Pyrazinamide-Induced Hepatitis Complicated by Obstructive Hydrocephalus Secondary to Tuberculous Meningitis: A Case Report| Chapter 6| Disease and Health Research: New Insights Vol. 2

Tuberculous meningitis recognized as the most devastating manifestation of tuberculosis, contributes to approximately 20% of childhood TB mortality. This case report focuses on a pediatric patient with obstructive hydrocephalus secondary to tubercular meningitis, complicated by pyrazinamide-induced hepatitis. The elevated dosages of essential antituberculosis agents for pediatric use, recommended by the World Health Organization, raise concerns about heightened hepatotoxicity risk. Drug-induced liver injury (DILI) from anti-tuberculosis drugs is defined as hepatic injury, due to anti-tuberculosis drugs as suggested by the international DILI Expert Working Group and American Thoracic Society and recent evidence questions the safety profile of pyrazinamide compared to earlier perceptions. The main objective of our study was to identify the anti-tubercular drug that caused hepatitis. The patient, a 10-month-old with a history of obstructive hydrocephalus due to TB meningitis, was started with anti-tubercular therapy for which the baby presented with yellowish discoloration of both eyes after 15 days of starting anti-tubercular therapy. Two months prior, an 8-month-old baby was admitted with insidious onset fever lasting for 8 days. Clinical and diagnostic findings, including head-to-toe examination, Cerebrospinal fluid (CSF) analysis, neuro sonogram, Contrast-enhanced magnetic resonance imaging (CEMRI) of the brain, and abdominal ultrasound, were detailed. Laboratory investigations revealed abnormal liver function and increased inflammatory markers. The liver being the metabolic factory of the body is responsible for drug metabolism and thereby more vulnerable to drug-induced liver injury. Identification of pyrazinamide as the specific hepatotoxic agent was established through dechallenge and rechallenge assessments. The patient's management plan was modified to incorporate non-tubercular medications. Adjustments to the treatment regimen, including the discontinuation of pyrazinamide, were executed, resulting in an extension of isoniazid and rifampicin therapy for 9 months. This study highlighted that follow-up requires screening for any hepatotoxicity besides general wellbeing of the patient helping in early detection and intervention that will reduce the risk of hepatic injury but also treatment failure. The case highlights the need for a multidisciplinary approach, individualized treatment plans, and close monitoring in pediatric tuberculosis cases, particularly considering neurological and hepatic complications. Further research and awareness are crucial for refining treatment guidelines and improving overall care.

 

Author(s) Details

Jammula Mounika
Department of Pharmacy Practice, Bapuji Pharmacy College, Shamanur Road, SS Layout, Davanagere- 577004, Karnataka, India.

 

Please see the book here:- https://doi.org/10.9734/bpi/dhrni/v2/1521

Screening of Antituberculosis Drugs by Thin Layer Chromatography: Experimental Investigation | Chapter 11 | Novel Aspects on Chemistry and Biochemistry Vol. 1

 Tuberculosis resumes to be a main public health issue in underdeveloped countries. In South Asian countries TB is a very universal and prevalent ailment and most of the treatment programmes are controlled directly through administration agencies and emergency rooms. In this study, a novel thin-layer chromatographic screening approach for the labeling of rifampicin, isoniazid, and pyrazinamide in pharmaceutical dosages was manifested. The solvent scheme used to determine these three drugs was (propanol: hexane: ethyl acetate: liquid) (5:2:1.7:0.2 v/v) and the Rf value of rifampicin, pyrazinamide and isoniazid was 0.68, 0.74 and 0.50, individually. The developed arrangement for retention determinant had intra-epoch and inter-era repeatability with a predictable difference (SD) of about 0.5-1.0%.

Author(s) Details:

Abhilasha Durgbanshi,
Department of Chemistry, Dr. Harisingh Gour Vishwavidyalaya (A Central University), Sagar-470 003, India.

Devasish Bose,
Department of Criminology and Forensic Science, Dr. Harisingh Gour Vishwavidyalaya (A Central University), Sagar-470 003, India.

Please see the link here: https://stm.bookpi.org/NACB-V1/article/view/10440Z

Role of Pyridine Containing Azetidinone Derivatives as Privileged Scaffolds in Anti Tubercular Agents | Chapter 9 | Technological Innovation in Pharmaceutical Research Vol. 11

In the current study, we synthesised a novel series of 3-Chloro-1-phenyl-4-(pyridine-4yl-)azetidin-2-one derivatives using Schiff base as an intermediary in the quest for prospective Tuberculosis treatments. The resulting Schiff base is then eliminated, resulting in named Azetidinone derivatives. Nucleophilic addition followed by elimination is the mechanism involved in the production of Schiff base. The newly produced Schiff base is then cyclized to produce novel Azetedinone derivatives. The named compounds were physically examined and structurally investigated using spectroscopic methods (IR, 1H-NMR, MASS). The chemicals Azt-1 to Azt-6 were tested for anti-tubercular activity in vitro. The Micro plate Alamar Blue Assay (MABA) method was used to test anti-tubercular activity in vitro. Azt-1(H), Azt-2(Cl), Azt-5 (O-OH), and Azt-6 (P-OH) were the most active compounds in the series compared to standards. The presence of electron withdrawing group -Cl, (Azt-2) and electron donating substituents -OH at ortho and para positions in the phenyl ring of (Azt-5) and (Azt-6) respectively could explain the potent anti tubercular activity.

Author (S) Details

N. Pramod
Department of Pharmaceutical Chemistry, A.G.M College of Pharmacy, Varur-581207, Hubli, Karnataka, India.

C. Bharath Kumar
Department of Pharmaceutical Chemistry, Annamacharya College of Pharmacy, Rajampet-516126, Kadapa, Andhra Pradesh, India.

P. Sri Lekha
Department of Pharmaceutical Chemistry, Institute of Pharmaceutical Technology, SPMVV, Tirupati-517502, Andhra Pradesh, India.

B. Mayuri
Department of Pharmaceutical Chemistry, Annamacharya College of Pharmacy, Rajampet-516126, Kadapa, Andhra Pradesh, India.

View Book :- https://stm.bookpi.org/TIPR-V11/article/view/3131