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Critical Care |

Adverse Drug Reaction in Treatment of Multidrug Resistant Tuberculosis

Rajendra Prasad, DSc; Abhijeet Singh, MD; Rahul Srivastava, MD; Ramawadhsingh Kushwaha, MD; Rajiv Garg, MD; Giridhar Belur Hosmane, MD; Amita Jain, MD
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Vallabhbhai Patel Chest Institute, Delhi University, Delhi, India


Chest. 2013;144(4_MeetingAbstracts):390A. doi:10.1378/chest.1703668
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Abstract

SESSION TITLE: ICU Infections Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: Multi Drug Resistant Tuberculosis is considered to be a worldwide problem with notoriously difficult and challenging treatment. Adverse Drug Reaction (ADR) associated with second- line drugs can have severe impact on adherence to treatment. The study has been framed to know the frequency of adverse effects in patients of MDR-TB treated under modified DOTS-PLUS strategy.

METHODS: A prospective cohort study analyzing 98 consecutive patients with MDR-TB attending the Department of Pulmonary Medicine, KGMU, between June 2009 to Feb 2010 with follow-up till February 2012.All the patients were given medications free of cost as per DOTS PLUS Protocol of Revised National Tuberculosis Control Programme (RNTCP) with relevant modifications framed by Chennai Consensus. ADR associated with treatment were recognized by laboratory data and/or clinical evidence during the course of treatment.

RESULTS: Among 98 patients, 81(82.7%) patients completed the treatment while 7(7.1%) defaulted and 10(10.2%) expired at the completion of treatment. 46(43.9%) patients experienced at least one ADR. Adverse Drug Reaction observed most frequently were nausea/vomiting 24(24.5%), hearing disturbances 12(12.3%), dizziness/vertigo 10(10.2%) and arthralgia 9(9.2%). 17(17.4%) patients had major adverse effects requiring change or stoppage of drugs that included ototoxicity (6.1%), headache and psychosis (4.1%), gastrointestinal intolerance and hypothyroidism (3.1%) as well as arthralgia and hepatitis (4.1%). Agents responsible for these adverse effects were Kanamycin (ototoxicity), Cycloserine (headache/psychosis), Ethionamide (gastrointestinal tolerance/hypothyroidism) and Pyrazinamide (arthralgia/hepatitis). At the end of treatment 71(72.4%) patients were treated successfully. There was no mortality due to occurrence of ADR.

CONCLUSIONS: 17(17.4%) patients had major ADR requiring change or stoppage of drugs. 71(72.4%) patients were successfully managed despite of occurrence of major ADR.

CLINICAL IMPLICATIONS: MDR TB can be cured successfully with appropriate combination of drugs if adverse effects associated with them can be managed aggressively and timely. Newer and less toxic drugs are urgently needed to treat MDR TB patients.

DISCLOSURE: The following authors have nothing to disclose: Rajendra Prasad, Abhijeet Singh, Rahul Srivastava, Ramawadhsingh Kushwaha, Rajiv Garg, Giridhar Belur Hosmane, Amita Jain

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