P56 Treatment of multidrug resistant tuberculosis: where are the guidelines for monitoring?

J, Keal; Khachi, H; Hanzaree, E; White, Vlc

doi:10.1136/thoraxjnl-2011-201054c.56

Cited by 5 publications

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“…Patients experiencing injectable anti-TB drug from previous treatment courses had complaints of injection site pain and abscess. In addition, such patients frequently developed serious side effects, especially hearing impairment and renal function deterioration [27, 28]. Hence, PMDT team follow up renal function tests and hearing assessments before the initiation of treatment, frequently.…”

Section: Discussionmentioning

confidence: 99%

Treatment delay and associated factors among adults with drug resistant tuberculosis at treatment initiating centers in the Amhara regional state, Ethiopia

et al. 2019

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Background A delayed initiation of tuberculosis treatment results in high morbidity, mortality, and increased person-to-person transmissions. The aim of this study was to assess treatment delay and its associated factors among adult drug resistant tuberculosis patients in the Amhara Regional State, Ethiopia. Methods An institution based cross-sectional study was conducted on all adult drug resistant tuberculosis patients who initiated treatment from September 2010 to December 2017. Data were collected from patient charts, registration books, and computer databases using abstraction sheets. The data were entered using Epi-info version 7 and exported to SPSS version 20 for analysis. Summary statistics, like means, medians, and proportions were used to present it. Binary logistic regression was fitted; Adjusted Odds Ratio (AOR) with a 95% Confidence Interval (CI) was also computed. Variables with p -value < 0.05 in the multi-variable logistic regression model was declared as significantly associated with treatment delay. Results The median time to commence treatment after drug resistant tuberculosis diagnosis was 8 (IQR: 3–37) days. Being diagnosed by Line probe assay [AOR = 5.59; 95% CI: 3.48–8.98], Culture [AOR = 5.15; 95% CI: 2.53–10.47], and history of injectable anti-TB drugs [AOR = 2.12; 95% CI: 1.41–3.19] were associated with treatment delays. Conclusion Treatment delay was long, especially among patients diagnosed by Culture or LPA and those who had a prior history of injectable anti-TB drugs. That suggested that the need for universal accesses to rapid molecular diagnostic tests, such as Gene Xpert and the PMDT team were needed to promptly decide to minimize unnecessary delays.

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Section: Discussionmentioning

confidence: 99%

Treatment delay and associated factors among adults with drug resistant tuberculosis at treatment initiating centers in the Amhara regional state, Ethiopia

et al. 2019

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“…1 A previous study identified that prior to the development of these monitoring guidelines the incidence of adverse effects associated with MDR TB medicines was high. 2 Objective To establish whether national guidelines for the monitoring of MDR-TB medicines at a tertiary centre are being adhered to. Results 9 patients with MDR-TB were included in the audit.…”

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P258 Multi-Drug Resistant Tuberculosis Monitoring Guidance: Are we following the national guidelines?: Abstract P258 Table 1

Parmar

Singal

Khachi

2015

Thorax

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IntroductionMulti-Drug Resistant Tuberculosis (MDR-TB) is a form of TB that is resistant to the two most powerful first-line anti-tuberculosis antibiotics available, rifampicin and isoniazid. Between 2004 and 2011, the proportion of cases with MDR-TB increased from 1.2% to 1.6%, of which it has remained stable over the past 3 years. Due to the complexity of treatment regimens used for MDR-TB, national monitoring guidelines have been developed to aid monitoring for adverse effects during treatment.1 A previous study identified that prior to the development of these monitoring guidelines the incidence of adverse effects associated with MDR TB medicines was high.2ObjectiveTo establish whether national guidelines for the monitoring of MDR-TB medicines at a tertiary centre are being adhered to.Results9 patients with MDR-TB were included in the audit. The findings (see Table 1) show that baseline monitoring was not undertaken in the majority of patients. Whilst on-going monitoring was predominantly undertaken in over 80% of occasions, the audit standard was not met.Abstract P258 Table 1 DrugNumber of patients taking drug [n = 9]Baseline monitoring carried out (%)On-going monitoring carried out (%)Drug specific monitoring carried out (%)Amikacin658%85%91%Capreomycin181%85%100%Clofazamine371%90%55%Co-amoxiclav338%77%N/A*Cycloserine961%82%91%Ethambutol464%84%52%Linezolid466%82%48%Moxifloxacin672%84%17%PAS453%82%94%Prothionamide860%83%53%Pyrazinamide346%71%N/A*Rifampicin169%72%N/A**Drugs did not require specific monitoring, according to drug monographs.ConclusionsDespite the presence of national guidance to support the monitoring of complex regimens for MDR-TB, this audit shows that monitoring of these in a tertiary centre is below the audit standard. Whilst adherence to on-going monitoring parameters were usually undertaken in over 80% of instances, it is of particular concern that baseline monitoring was significantly below the audit standard. Pharmacists are ideally placed to support the safe and effective monitoring of these often toxic medicines. The development of a pharmacist to support the TB clinics and specifically to support the monitoring of patients with MDR-TB could significantly improve this adherence and reduce the risk of adverse effects as a result of sub-optimal monitoring.References1 Potter JL, Capstick T. A UK based resource to support the monitoring and safe use of anti-tuberculosis drugs and second line treatment of multi-drug resistant tuberculosis. First published May 2014, Latest update January 20152 Keal JL, Khachi H, Hanzaree E, et al. Treatment of multidrug resistant tuberculosis: where are the guidelines for monitoring? Thorax 2011;66(Suppl 4):A91

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P257 Modern Day Scrofulous Swellings: Breast Tuberculosis in East London

Butler

Khanam

White

et al. 2015

Thorax

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IntroductionBreast tuberculosis (TB) is rare and diagnosis may be delayed. It was first described in 1829. Incidence is highest in TB endemic areas. Here we describe a series of cases diagnosed in East London (UK).MethodsWe conducted a retrospective study of all patients treated at our institution for breast TB between 2005 – 2015. Data including demographics, symptoms, microbiological, histological diagnoses and treatment outcomes were recorded.Results35 cases of breast TB were identified (1 male). Mean age at diagnosis was 33 years (range 16 – 63). 24 patients were from the Indian subcontinent, 3 Asian other, 7 Black-African and 1 Middle Eastern; no patients were Caucasian. Three patients were lactating, two were pregnant. Four patients had a previous history of TB and one was HIV positive. All patients presented with a breast lump, 58% in the upper outer quadrant. 25 patients initially presented to their general practitioner (GP), of which 24 were referred to breast clinic and 1 directly to TB clinic. Eight cases presented to hospital. In two cases there was insufficient data. The breast lump was associated with skin changes in six cases, inverted nipple in three, discharge in one, and 49% had ipsilateral axillary lymphadenopathy. Erythrocyte sedimentation rate and C-reactive protein was raised in 84% and 53% cases respectively. Thirty percent of patients had abnormal mammography, 68% abnormal ultrasound breast findings. 25 out of 35 cases had biopsies/fine needle aspirations (FNA), all of these were sent for culture; 17 were culture positive with 3 drug resistant cases. Nine cases had necrotising granulomatous changes on histology, of which 1 was positive for Ziehl-Neelson (ZN) stain, 9 cases had non-necrotising granulomas, of which 2 were ZN positive, and 7 cases had inflammatory changes only (none were ZN positive). All patients received at least three anti-tuberculous drugs. Median treatment duration was six months, leading to complete resolution of breast TB.ConclusionThis case series highlights the difficultly in diagnosing breast TB. Raising awareness of the classical presentation of breast TB amongst GPs and breast services may improve diagnosis and treatment of this rare disease.

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P56 Treatment of multidrug resistant tuberculosis: where are the guidelines for monitoring?

Cited by 5 publications

References 0 publications

Treatment delay and associated factors among adults with drug resistant tuberculosis at treatment initiating centers in the Amhara regional state, Ethiopia

Treatment delay and associated factors among adults with drug resistant tuberculosis at treatment initiating centers in the Amhara regional state, Ethiopia

P258 Multi-Drug Resistant Tuberculosis Monitoring Guidance: Are we following the national guidelines?: Abstract P258 Table 1

P257 Modern Day Scrofulous Swellings: Breast Tuberculosis in East London

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