Síndrome DRESS asociado a fármacos antituberculosos / DRESS syndrome associated with antituberculous drugs

RESUMEN El síndrome DRESS es una farmacodermia grave, potencialmente fatal, que se caracteriza por eosinofilia periférica y compromiso sistémico. Los fármacos implicados con mayor frecuencia comprenden anticonvulsivantes, alopurinol, sulfasalazina y antivirales. Otros, como antibióticos, AINES y antituberculosos, también se han reportado como agentes causantes. Presentamos el caso clínico de un paciente masculino de 31 años de edad, con diagnóstico de pleuresía tuberculosa, que recibió tratamiento con isoniacida, rifampicina, pirazinamida y etambutol. A los 15 días desarrolló un exantema cutáneo febril, con compromiso hepático, pulmonar y hemodinámico, que requirió cuidados intensivos. Se suspendió el tratamiento y se administraron corticoides, con buena evolución.

ABSTRACT DRESS syndrome is a serious, potentially life-threatening adverse drug reaction, characterized by peripheral eosinophilia, and systemic compromise. The most frequently implicated drugs include anticonvulsants, allopurinol, sulfazalazine and antivirals. Others, such as antibiotics, NSAIDs and antituberculosis agents, have also been reported as causative agents. We present the clinical case of a 31-year-old male patient, diagnosed with pleural tuberculosis, who was treated with isoniazid, rifampicin, pyrazinamide and ethambutol. Fifteen days after he developed a febrile skin rash, with hepatic, pulmonary and hemodynamic involvement, which required intensive care. The treatment was suspended and corticosteroids were administered, with favorable evolution.

Study on evaluation of bioavailability of rifampicin in mixed antituberculous drug with 2 and 3 components available in Vietnam

Comparative bioavailability study of rifampicin from 2-FDC and 3- FDC with standard separate tablets at the same dose level was conducted in 12 healthy volunteers. The study was designed as a cross-over experiment with a washout period of 1 week. Bioavailability of rifampicin was estimated by plasma concentration of rifampicin from Oh to 24h after dosed. Plasma rifampicin concentration was determined by HPLC method. The results revealed that: Cmax and AVC for rifampicin in 2-FDC and 3FDC formulation were lower (but Tmax were higher) than the standard separate formulations. It was concluded that FDC tablets are of poor relative bioavailabity of rifampicin. The implication for National Tuberculosis Programme is extremely serious and warrants urgent attention