MDR-TB in Pakistan: Challenges, efforts, and recommendations

Khan, Mahad Ahmed; Bilal, Wajeeha; Asim, Hanzla; Rahmat, Zainab Syyeda; Essar, Mohammad Yasir; Ahmad, Shoaib

doi:10.1016/j.amsu.2022.104009

Cited by 8 publications

(11 citation statements)

References 15 publications

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“…Moreover, each analyte has specific reagent and quality control. Furthermore, decentralized setups, lack of specialized hospitals for tuberculous patients and pharmacokinetic laboratories with few qualified clinical pharmacologists for interpretation of these results 26,27 are all deterring standardization and optimum TB outcomes in our local population.…”

Section: Discussionmentioning

confidence: 99%

Therapeutic Drug Monitoring of Isoniazid Among Newly Diagnosed Pulmonary Tuberculosis Patients

Talha Laique,

Navida Manzoor,

Qura-tul-ain

et al. 2024

Proceedings S.Z.M.C

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Introduction: Tuberculosis has a higher incidence in lower income countries. Positive treatment outcomes may be fewer due to comorbidities like diabetes mellitus and immunosuppressive illnesses. The Global Tuberculosis Network working under the umbrella of World Health Organization has composed different committees. The TB Pharmacology Committee has given the concept of precision medicine and treatment based on drug susceptibility testing. Achievement of optimum plasma levels of anti-tuberculous drugs by therapeutic drug monitoring (TDM) is imperative and being emphasized to achieve a TB cure. Aims and Objectives: To determine the levels of INH in low responders to ATT have lower plasma levels of Isoniazid. Place and Duration of study: University of Health Sciences and Gulab Devi Chest Hospital, Lahore, for 1 year from August 2017- July 2018. Material and Methods: A first dose therapeutic drug monitoring (TDM) of isoniazid (INH) was planned in 25 newly enrolled sputum positive tuberculous patients at Gulab-Devi Hospital. The work was approved by Ethical Review Committee. Fixed dose combination (FDC) of anti-tuberculous drugs was given under direct observation and blood samples were withdrawn at two hours (C2h) and six hours (C6h) on days one, 14 and 56th of drug therapy. Samples of sputum for acid fast bacilli (AFB) were also taken during blood sampling. Method development and validation of isoniazid estimation by high-performance liquid chromatography was carried out. Plasma INH concentration in test samples was measured with Shimadzu Chromatographic System, Japan. Data was entered and analyzed using SPSS version 20. A p value ? 0.05 was taken as statistically significant. Results: Among 25 patients enrolled to the current study, the mean plasma levels of isoniazid were 1.29±0.79 µg / ml and 0.56±0.43 µg / ml at two hours and six hours respectively throughout the research duration. Most of the patients had lesser plasma INH levels than the target ranges (< 3µg / ml). Sputum for acid fast bacilli was found 100% positive on day one and 14 however sputum conversion was 56% after four weeks drug therapy. Conclusion: An early TDM monitoring has revealed low plasma INH concentration. Correction of dose to achieve expected plasma INH level will have promising effect on sputum culture conversion. It will minimize the total statewide burden of slow responders and tuberculosis resistant cases.

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Section: Discussionmentioning

confidence: 99%

Therapeutic Drug Monitoring of Isoniazid Among Newly Diagnosed Pulmonary Tuberculosis Patients

Talha Laique,

Navida Manzoor,

Qura-tul-ain

et al. 2024

Proceedings S.Z.M.C

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“…Approximately one third of all people who develop active TB will die from the disease [25]. The leading cause of TB deaths is the progression of the disease to the internal organs (known as multidrug-resistant tuberculosis or MDR-TB); the development of resistance to medications used to treat TB is known as drug resistance [26]. In 2016, there were approximately two million cases of drug-resistant TB around the world, including 200,000 cases in the United States [27].…”

Section: Prevalence Of Tbmentioning

confidence: 99%

Pulmonary tuberculosis risks and challenges

et al. 2023

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Pulmonary Tuberculosis (PTB) is an airborne bacterial infection that can be deadly if not treated. PTB is most common in developing countries, ecologically problematic, where it kills about 1 million people each year. Pulmonary tuberculosis is a dreaded disease that can have a devastating impact on its victims. Tuberculosis is a serious respiratory infection caused by the bacterium Mycobacterium tuberculosis. It commonly affects the lungs but can also affect other parts of the body, such as the kidney, spine and brain. This review article discusses the PTB risks and challenges word wide. The global burden of TB remains high, with approximately one-third of the world's population being infected with the bacterium. Overall, more needs to be done to improve the management of TB worldwide in order to ensure that no person is left to suffer from the devastating effects of this disease.

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“…An attempt to grow TB and drug susceptibility testing should always be considered if possible as part of the diagnosis, especially because of the fact that among the 30 high burden TB countries, Pakistan has ranked fifth with an estimated 518,000 TB cases, including 15,000 multidrug-resistant TB cases and the outcome for this patient who was empirically treated for drug susceptible TB based on ZN stain and IGRA without a microbiological confirmation could have been sub-optimal if the primary underlying diagnosis was MDR-TB. 5…”

Section: Dear Editormentioning

confidence: 99%

TB or not TB, The ethereal conundrum!

Waqas

2023

Journal of the Royal College of Physicians of Edinburgh

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MDR-TB in Pakistan: Challenges, efforts, and recommendations

Cited by 8 publications

References 15 publications

Therapeutic Drug Monitoring of Isoniazid Among Newly Diagnosed Pulmonary Tuberculosis Patients

Therapeutic Drug Monitoring of Isoniazid Among Newly Diagnosed Pulmonary Tuberculosis Patients

Pulmonary tuberculosis risks and challenges

TB or not TB, The ethereal conundrum!

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