Predictors of therapeutic failure among naïve patients with pulmonary tuberculosis: contribution of diabetes mellitus and metformin therapy

Abstract

Background:The rising epidemic of diabetes mellitus (DM) can increase the global burden of tuberculosis (TB). Our research hypothesis is that comorbidities (noninfectious and infectious) can affect the therapeutic response to antituberculosis therapy (ATT). The aim of this study is to determine the frequency of therapeutic failure among the naïve patients with pulmonary TB and to explore the predictors of therapeutic failure. Patients and methods:The study included 483 consecutive, naïve, patients with pulmonary TB. The diagnosis of pulmonary TB relied on positive culture of sputum. For all the study population, clinical evaluation, imaging studies (including chest radiography), and laboratory investigations (including microscopic examination for urine and stool) were conducted. All the enrolled patients received the standard of care ATT therapy. Results:The mean age of the study population was 37 ± 12.5 years; 53.8% of them were males. Therapeutic failure developed in 31.7% of the patients; 17% of the patients had adverse effects. Diabetes mellitus, helminth infection, tobacco smoking, and lack of metformin therapy were the predictors of therapeutic failure. Conclusions:In conclusion, the therapeutic failure rate of ATT among the Egyptian, naïve patients with pulmonary TB is increasing. The predictors of therapeutic failure include DM, lack of metformin use, helminth infection, and tobacco smoking.TB, DM leads to delayed conversion of sputum culture, increased risk of therapeutic failure failure, relapse, and mortality [12]. Subsequently, the rising epidemic of DM can increase the global burden of TB.Metabolic similarity exists between DM and TB with common underlying hyperglycemia, which can be transiently induced by fever in TB, elevated serum levels of pro-inflammatory cytokines, and a state of oxidative stress [13,14]. Thus, the use of metformin-augmented ATT may enhance the therapeutic response among patients with TB, even among the nondiabetic patients [15,16]. Our research hypothesis is that comorbidities (noninfectious and infectious) can affect the therapeutic response to ATT. The aim of this study is to determine the frequency of therapeutic failure among the naïve patients with pulmonary TB and to explore the predictors of therapeutic failure.