Drug Provocation Test as a Diagnostic Approach for Hypersensitivity Reaction to Antituberculosis Drugs: A Report of Two Cases

Abstract

Pulmonary tuberculosis (PTB) continues to be a public health problem, especially in developing countries. The necessity use of multidrug regimens of antituberculosis drug (ATD) in PTB treatment has been associated with increased risk of drug hypersensitivity reactions (DHRs). DHR is a type of unpredictable reaction, refers to immunologically mediated hypersensitivity reactions. It is observed more frequently in the intensive phase of the PTB treatment with varying degrees of severity. DHR can lead to reduce the patient adherence, thereby leading to stoppage of the drugs by the patient. The definite diagnosis based on drug provocation test (DPT) that should be performed at a hospital. The recommended therapeutic approach is rapid desensitization by reintroducing drugs in safety and optimal under threshold dose until usual daily dose is reached. We present two cases of DHR to ATD, DPT as the diagnosis and rapid desensitization as the therapeutic approach.

Test dosing as an alternative treatment approach in urinary tract infection patient with Cefoperazone allergy

“…14,15 Test dosing can be given by injection, intravenous infusion or oral. 3,16 In this case, levofloxacin is given by IV fluids from the lowest dose of 50 mg (10 drops per minute). Every 30 minutes the dose is increased slowly to see the drug reaction arising at certain doses.…”

“…1 Only when a definite immunological mechanism (either clinically significant drug-specific IgE or IgG antibodies or T cells, immediate or delayed hypersensitivity reaction) is demonstrated, these reactions should be classified as drug allergic reactions. [2][3][4] Antibiotics are the most frequently prescribed drugs given to patients to treat bacterial infections and reduce bacterial growth, one of which is in patients with urinary tract infections. 5 Cephalosporins are one of the drugs used in the treatment of urinary tract infections, including cefoperazone.…”

The Sensitivity Test of Mycobacterium Tuberculosis Isolates From Suspect Tuberculosis Patients to the Seromucous of Snail and Chitosan as an Alternative Anti-Tuberculosis Drugs

“…DHR has various clinical manifestations and it is unpredictable. It should avoid unnecessary drug interruption or suboptimal treatment in order not to lead a treatment failure or resistance [33].…”