Suivi Thérapeutique Pharmacologique Des Antituberculeux : Quinze Ans d’Expérience

Abstract

Tuberculosis is a world public health problem. Its treatment is based on a set of drugs that can cause many side effects. Liver toxicity remains one of the most common and severe side effect causing treatment failure. The objective of this study is to demonstrate the interest of therapeutic drug monitoring in the treatment of tuberculosis through the experience of the Laboratory of Toxicology and Pharmacology of the Anti Poison Center. This retrospective study involved 1152 patients who had benefited from a determination of plasma levels of first line antitubureculosis drugs (isoniasid, pyrazinamid, rifampicin) during 15 years. 135 patients had developed hepatotoxicity. The study showed that at therapeutic dose, 71.2% of TB patients had plasma concentrations lower than the therapeutic range, and 57.8% of patients had isoniazid plasma concentrations above the therapeutic range. This interindividual variability justifies the need for therapeutic drug monitoring to assess an inadequate response to tuberculosis treatment and prevent the development of hepatotoxicity.

Fulminant Hepatitis Secondary to Anti-tuberculosis Drug-induced Hepatotoxicity Complication, Its Prevention Strategies and Management: A Case Report

“…The frequency of hepatotoxicity during antituberculosis treatment varies according to the studies, 12% [6], 27% [7], and 11.7% [8].…”

“…Combined Strategy to identifying slow acetylors with pharmacogenetics analysis and therapeutic drug monitoring by measureament of plasmatic concentration levels of isoniazid and rifampicin can be useful to predict pharmacokinetic variability and leads to optimizing treatment [8]. Among 1152 Moroccan patients at therapeutic dose, 57.8% had plasma concentrations of isoniazid above the therapeutic range [8]. However, the cost necessary for such a strategy would be significant to adopt it on a collective level.…”