苏拉特一家三级医院室内结核病患者接受标准化抗结核治疗(直接观察短期治疗和耐药性结核病规划管理)的药物不良反应研究

P. Naik, Arvind Panwar, Swati Patel
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摘要

背景:结核病在印度是一个严重的公共卫生问题。所采用的治疗方案是直接观察短程治疗(DOTS)和耐药性结核病规划管理(PMDT)方法。在长期的治疗中,药物不良反应(adr)可能是一个重要的规划问题。因此,对苏拉特一家三级医院室内患者抗结核治疗引起的不良反应进行了研究。方法:采用观察性、前瞻性研究,为期一年。因果关系采用WHO UMC量表,严重程度采用改良Hartwig和Siegel量表。采用卡方检验进行统计分析。结果:255例结核病患者中,85例(33.3%)发生不良反应。不良反应发生率以女性居多(46.6%)。最常见的累及系统是胃肠道(40.6%),其次是血液系统(17.9%)。最常见的不良反应是恶心和呕吐(21.7%)。引起不良反应的药物比例最高的是异烟肼(30.6%),其次是利福平(26.1%)。因果关系评估显示,可能发生不良反应的占60.4%,可能发生不良反应的占37.7%,确定发生不良反应的占1.9%。严重性评定量表中,中度评分占81.1%,轻度评分占12.3%,重度评分占6.6%。PMDT组不良反应发生率(60%)高于DOTS组(31.06%)[p值= 0.0084 (p值< 0.05)]。结论:抗结核治疗更安全,但需要早期发现、管理和报告不良反应,在早期预防,有助于降低违约率。
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The study of adverse drug reactions in indoor patients of tuberculosis taking standardized antitubercular therapy (directly observed treatment short-course and programmatic management of drug resistant tuberculosis) in a tertiary care hospital at Surat
Background: Tuberculosis is a serious public health issue in India. The treatment regimen followed is Directly observed treatment short-course (DOTS) and Programmatic Management of Drug resistant Tuberculosis (PMDT) approach. In a long period of treatment adverse drug reactions (ADRs) can be an important programmatic issue. Thus, study was undertaken to assess the ADRs caused by antitubercular therapy in indoor patients in a tertiary care hospital at Surat. Methods: The Observational, prospective study was carried out for one year period. The causality was determined by WHO UMC scale and severity was determined by Modified Hartwig and Siegel scale. Chi square test was applied for statistical analysis. Results: Among 255 tuberculosis patients, 85 (33.3%) patients developed ADRs. Occurrence of ADRs was more among females (46.6%). The commonly involved systems are gastrointestinal (40.6%) followed by haematological (17.9%). The most common ADRs observed were nausea and vomiting (21.7%). High percentage of ADRs causing drugs were isoniazid (30.6%) followed by rifampicin (26.1%). Causality assessment showed 60.4% ADRs were possible, 37.7% ADRs were probable and 1.9% ADRs was certain. Severity assessment scale showed 81.1% of moderate, 12.3% of mild and 6.6% of severe grading. Occurrence of ADRs was more among PMDT (60%) in comparison to DOTS therapy (31.06%) [p value = 0.0084 (significant p value < 0.05)]. Conclusions: Antitubercular treatment is safer but early detection, management and reporting of ADRs is required to prevent it at initial stage and helps to decrease default rate.
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