Adverse reactions among patients being treated for multi-drug resistant tuberculosis at Abbassia Chest Hospital

BackgroundPulmonary tuberculosis is a major cause of morbidity and mortality worldwide, resulting in the greatest number of deaths due to any one single infectious agent. Drug resistance threatens global tuberculosis control efforts.ObjectiveThe aim of this study was to assess adverse reactions of second-line TB drugs in patients treated for MDR-TB at Abbassia Chest Hospital from 1st of January 2009 to 1st of January 2012.Subjects and methodsThis study included 107 patients admitted at Abbassia Chest Hospital; during the period from January 2009 to January 2012. The patients were resistant to at least Rifampicin and INH. All patients’ files were analyzed and the following data were discussed: meticulous history taking, complete clinical examination, drug susceptibility testing, and initial laboratory investigations, adverse reactions were determined by clinical criteria and/or laboratory data, severity code, management of side effects and fate of treatment.Results72.9% of the patients were males and 27.1% were females. The mean of age was 37.1 years. The special habits detected among the studied cases were tobacco smoking, drug addiction and alcohol intake. According to type of resistance, acquired resistance was 95.3% and primary resistance was 4.7%. The most common co-morbidities associated with MDR-TB in the studied cases were diabetes (29.9%) and chronic obstructive lung disease (11.2%). Side effects of drugs were; 57% GIT manifestations, 53.3% peripheral neuritis, hypokalemia 26.2%, irritable bowel syndrome 22.4%, ototoxicity 17.8%, skin reaction 10.3%, hypothyroidism 10.3%, hepatotoxicity 9.3%, hypoalbuminemia 5.6%, depression 3.7%, arthritis 0.9%, gynecomastia 2.8%, hyponatremia 5.6%, hypomagnesaemia 1.9%, dizziness 0.9%, nephrotoxicity 3.7%. Most of the drugs’ side effects started to appear within the first 3 months of treatment. The frequency of nephrotoxicity, hepatotoxicity and hypoalbuminemia were significantly higher in diabetic than in non-diabetic cases. Elevations of liver enzymes began from the 3rd month after treatment and these elevations became statistically significant beginning from the 6th month. Also, elevations of creatinine levels began from the 3rd month after treatment and became statistically significant beginning from the 6th month, while there were no significant changes in potassium levels among the studied cases all through the follow up period. It was noticed that highly significant gain of body weight started from the 3rd month after treatment. 92.5% of the studied cases were cured, 6.5% died and 0.9% was defaulter. The predictors of patients’ outcome were sputum conversion, number of previous TB treatment and associated co-morbidities.ConclusionsThere is a relation between both tobacco smoking and drug addiction, and MDR TB. The most common type of resistance is acquired resistance because of lack of adherence to treatment or inappropriate treatment. The most common co-morbidities associated with MDR TB are diabetes and chronic obstructive lung diseases. The most important predictors of patients’ outcome are sputum conversion, number of previous TB treatment and presence of co-morbidities.