Profile of the adverse drug reactions among the multidrug resistant tuberculosis patients treated at a tertiary level hospital in southern India

Abstract

Background: The prevalence of multi-drug resistant tuberculosis (MDR-TB) is increasing worldwide. The treatment of MDR-TB is challenging due to its delayed diagnosis, prolonged duration of therapy with larger number of drugs, coupled with their great potential for adverse drug reactions (ADRs), which severely impair treatment adherence. Early identification and effective management of ADRs form the cornerstone to ensure treatment adherence, which is an essential aspect in better treatment outcome. Materials and Methods: A prospective observational study was conducted for a period of 3 years, at Basaveshwara Medical College and Hospital, Chitradurga. All MDR-TB patients who fulfilled study criteria were included in study. After pre-treatment clinical evaluation, necessary radiological, serological and bacteriological investigations, patients were treated by Cat IV regimen for MDR TB and monitored for development of ADRs and treated appropriately. Results: Mean age of patients was 38 ± 3.6 years. A 70.9% of patients had low body mass index (BMI). A 74.5% of patients got successfully cured. ADRs were reported among 52.6% of patients. GI intolerance (49.1% in intensive phase) and psychiatric symptoms (41.8% in continuation phase) were most common ADRs reported. Low BMI was found to be significantly associated with ADRs. Conclusion: Meticulous and regular follow-ups with emphasis on early detection of ADRs during the course of ATT, dosage adjustments to effectively manage ADRs, addressing problem of malnutrition, a compulsory psychiatrist opinion as part of pre-treatment evaluation and also during continuation phase of ATT to detect the emergence of psychiatric symptoms, will go a long way in achieving high rates of favourable outcomes among MDR-TB patients. Keywords: Adverse drug reactions; Depression; Suicidal tendencies; Malnutrition; Gastro-intestinal intolerance.