Caries prediction by multiple salivary mutans streptococcal counts in caries-free children with different levels of fluoride exposure, oral hygiene and sucrose intake.

PURPOSE: Drug-Related Problems (DRPs) are a leading cause of preventable harm to hospitalized children, yet the data from low- and middle-income countries (LMICs) are limited. This study aimed to determine the prevalence, severity and determinants of DRPs in children with community-acquired infections (CAIs) using standard classification, and to quantify clinical and economic impact of pharmacist-led interventions.

METHODS

A prospective interventional study conducted (June 2024-March 2025), in pediatric ward of tertiary care public hospital, Karachi, Pakistan. Children aged 2months-14 years with CAIs were enrolled. A trained pharmacist reviewed medication orders daily, identifying DRPs (classified by PCNE V9.1 and severity by NCC MERP criteria). Interventions were proposed to physicians and acceptance rates recorded. Direct cost savings were calculated and DRP predictors were identified using logistic regression.

RESULTS

A total of 3,842 medication orders were reviewed for 400 patients, identifying 2,010 DRPs (5.03 DRPs/patient). Primary causes were dose-selection (C3-58.13%), drug-form (C2-15.01%), and drug-selection (C1-13.08%). Severity assessment classified 9.0% of errors as having potential to cause serious harm. Pharmacist interventions had 98.7% acceptance and 81.1% DRPs were resolved. Number of medications (AOR 1.32), fever (AOR 2.84) and length of stay >7days (AOR 1.76) were identified as predictors of DRPs; past immunization was protective (AOR 0.51). Direct cost saving was PKR 363,184 (USD1,290) over 10 months (23:1 cost ratio). Cost per DRP prevented was PKR 241 (USD 0.86), with 142% return on investment.

CONCLUSION

DRPs affected 52.3 per 100 medication orders in hospitalized children with CAIs, with dose selection DRPs predominant and 9% having serious harm potential. Pharmacist-led interventions demonstrated a 98.7% acceptance rate and 81.1% resolution of DRPs, and were associated with substantial cost savings, providing evidence for integrating clinical pharmacy services in LMICs.