Pharmacoepidemiology

Probiotics and microbiome-based therapeutics are increasingly used to prevent antibiotic-associated diarrhea (AAD) and support gut microbiota health across children, adults, and elderly populations. Evidence synthesized in this narrative review from randomized controlled trials and meta-analyses (>20,000 participants) suggests that early probiotic administration, particularly Lactobacillus rhamnosus GG, Bifidobacterium species, multistrain formulations, and Saccharomyces boulardii, is associated with a 30–40% relative reduction in AAD incidence across heterogeneous studies, with absolute risk reductions of approximately 5–12% depending on baseline risk, strain, dose, and timing. Probiotics are generally well tolerated, with mild gastrointestinal adverse effects reported in 3–5% of users and rare serious events mainly in immunocompromised individuals. However, heterogeneity in formulations, populations, and limited long-term real-world data underscores the need for further pharmacoepidemiological studies, microbiome surveillance, and evaluation of antimicrobial resistance implications.

Background/Objectives: Sodium-glucose cotransporter-2 (SGLT2) inhibitors are widely used in type 2 diabetes mellitus for glycemic control and cardiovascular–renal protection, but adverse effects such as acute kidney injury (AKI), urinary tract infection (UTI), euglycemic diabetic ketoacidosis (Eu-DKA), and acute pancreatitis remain concerns. We aimed to determine the prevalence of adverse drug reactions (ADRs) associated with SGLT2 inhibitor use. Methods: This retrospective study assessed the prevalence of these adverse events and identified factors associated with UTI among SGLT2 inhibitor users at Suddhavej Hospital (1 January 2019–15 August 2023). Data were extracted from the hospital electronic medical record system (BMS-HOSxP). Results: We analyzed 293 patients (59.73% male; mean age 63.08 ± 0.667 years; 62.08% aged >60). Dapagliflozin had the highest prevalence of AKI (11.42%) and UTI (13.40%). No acute pancreatitis cases were reported. Logistic regression identified female sex (odds ratios [OR] 2.31, 95% confidence intervals [CI] 1.08–4.96; p = 0.032), AKI diagnosis (OR 3.31, 95% CI 1.10–9.89; p = 0.032), age ≥ 60 years (OR 2.78, 95% CI 1.09–7.09; p = 0.033), and SGLT2 inhibitor use <6 months (OR 5.78, 95% CI 2.74–14.18; p = 0.017) as significant risk factors for UTI. Conclusions: Dapagliflozin was associated with the highest prevalence of AKI and UTIs. Female sex, AKI diagnosis, age ≥ 60 years, and SGLT2 inhibitor use <6 months were significant risk factors for UTI among SGLT2 inhibitor users.

Objective: The objective of this study was to determine whether Non-Hispanic Black (NHB) or Non-Hispanic White (NHW) Alzheimer dementia patients with neuropsychiatric symptoms (ADNPS) differ regarding treatment with second-generation antipsychotics (SGAs), central acetylcholinesterase inhibitors (CAIs), and selective serotonin reuptake inhibitors (SSRIs). Methods: Pharmacologic and demographic factors associated with male and female ADNPS were examined using retrospective data collected from a registry from 2016 and 2020 in a regional AD care center. The logistic regression model was developed to generate odds ratios (OR) to determine factors that were associated with male or female ADNPS. Results: A total of 7031 AD patients were identified. Overall, 6237 patients were NHWs, and 794 were NHBs. Among the NHW AD patients, 1909 presented with behavioral disturbances or neuropsychiatric symptoms (NPS), and 168 NHB AD patients presented with NPS. In the adjusted analysis, NHW ADNPS patients were more likely to be treated with galantamine (OR = 1.538, 95% CI, 1.001–2.364, p = 0.049), memantine (OR = 1.222, 95% CI, 1.086–1.375, p < 0.001), olanzapine (OR = 2.323, 95% CI, 1.794–3.009, p < 0.001), risperidone (OR = 4.181, 95% CI, 3.539–4.939, p < 0.001), and escitalopram (OR = 1.401, 95% CI, 1.225–1.602, p < 0.001). In contrast, NHB ADNPS patients were more likely to be treated with memantine (OR = 2.601, 95% CI, 1.746–3.875, p < 0.001) and risperidone (OR = 5.526, 95% CI, 3.411–8.951, p < 0.001). Conclusions: Our findings show the use of memantine and risperidone to treat both NHB and NHW ADNPS patients. NHW ADNPS patients were more likely to be treated with galantamine, memantine, olanzapine, risperidone, and escitalopram. In contrast, NHB patients with ADNPS were more likely to be treated with memantine and risperidone.