The Influence of Adverse Drug Reactions on First-line Anti-tuberculosis Chemotherapy in the Elderly Patients / 결핵및호흡기질환

BACKGROUND: Pulmonary tuberculosis (TB) is still common disease among the elderly patients in Korea where the overall incidence of TB is decreasing. Adverse drug reactions (ADR) associated with anti-TB drugs occurs frequently. Especially the aged tends to have more frequent ADRs than younger ones. These ADRs can cause significant morbidity, compromise therapeutic effects of drugs and even induce drug resistance. Therefore we evaluated the effect of ADRs on the first-line anti-TB drugs in elderly patients with active pulmonary TB. METHODS: We retrospectively reviewed the charts and radiological findings of the patients with 65 and older who were bacteriologically confirmed as active TB and treated with standard anti-TB drugs for at least 6 months. Major ADR was defined with temporary or continuous stop of any first-line drugs intake. RESULTS: An ADR was noted in 54% of all patients. The incidence of major ADR was 32% in all elderly patients. Dermatologic ADR (9%) was the most common among the major ADRs. GI trouble (8%), arthralgia (6%), visual change (6%), hepatotoxicity (4%), and fever (1%) were also noted. The drugs responsible for major ADR were ethambutol (62%), pyrazinamide (35%), rifampin (18%) and isoniazid (9%). Major ADRs were associated with higher ESR level at the initiation of anti-TB drugs. CONCLUSION: First-line anti-TB drugs in elderly patients frequently caused the major ADRs. Therefore the elderly patients receiving anti-TB drugs should be closely monitored and better tolerable therapy should be considered as part of a TB research agenda.

A case of rifampicin-induced interstitial pneumonitis / 대한내과학회지

Rifampicin is a powerful agent for the treatment of pulmonary tuberculosis. However, it may induce several adverse effects, including rare cases of lung toxicity. Here, we report a case of rifampicin-induced interstitial pneumonitis. A 57-year-old woman diagnosed with cerebellar tuberculoma developed progressive dyspnea after the 5th day of anti-tuberculosis medication. Chest X-ray revealed newly developed ground glass opacities on both lower lung fields. Drug-induced pneumonitis was suspected and all anti-tuberculosis medications were halted. Transbronchial lung biopsy was consistent with desquamative interstitial pneumonitis. After clinical improvement, a rechallenge test with each anti-tuberculosis medication was attempted. No primary anti-tuberculosis drug except rifampicin triggered recurrence of symptoms, supporting a diagnosis of rifampicin-induced interstitial pneumonitis. Clinicians should be aware of this rare, but serious, side effect of rifampicin treatment.