Factors Affecting Treatment Outcomes in Second-Line Drug-Resistant Tuberculosis | Chapter 10 | Medical Science: Trends and Innovations Vol. 10

The emergence of drug-resistant tuberculosis jeopardizes the TB control programme activities globally. Multidrug-resistant TB is defined as tuberculosis strains resistant to at least two first-line drugs, rifampicin (RIF) and isoniazid (INH). Extensively drug-resistant TB refers to the resistance against any fluoroquinolone drug and one of the second-line injectable drugs (i.e., amikacin, kanamycin, or capreomycin). Mutations in gyrA and gyrB lead to acquired resistance to fluoroquinolones and these have been widely used as predictive markers for fluoroquinolones resistance in molecular diagnostics. The present study aimed to analyze the treatment outcomes and risk factors associated with fluoroquinolone drug resistance due to mutations in the gyrA and gyrB genes. A total of 258 pulmonary tuberculosis (TB) samples resistant to first-line drugs (H, R, or HR) were tested using the GenoType MTBDRsl assay for the molecular detection of mutations. Among these samples, 251 were identified as drug-resistant tuberculosis (DR-TB), while seven were sensitive to all first-line anti-TB drugs. Of the 251 DR-TB cases, 42 were classified as multidrug-resistant tuberculosis (MDR-TB), 200 as isoniazid mono-resistant, and nine as rifampicin mono-resistant. The analysis of the DR-TB cases using the MTBDRsl assay revealed that 14 cases had pre-extensively drug-resistant (pre-XDR) fluoroquinolone, one had pre-XDR with a second-line injectable, and one case was classified as extensively drug-resistant tuberculosis (XDR-TB). The remaining 235 cases were sensitive to both fluoroquinolone and second-line injectable drugs. The median age of the study group was 42.7 years (± 16.4 years). The overall successful treatment outcomes were 70.6% for MDR-TB, 82.0% for isoniazid mono-resistant cases, and 51% for pre-XDR patients. The risk of unfavorable outcomes was significantly increased for pre-XDR, isoniazid mono-resistant, and XDR cases, with a relative risk of 2.14, indicating a 113.84% increased risk (95% CI: 0.7821–5.8468). An independent risk factor associated with treatment failure showed a 77.78% increased risk, with a relative risk of 1.78 (95% CI: 0.3375–9.3655). Logistic regression analysis revealed significant relative risks among MDR-TB patients: resistance (OR: 4.00), male gender (OR: 2.02), being aged 61 years and older (OR: 2.26), and having diabetes (OR: 1.075) were associated with increased risks of 84.62%, 95.83%, and 4.76%, respectively. For isoniazid mono-resistant cases, significant independent risk factors included being aged 16-60 (OR: 1.16) and being 61 years or older (OR: 1.18). This study highlights the significant risks associated with isoniazid mono-resistance, pre-XDR, and MDR tuberculosis among males, young adults, individuals with diabetes, and patients with a history of treatment failure. The correlation of the mutation region in the target gene with the patient’s outcome might give better insight into drug-resistant tuberculosis management for controlling tuberculosis effectively. Timely identification of high-risk patients will be crucial for effectively controlling drug-resistant tuberculosis.

 

Author (s) Details

 

Balasundaram Revathi Mania
Department of Biochemistry, Queen Mary’s College, Madras, Tamil Nadu, India.

 

Usharani Brammacharry
Institute of Basic Medical Sciences, University of Madras, Chennai, Tamil Nadu, India.

 

Venkateswari Ramachandra
Institute of Basic Medical Sciences, University of Madras, Chennai, Tamil Nadu, India.

 

Suganthi Palavesam
Institute of Basic Medical Sciences, University of Madras, Chennai, Tamil Nadu, India.

 

Muthuraj Muthaiah
Department of Microbiology, State TB Training and Demonstration Centre, Intermediate Reference Laboratory, Government Hospital for Chest Diseases, Puducherry, India.

 

Please see the book here:- https://doi.org/10.9734/bpi/msti/v10/4695

Prescribing Pattern of Antimicrobial Agents in the Post-operative General Surgery Ward of a Tertiary Care Teaching Hospital: A Prospective Observational Study | Chapter 15 | Technological Innovation in Pharmaceutical Research Vol. 8

 Background: This prospective observational study was done to know the current prescription trend of antimicrobial agents in the post-operative ward. To evaluate the current pattern of antimicrobial agents in the post-operative surgical cases of a tertiary care teaching hospital.

The goal of this study was to look at the antimicrobial resistance pattern of culture isolates in post-operative general surgery cases. To evaluate the case for switching from one antimicrobial agent to another.

Methods: From April 2013 to March 2014, the study was conducted in conjunction with the Departments of General Surgery and Pharmacology. In the carefully built case proforma, all factors such as demographic data, antimicrobials agents given by surgeons, dose, frequency, duration, route, formulation, brand or generic medications, and adverse events were collected. SPSS version 17.0 was used to perform descriptive statistics.

Results: During the study period, 513 patient case records were analysed in which males are higher than females. A total of 816 drugs were used in 484 patients during the study period. 162 were on a single drug, 190 were on two drugs, 42 were on three drugs and 90 were on fixed dose combination. Brand name of the drugs and parenteral route of administration were preferred in the study. Cephalosporins (52.32 percent ) and metronidazole (34.38 percent ) were the most commonly prescribed group of antimicrobials followed by penicillin (0.9 percent ), aminoglycosides (6.58 percent ), quinolones (5.23 percent ), macrolides (0.45 percent ) and tetracycline (0.14 percent ). In all, 135 patients (27.89%) received pharmaceuticals that were not on the WHO's essential medicine list, while 112 patients (23.14%) received drugs that were not on the national EML.

Conclusions: Third-generation cephalosporins were the most commonly administered antibacterial medication in the post-operative ward. Antibiotics should be prescribed rationally to avoid polypharmacy and medication resistance. To support the appropriate use of medications in surgery, there is a definite need for the development of prescribing guidelines and educational programmes. Our research will aid clinicians in their understanding of the essential medicine list.

Author (s) Details

Velvizhy Ramalingam
Department of Pharmacology, Aarupadai Veedu Medical and Hospital, Pondicherry, India.

J. Johan Pandian
Department of Pharmacology, Mahatma Gandhi Medical College and Research Institute, Pondicherry, India.

View Book :- https://stm.bookpi.org/TIPR-V8/article/view/2218