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November 25, 1998

Adverse Drug Reactions in Hospitalized Patients

Author Affiliations

Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor

JAMA. 1998;280(20):1741. doi:10-1001/pubs.JAMA-ISSN-0098-7484-280-20-jac80013

To the Editor.—Dr Lazarou and colleagues1 mentioned but failed to emphasize that the majority of ADRs in hospitalized patients were probably not preventable. The Adverse Drug Event Subcommittee at Santa Clara Valley Medical Center has been intensively evaluating ADRs at our hospital through an active surveillance of all admissions. We have analyzed each ADR to determine whether it was preventable and have consistently found that only 30% of the ADRs that occur in our inpatient wards are preventable. Examples of nonpreventable ADRs include severe allergic reactions to antibiotics and contrast media in patients who have had no previously noted reactions, renal failure associated with antibiotics in acutely ill patients receiving appropriate therapeutic doses of the antibiotic, and bleeding complications in patients receiving therapeutic doses of warfarin. The current practice of medicine requires the use of therapeutic agents that have a known risk of ADRs that must be balanced with their beneficial therapeutic effects. To eliminate the 70% of nonpreventable ADRs in our hospital, we would have to avoid the use of contrast media, antibiotics, and warfarin in situations for which they are clinically indicated. Prior studies of ADRs also have concluded that only 28% were preventable.2