RESUMO
The emergence of drug resistant mycobacterium has become a significant public health problem creating an obstacle to effective tuberculosis (TB) control. Freedom from TB is possible with timely, regular, complete treatment, with assurance, prevention and management of side effects of antitubercular drugs. Present study was conducted to evaluate common and rare adverse drug reactions (ADR) of CAT IV and CAT V to analyse demographic, radiological and bacteriological profile and treatment outcome in MDR & XDR patients. We wanted to evaluate the common and rare adverse drug reactions of intensive phase treatment of Multi Drug Resistant Tuberculosis (MDR) and Extensively Drug Resistant Tuberculosis (XDR) as per WHO-UMC Causality Assessment Scale.METHODS76 patients of MDR and XDR Tuberculosis were admitted in DR-TB (Drug Resistant TB) centre, Burdwan Medical College and Hospital and the adverse drug reaction profile of 2nd line drugs were analysed during the intensive phase from April 2016 to September 2017 after fulfilling the inclusion and exclusion criteria. Treatment was given as per the guidelines of Revised National TB Control Program PMDT (Programmatic Management of Drug-Resistant TB).RESULTSAdverse drug reactions on GI system were nausea 73 patients (96.10%), vomiting 70 (92.10%), acidity 41 (53.9%), and sulphurous belching and hepatitis 1 (1.31%) each. Peripheral neuropathy, hearing deficit, myopathy, skin rashes, hepatitis, nephrotoxicity, cardiac toxicity and convulsion were also observed. In psychosis, 3 (3.95%) had depression and made suicidal attempt. 1 each (1.31%) in hallucination and paranoia. 5 patients (6.58%) had blurring of vision, 2 patients (3.95%) had redness of eyes and one (1.31%) had eye irritation. Reactions were common in first 60 days of the regimen and in patients with BMI ≤18.CONCLUSIONSVigilant monitoring is required for these patients during the initial period and sputum smear and culture conversion is very well correlated with clinical and radiological improvement.
RESUMO
Globally, an estimated 10.0 million people developed Tuberculosis in 2017. Side effects and toxicity of the first line anti-tubercular drugs were hepatotoxicity, skin rash, and joint pain. If hepatotoxicity develops on reintroduction of treatment with the same regimen, then treatment should be started with hepato-safe regimen. Majority of the reports have used an elevated Alanine Transaminase (ALT) or Aspartate Transaminase (AST) of 3 times upper limit of normal range (ULN) with symptoms attributable to liver injury or 5 times ULN of ALT or AST without symptoms to define hepatotoxicity. Due to paucity of studies regarding adaptive response, this study was conducted to find out the proportion of anti-tubercular drug (ATD) induced hepatitis during Anti-TB treatment and frequency of adaptive changes in Liver Enzymes during the course of anti TB treatment.METHODS116 patients who were diagnosed to have Pulmonary (PTB)/ Extrapulmonary (EPTB) tuberculosis at Outpatient & In-Patients of Department of Chest Medicine, Burdwan Medical College & Hospital, for eleven months after fulfilling the inclusion and exclusion criteria were included in the study. Treatment was given as per guidelines of Revised National TB Control Program.RESULTSIn 83.3% patients only SGPT level was elevated, while in 71% SGOT was only elevated. Both SGPT and SGOT were elevated in 66.7% of cases. Only 1.8% cases were observed with elevated SGPT and SGOT on six occasions. Only 16.7% had no elevation in SGPT and 28.9% had no elevation in SGOT. Most of the patients had asymptomatic elevation of liver enzymes and didn’t need any treatment interruption. 4.38% patients developed drug induced hepatitis and needed treatment interruption for about two weeks and all were reintroduced with the same regimen successfully.CONCLUSIONSDrug induced liver function abnormality is a common occurrence during the course of anti-TB treatment. Most patients show tolerance to anti-TB drugs and get adjusted after transient rise in liver enzymes. Concomitant use of hepatotoxic agent should be avoided as far as possible.
RESUMO
COPD is defined by GOLD as a disease characterized by airflow limitation that is not fully reversible. The chronic airflow limitation characteristic of COPD is caused by small airway disease (obstructive bronchiolitis) and parenchymal destruction (emphysema). We wanted to compare the efficacy and safety of theophylline, doxophylline and acebrophylline in the management of stable COPD patients.METHODSA prospective observational study was conducted in Burdwan Medical College and Hospital where 125 newly diagnosed adult stable COPD patients were divided into three groups each of which received theophylline, doxophylline or acebrophylline as add-on therapy over the standard for COPD. The study was conducted over a period of 13 months for spirometric parameters, severity of dyspnoea, quality of life. Assessment of adverse drug reactions was done by Naranjo’s causality assessment scale.RESULTSPatients of all three groups showed statistically significant difference in improvement in spirometric parameters and modified medical research council score and quality of life within each group. Few adverse effects like nausea were found in 2 (5.88%) patients of theophylline group, 2 (6.06%) patients of doxophylline group, and 2 (6.06%) patients of acebrophylline group. Palpitation was found in 1 (2.94%) patient of theophylline group while headache was found in 2 (6.06%) patients of acebrophylline group. Thus, it is seen that cardiological complications are more in theophylline group.CONCLUSIONSIn this study, all patients had shown some form of improvement in spirometry parameters after treatment which was maximum with doxophylline. Adverse effects were similar and non-serious in all the study patients.