Drug resistance patterns, treatment outcomes and factors affecting unfavourable treatment outcomes among extensively drug resistant tuberculosis patients in Pakistan; a multicentre record review

Atif, Muhammad; Mukhtar, Saba; Sarwar, Sajjad; Naseem, Mehwish; Malik, Iram; Mushtaq, Azam

doi:10.1016/j.jsps.2022.01.015

Cited by 8 publications

(10 citation statements)

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“…In addition to being a country with high consumption and irrational use of antibiotics (6)(7)(8)(9), Pakistan is among the top countries where treatment options for many infectious diseases have become ineffective due to development of resistance against causative agents (10)(11)(12)(13)(14)(15)(16)(17). Pakistan ranks fourth in the world among the high burden MDR-TB countries, while ranks first in the Eastern Mediterranean Region (2).…”

Section: Introductionmentioning

confidence: 99%

Frequency and Factors Associated With Adverse Events Among Multi-Drug Resistant Tuberculosis Patients in Pakistan: A Retrospective Study

Atif

Ahmed

Iqbal³

et al. 2022

Front. Med.

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BackgroundTreatment of multi-drug resistant tuberculosis (MDR-TB) for a prolonged period with comparatively less effective and more toxic second-line anti-TB drugs is associated with greater incidence of adverse events.Study aimThis study aimed to evaluate the frequency and factors associated with occurrence of adverse events among patients with MDR-TB attending the Bahawal Victoria Hospital, Bahawalpur, Pakistan.Study designThis retrospective study included all patients with MDR-TB who were registered and treated at the study site between June 2014 and December 2016 and had their treatment outcomes available at the time of data collection (i.e., November 2018).Measures and outcomesThe Electronic Nominal Record System (ERNS) records, medical charts of patients, and laboratory reports were reviewed to obtain the data. Adverse events were reported as per the standard criteria recommended by the WHO. Multivariate binary logistic regression was used to find the independent factors associated with the occurrence of adverse events.ResultsA total of 179 patients with MDR-TB were included in the final analysis. Out of these, 114 (63.7%) patients experienced at least one adverse event during the course of their treatment. Depression was the most common adverse events (33%), followed by nausea and vomiting (27.4%) and arthralgia (27.4%). The factors associated with the occurrence of adverse events included presence of comorbidity (adjusted odds ratio [AOR] 2.951; 95% CI 1.423, 6.118) and being employed (AOR 3.445; 95% CI 1.188, 9.993).ConclusionAdverse events were prevalent in this cohort, however, resolved with the effective management approaches. Patients with identified factors for occurrence of adverse events need special attention and enhanced clinical management.

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Section: Introductionmentioning

confidence: 99%

Frequency and Factors Associated With Adverse Events Among Multi-Drug Resistant Tuberculosis Patients in Pakistan: A Retrospective Study

Atif

Ahmed

Iqbal³

et al. 2022

Front. Med.

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304

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“…The ignorant perception of patients may be attributed to a lack of education, poor health literacy, and limited access to pharmacy services. It is important to note that most of the TB patients in Pakistan have a low educational background and belong to rural areas ( Atif et al, 2016a ; Atif et al, 2018 ; Khan et al, 2019 ; Atif et al, 2020a ; Atif et al, 2020b ; Atif et al, 2021 ; Khan et al, 2022a ). The same was reported in other studies ( Ried et al, 1999 ; Wilbur et al, 2010 ; Adnan et al, 2014 ), where patients did not know the role of pharmacists, particularly in the provision of pharmaceutical care.…”

Section: Discussionmentioning

confidence: 99%

“…The interview schema was developed through formulating questions that answer the research problem and address gaps in the literature ( Atif et al, 2016a ; Atif et al, 2018 ; Khan et al, 2019 ; Atif et al, 2020a ; Atif et al, 2020b ; Atif et al, 2021 ). The patient and health professional interview schemas had six and seven questions (with additional sub-questions), respectively.…”

Section: Methodsmentioning

confidence: 99%

“…Pharmacists can play a significant role in direct patient care. For example, counseling by pharmacists can minimize missing dose scenarios and aid in promoting adherence to anti-TB treatment, which are main barriers to favorable treatment outcomes in Pakistan ( Atif et al, 2016a ; Atif et al, 2018 ; Khan et al, 2019 ; Atif et al, 2020a ; Atif et al, 2020b ; Atif et al, 2021 ). Besides, appropriate medicine use and self-care practices can be improved through patient/caregiver education on medication use and disease control and prevention.…”

Section: Introductionmentioning

confidence: 99%

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Perceptions of healthcare professionals and patients on the role of the pharmacist in TB management in Pakistan: A qualitative study

et al. 2022

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Background: Globally, tuberculosis (TB) is the second major cause of death from infectious diseases, particularly in developing countries. A multidisciplinary approach to the management of TB may help to curb the disease burden.Objective: The objective of this study was to outline the perceptions of healthcare professionals and patients regarding the potential role of pharmacists in TB management in Pakistan.Method: This was a large-scale qualitative study conducted at the Chest Disease Unit (CDU) of the Bahawal Victoria Hospital (BVH), Punjab, Pakistan. Data were collected through semi-structured interviews with physicians, pharmacists, and patients recruited using a mix of convenient and snowball sampling. The sample size was decided through standard saturation point criteria. All interviews were audio recorded and transcribed verbatim. The data were analyzed to draw conclusions using a thematic analysis approach.Results: Analysis of the data yielded 19 categories and seven themes. Physicians considered pharmacists qualified healthcare professionals, whereas patients considered them merely dispensers. Inventory management and dispensing of medicines were considered as major responsibilities of pharmacists. Physicians were extremely overburdened and wanted to delegate certain duties to pharmacists, subject to their prior extensive trainings. However, most of the physicians were unaware of the legal scope of pharmacy practice in Pakistan. With regard to the potential duties of pharmacists, physicians, pharmacists, and patients (patients—upon explaining the potential roles during the interview) endorsed monitoring, counseling, medicine brand selection, dose adjustment, inventory management, dispensing, and polypharmacy assessment as their potential roles. In view of all stakeholders, the rationale for integrating pharmacists in TB management included overburdened physicians, sub-standard patient care, medication safety issues, and patient dissatisfaction. The healthcare professionals highlighted that the major barriers to integrating pharmacists within the TB management system were limited interest of regulatory authorities and policy makers, followed by inadequate training and experience-driven questionable competency of pharmacists.Conclusion: The study participants acknowledged the potential role of pharmacists in TB management. However, it was emphasized that healthcare policy makers should devise strategies to overcome the underlying barriers before assigning medicine-related clinical roles to pharmacists.

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“…In addition, an appreciable proportion of the global burden of AMR is reported to be from South Asian countries, including Pakistan [34]. Both multi-drug-resistant (MDR) and extensively drug-resistant (XDR) bacteria have been identified in different regions of Pakistan, representing an appreciable problem globally due to associated economic costs and mortality with rising AMR rates [35][36][37]. A previous meta-analysis on the extent of AMR in Pakistan indicated that 90% Salmonella spp.…”

Section: Introductionmentioning

confidence: 99%

Understanding of Final Year Medical, Pharmacy and Nursing Students in Pakistan towards Antibiotic Use, Antimicrobial Resistance and Stewardship: Findings and Implications

Raees

Atif²,

Aslam

et al. 2023

Antibiotics

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Antimicrobial resistance (AMR) is a leading public health threat, which is exacerbated by the high and inappropriate use of antibiotics. Consequently, there is a need to evaluate knowledge regarding antibiotic use, AMR and the readiness to implement antimicrobial stewardship programs (ASPs) among final year medical, pharmacy and nursing students in Pakistan. This reflects the high and increasing rates of AMR in the country, and students as future healthcare professionals (HCPs). A cross-sectional study was conducted among 1251 final year students from 23 public and private educational institutions in Punjab. The majority of the surveyed participants possessed good knowledge of antibiotic use, AMR and the potential causes of AMR. The most common sources of the information on antibiotics were smartphones (69.9%), peers (35.9%) and medical textbooks (30.6%). However, most surveyed participants were not fully prepared to participate in ASPs. They knew, though, how to reduce AMR by educating HCPs about appropriate prescribing, implementing ASPs and improving laboratory facilities. There was a significant association between antibiotic knowledge and causes of AMR with sex, family income and student type (p < 0.05). Being a student at a public sector university (OR = 4.809; CI = 3.261–7.094; p < 0.001) and age (OR = 0.524, CI = 0.327–0.842; p < 0.008) were among the key factors impacting students’ training on ASPs. Educational curricula must be improved to include more information about appropriate antibiotic use and ASPs, along with sufficient training, workshops and clinical rotations in the final year, to fully equip students by graduation.

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Drug resistance patterns, treatment outcomes and factors affecting unfavourable treatment outcomes among extensively drug resistant tuberculosis patients in Pakistan; a multicentre record review

Cited by 8 publications

References 36 publications

Frequency and Factors Associated With Adverse Events Among Multi-Drug Resistant Tuberculosis Patients in Pakistan: A Retrospective Study

Frequency and Factors Associated With Adverse Events Among Multi-Drug Resistant Tuberculosis Patients in Pakistan: A Retrospective Study

Perceptions of healthcare professionals and patients on the role of the pharmacist in TB management in Pakistan: A qualitative study

Understanding of Final Year Medical, Pharmacy and Nursing Students in Pakistan towards Antibiotic Use, Antimicrobial Resistance and Stewardship: Findings and Implications

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