ABSTRACT
Objective: This study aimed to measure concordance between different renal function estimates in terms of drug doses and determine the potential significant clinical differences. Methods: Around one hundred and eighty patients (≥ 18 y) with chronic kidney disease (CKD) were eligible for inclusion in this study. A paired-proportion cohort design was utilized using an artificial intelligence model. CKD patients refined into those who have drugs adjusted for renal function. For superiority of Cockcroft-Gault (CG) vs. modified diet in renal disease (MDRD) guided with references for concordance or discordance of the two equations and determined the dosing tiers of each drug. Validated artificial neural networks (ANN) was one outcome of interest. Variable impacts and performed reassignments were compared to evaluate the factors that affect the accuracy in estimating the kidney function for a better drug dosing. Results: The best ANN model classified most cases to CG as the best dosing method (79 vs. 72). The probability was 85% and the top performance was slightly above 93%. Creatinine levels and CKD staging were the most important factors in determining the best dosing method of CG versus MDRD. Ideal and actual body weights were second (24%). Whereas drug class or the specific drug was an important third factor (14%). Conclusion: Among many variables that affect the optimal dosing method, the top three are probably CKD staging, weight, and the drug. The contrasting CKD stages from the different methods can be used to recognize patterns, identify and predict the best dosing tactics in CKD patients.
ABSTRACT
A 46 years old patient with history of type II diabetes mellitus (DM) approached chest clinic with complaints of productive cough, low grade fever and night sweating. Positive sputum smear and cavities in upper lobe of left lung confirmed him as a pulmonary tuberculosis patient (PTB). He was prescribed World Health Organization recommended six months therapy for tuberculosis (TB). During treatment, patient suffered from persistent vomiting for which he was prescribed metoclopramide tablet (10mg). Total duration of TB treatment was prolonged up to 10 months which was attributed to frequent vomiting and uncontrolled blood sugar level throughout therapy. Appropriate glycaemic control is cornerstone in management of PTB patients with type II DM. According to United State Pharmacopoeia, dissolution time specification for rifampicin in fixed dose combination (FDC) is 45 minutes. This indicates that anti TB drugs must remain in gastrointestinal tract for at least 45 minutes. Administration of metoclopramide at least one hour before taking anti TB drugs can trim down episodes of vomiting.