Background: Drug-resistant tuberculosis (DR-TB) is more difficult to treat with multiple therapies and a longer duration than drug-sensitive tuberculosis. Pre-XDR and XDR-TB are highly DR-TB with a lower success treatment than MDR-TB. Therapy for high DR-TB with fewer drugs and shorter treatment is required to increase the success of treatment. We comprehensively reviewed the risk factors for unfavorable outcomes (death, treatment failure, and loss of follow-up) related to all oral regimens containing bedaquiline and or delamanid in patients with MDR-TB. Method: This was a narrative review to summarize the role of the BPaL regimen to manage highly DR-TB patients. Results: The six months of BPaL regimen was reported to provide treatment success in two previous trials, Nix and Zenix TB. BPaL offers treatment success, especially in highly DR-TB compared to standard regimens containing bedaquiline. However, several adverse effects, such as myelosuppression, peripheral neuropathy, and optic neuritis were more common in BPaL regimens than in standard regimens. In addition, the incidence of QTc interval prolongation was lower in BPaL regimens compared with standard regimens. It is mandatory to monitor adverse effects associated with linezolid in the BPaL regimen and how to manage them. Conclusion: This review concludes that the BPaL regimen provides treatment success over six months of treatment. Health facilities should prepare for the implementation of BPaL to manage DR-TB patients.
Puskesmas merupakan tempat fasilitas kesehatan untuk layanan pasien tuberkulosis (TB). Evaluasi penyelenggaraan pelayanan kesehatan penting dilaksanakan untuk mendapatkan pelayanan yang lebih baik, termasuk pelayanan kefarmasian di puskesmas sebagai fasilitas kesehatan tingkat I. Penelitian ini bertujuan untuk mengukur tingkat kepuasan pasien tuberkulosis (TB) terhadap layanan informasi obat di salah satu Puskemas di Surabaya berdasarkan lima dimensi mutu pelayanan, yaitu kehandalan (reliability), ketanggapan (responsiveness), jaminan (assurance), empati (emphaty) dan keberwujudan (tangibles). Penelitian ini merupakan penelitian observasional dengan desain cross sectional menggunakan instrumen kuesioner yang sudah tervalidasi. Sampel penelitian yakni pasien TBC kategori I pada fase intensif dan sedang menjalani terapi OAT serta mendapatkan layanan informasi obat. Pasien TB dipilih secara non random dengan metode consecutive sampling. Pengambilan data dilakukan pada bulan Juli-November 2018. Data dari kelima dimensi mutu pelayanan dianalisis dengan metode SERVQUAL. Didapatkan 80 pasien TB yang memenuhi kriteria inklusi. Hasil menunjukkan bahwa nilai rata-rata gap antara harapan dan kinerja ialah -0,49 dengan nilai gap terbesar ditunjukan pada dimensi reliability yaitu -0,80. Pada tingkat kepuasaan secara keseluruhan didapatkan hasil sebesar 88%. Kesimpulannya ialah tingkat harapan pasien TB kategori I fase intensif lebih tinggi daripada tingkat kinerja layanan informasi obat yang diberikan oleh pihak puskesmas dengan tingkat kepuasaan pasien yang tergolong baik.
Adrenal suppression is a condition that refers to the deficit or inadequate cortisol production that results from exposure of the HPA axis to exogenous glucocorticoid. Corticosteroid (prednisone) is the backbone therapy for childhood nephrotic syndrome which is a sensitive steroid. According to KDIGO and IDAI, the protocol therapy for nephrotic syndrome is prednisone which given as initial and maintenance therapy. The initial therapy is by giving prednisone 60 mg/m2 for 3 – 4 weeks in divided dose or single dose followed by the alternate day 40 mg/m2 for 4 – 12 weeks. This protocol may suppress endogenous cortisol production by inhibiting the adrenal cortex. The long suppression of the hypothalamic-pituitary-adrenal (HPA) axis has significant impact on its function for several months to years. Even though a study about adrenal suppression in children with nephrotic syndrome was conducted, it was important to assess cortisol levels in children with a high dose and long term prednisone exposure based on its protocol. All studies showed a decrease in cortisol levels in the end of treatment, it lasted for years to return in normal condition. Inability to reach cortisol level in normal range may indicate adrenal suppression. This article will discuss the potential development of adrenal suppression in the patient who treated by prednisone in divided dose by monitoring cortisol level.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.