ObjectivesThis study aims to analyze the profile and relevance of pharmaceutical interventions (PIs) in the management of tuberculosis (TB) at inpatient settings.Patients and methodsCross-sectional descriptive study conducted from March to December 2014 within the inpatient unit of pneumophtisiology department, Ivory Coast. Information collected was based on the classification of drug-related problems (DRPs) and PIs outlined by the French Society of Clinical Pharmacy. A score was assigned to each PI according to the importance of the potential clinical impact. This score was correlated with the severity of clinical consequences avoided by the intervention. The listing of interventions was made by pneumophtisiology specialists. The score assigned to each intervention ranged from 0 (without clinical impact) to 3 (vital clinical impact). The acceptance rate of interventions by physicians was evaluated.ResultsOf 130 patients, 28.5% received PIs. The main reasons for interventions were drug–drug interactions (26.4%), noncompliance with recommendations (24.5%), and adverse effects (24.5%). Antituberculosis drugs were involved in 40.3% of DRPs. Interventions were predominantly proposals for monitoring treatment effectiveness and safety parameters (52.7%) followed by proposals of therapeutic choice (28.1%). All interventions were accepted by the physicians. Most interventions (59.6%) were listed as interventions with significant clinical impact.ConclusionThe presence of a pharmacist at inpatient setting has contributed to the prevention and resolution of problems related to the pharmacotherapeutic management of TB. Pharmacists can position themselves as major players in the therapeutic management of TB inpatient in resource-limited setting.
Background: Multiple biochemical parameters related to cytolysis, cholestasis and/or liver failure, can be used to evaluate liver tolerance to antiretroviral (ARV) drugs. what parameters are most suitable for monitoring early hepatic tolerance in the developing countries? Objective: to evaluate liver tolerance to NVP (nevirapine) or EFV (efavirenz)- based regimens during the first six months. Method: This is a preliminary prospective cohort study with 125 naive ivorian HIV1-infected patients, by observing the level of ALT (alanine aminotransferase), AST (aspartate aminotrans- ferase), ALP (alkaline phosphatase), GGT (gamma-glutamyl transferase), and TBR (total bilirubin). Results: variable changes are noticed in the level of various biochemical parameters from M0 to M6. Nevertheless, we found that the values of these parameters studied fall within normal ranges except for GGT which showed an increased level with NVP-based regimen. Biological liver tolerance to NVP or EFV-based regimen was good at M3 and M6 during therapy. The percentage of patients who had elevated ALT activity had tripled with each ARV regimen from M3 to M6. We noticed a decrease in the median value of transaminases (ALT and AST) from M0 to M6. This decrease was statistically significant for patients on EFV-based regimen from M0 to M3 and from M0 to M6. The ALP enzymes were the least affected after initiation of therapy, regardless of the regimen taken. In general,we noticed an hepatotoxicity of grade 1 or 2, in the two ARV regimens. The hepatotoxicity of grade 3 or 4 were rare (only with transaminases and GGT). Conclusion: we suggest a study of longer duration involving more patients, probably limited to the monitoring of transaminases (ALT and AST) and GGT, due to the results more or less sensitive about them in our analysis
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