A 29-year-old Caucasian woman with a history of schizoaffective disorder visited the emergency department with oral candidiasis. After a short wait, a junior doctor conducted a thorough history and examination. Swabs from her mouth were taken for culture and sensitivity tests, and the case was discussed with a senior colleague. Her medications were briefly reviewed, and she was discharged with a prescription for oral antifungal treatment.
Three weeks later, the patient returned to the emergency department complaining of nausea, vomiting, and palpitations. Her ECG and echocardiography revealed abnormalities, including pericardial effusion. She was admitted to the Coronary Care Unit, where multiple medical teams eventually diagnosed her with Clozapine toxicity. Her symptoms improved after discontinuing the antifungal treatment and oral contraceptives. This case highlights the severe harm caused by drug interactions.
The same junior doctor used Katana AI before prescribing the antifungal treatment. Katana AI flagged a Red Alert drug interaction between the antifungal medication, clozapine, and oral contraceptives. The AI explained that clozapine is metabolised by cytochrome P450, and inhibitors or other substrates of cytochrome P450, such as antifungals and oral contraceptives, can cause long-lasting interactions leading to Clozapine toxicity. As a result, the doctor withheld the oral contraceptive, and after consulting with the patient's psychiatrist, the clozapine dose was reduced during the antifungal treatment. The patient was successfully treated without complications.
Estimated healthcare costs
Total saving €114,200
*Average settlement cost for medical negligence due to medication error as reported in Medication related litigation in Ireland: A 6‐year review. Mark McCullagh and Dubhfeasa Slattery. Br J Clin Pharmacol. 2019 Sep; 85(9): 2155–2162.
A 64-year-old man was admitted to the hospital with right lower limb cellulitis. The medical registrar conducted a thorough history and evaluation, determining that the cellulitis was due to a superficial infection from long-standing venous eczema. Due to a severe penicillin allergy, penicillin-based antibiotics and cephalosporins were avoided. Fluoroquinolones were also not used due to other potential risks. After discussing the case with the Microbiology department, erythromycin was recommended based on previous culture sensitivities.
After three days of treatment, the cellulitis improved, but the patient complained of muscle aches. On the fourth day, the patient reported brown urine, and tests showed elevated Creatine Kinase levels, leading to a diagnosis of rhabdomyolysis. Despite intravenous hydration, the patient developed acute renal failure and was transferred to ICU for hemofiltration. After several days in ICU, he recovered and was discharged to the ward and eventually home after a prolonged hospital stay.
The medical registrar used Katana AI before starting the antibiotic treatment. Katana AI flagged a red alert interaction between erythromycin and the patient’s current statin. The AI explained that concomitant use of statins and erythromycin can cause elevated serum transaminase levels, myopathy, rhabdomyolysis, and acute renal failure. Consequently, the registrar held the statin and treated the patient, remaining vigilant for signs of rhabdomyolysis and ensuring proper hydration. The patient made an uncomplicated recovery and a short hospital stay. He resumed his statin after completing the antibiotic course.
Estimated healthcare costs
Total saving €127,900
*Average settlement cost for medical negligence due to medication error as reported in Medication related litigation in Ireland: A 6‐year review. Mark McCullagh and Dubhfeasa Slattery. Br J Clin Pharmacol. 2019 Sep; 85(9): 2155–2162.
A 77-year-old man was referred to a Urologist for the treatment of prostatitis. His medical history included hypertension, benign prostatic hypertrophy, type 2 diabetes, hypothyroidism, squamous cell carcinoma of the pharyngeal wall, and recent coronary artery bypass grafting. He was on numerous medications, including warfarin, aspirin, levothyroxine, and atorvastatin. Following history and examination, post-prostatic message cultures were sent for analysis, and he was prescribed fluoroquinolone antibiotics for one month.
Later, the patient presented to the emergency department with profound left-sided weakness. A CT scan showed a haemorrhage in the right cerebral hemisphere with a 10-mm midline shift. His prothrombin time and INR were significantly elevated. He became comatose and died within hours of arrival.
The urologist used Katana AI before starting treatment. Katana AI highlighted a Red Flag interaction between fluoroquinolones and warfarin, noting that fluoroquinolones potentiate the effects of warfarin by inhibiting vitamin K-producing intestinal flora. The AI also noted increased risk with co-administration of aspirin and levothyroxine. As a result, the urologist chose an alternative antibiotic and implemented regular INR monitoring with the practice nurse. The patient experienced no adverse outcomes.
Estimated healthcare costs
Total saving €871,400
Total cost saving 1,113,500 with Katana AI
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