receiving treatment for an infectious disease, especially considering their chronic conditions, when initiating the process of deprescribing. Effective collaboration among the physician, clinical pharmacist, and patient is vital for maximizing the advantages of deprescribing. Additionally, clinical pharmacists play a crucial role in promoting, improving, and widely implementing these practices in the healthcare sector. This review aims to examine the available data on deprescribing practices in the treatment of infectious diseases and to evaluate the practices and their benefits.

Keywords: Polypharmacy; deprescribing; infectious diseases; drug-drug interaction; adverse effects
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