P258 Multi-Drug Resistant Tuberculosis Monitoring Guidance: Are we following the national guidelines?: Abstract P258 Table 1

Abstract

IntroductionMulti-Drug Resistant Tuberculosis (MDR-TB) is a form of TB that is resistant to the two most powerful first-line anti-tuberculosis antibiotics available, rifampicin and isoniazid. Between 2004 and 2011, the proportion of cases with MDR-TB increased from 1.2% to 1.6%, of which it has remained stable over the past 3 years. Due to the complexity of treatment regimens used for MDR-TB, national monitoring guidelines have been developed to aid monitoring for adverse effects during treatment.1 A previous study identified that prior to the development of these monitoring guidelines the incidence of adverse effects associated with MDR TB medicines was high.2ObjectiveTo establish whether national guidelines for the monitoring of MDR-TB medicines at a tertiary centre are being adhered to.Results9 patients with MDR-TB were included in the audit. The findings (see Table 1) show that baseline monitoring was not undertaken in the majority of patients. Whilst on-going monitoring was predominantly undertaken in over 80% of occasions, the audit standard was not met.Abstract P258 Table 1 DrugNumber of patients taking drug [n = 9]Baseline monitoring carried out (%)On-going monitoring carried out (%)Drug specific monitoring carried out (%)Amikacin658%85%91%Capreomycin181%85%100%Clofazamine371%90%55%Co-amoxiclav338%77%N/A*Cycloserine961%82%91%Ethambutol464%84%52%Linezolid466%82%48%Moxifloxacin672%84%17%PAS453%82%94%Prothionamide860%83%53%Pyrazinamide346%71%N/A*Rifampicin169%72%N/A**Drugs did not require specific monitoring, according to drug monographs.ConclusionsDespite the presence of national guidance to support the monitoring of complex regimens for MDR-TB, this audit shows that monitoring of these in a tertiary centre is below the audit standard. Whilst adherence to on-going monitoring parameters were usually undertaken in over 80% of instances, it is of particular concern that baseline monitoring was significantly below the audit standard. Pharmacists are ideally placed to support the safe and effective monitoring of these often toxic medicines. The development of a pharmacist to support the TB clinics and specifically to support the monitoring of patients with MDR-TB could significantly improve this adherence and reduce the risk of adverse effects as a result of sub-optimal monitoring.References1 Potter JL, Capstick T. A UK based resource to support the monitoring and safe use of anti-tuberculosis drugs and second line treatment of multi-drug resistant tuberculosis. First published May 2014, Latest update January 20152 Keal JL, Khachi H, Hanzaree E, et al. Treatment of multidrug resistant tuberculosis: where are the guidelines for monitoring? Thorax 2011;66(Suppl 4):A91