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Hepatotoxic reactions during treatment of newly diagnosed patients with pulmonary multiple drug resistant tuberculosis

https://doi.org/10.21292/2075-1230-2019-97-7-21-27

Abstract

216 new pulmonary tuberculosis patients suffering from multiple drug resistance (MDR) were examined. The patients were divided into 2 groups. The first group consisted of 164 patients in whom when admitted to hospital, GeneXpert MTB/RIF was used to test the resistance of Mycobacterium tuberculosis (MTB) to rifampicin. Initially, patients in this group were treated with chemotherapy regimen 4 (pyrazinamide, kanamycin/amikacin/capreomycin, fluoroquinolones, cycloserine/terizidone, prothionamide, PAS). Group 2 included 97 patients. They all were treated with chemotherapy regimen 1 (isoniazid, rifampicin, pyrazinamide, ethambutol/streptomycin) before MDR was confirmed in them by sputum culture on solid media (in 2-3 months of treatment) after that treatment regimen was amended with re-registration for chemotherapy regimen 4. It was found out that hepatotoxic reactions in patients without initial abnormal liver function when prescribing chemotherapy regimen 4 occurred in 31.3% of cases and when initially using regimen 1 followed by switching to regimen 4 – in 87.8% of cases ( p < 0.001). In the course of treatment, the signs of liver damage in patients who initially received regimen 4 were more frequent in the first 2 months of treatment, whereas in patients treated initially with regimen 1 with subsequent switching to regimen 4 – during the first 4 months. In the overwhelming majority of cases, hepatotoxic reactions were mild in patients who initially received regimen 4 as well as in patients initially treated with regimen 1 followed by switching to regimen 4. However, severe hepatotoxic reactions were more often observed in patients from Group 2.

About the Authors

R. Yu. Аbdullаev
Central Tuberculosis Research Institute
Russian Federation

Rizvan Yu. Аbdullaev - Doctor of Medical Sciences, Professor, Leading Researcher of Department for Pathological Anatomy, Electronic Microscopy and Biochemistry, Head of Biochemical Laboratory.

2, Yauzskaya Alleya, Moscow, 107564, Phone: +7 (499) 748-30-23



O. G. Komissаrovа
Central Tuberculosis Research Institute; Pirogov Russian National Research Medical University
Russian Federation

Oksana G. Komissarova - Doctor of Medical Sciences, Deputy Director for Research and Therapy.

2, Yauzskaya Alleya, Moscow, 107564, Phone: +7 (499) 785-90-60



E. S. Chumаkovа
Regional Clinical TB Dispensary
Russian Federation

Elena S. Chumakova - Head of Therapy Department.

56, Dostoevskiy St., Stavropol, 355019, Phone/Fax: +7 (8652) 28-83-60



V. S. Odinets
Regional Clinical TB Dispensary
Russian Federation

Vasiliy S. Odinets - Head Physician.

56, Dostoevskiy St., Stavropol, 355019, Phone/Fax: +7 (8652) 28-83-60



A. E. Ergeshov
Central Tuberculosis Research Institute
Russian Federation

Atadzhan E. Ergeshov - Doctor of Medical Sciences, Professor, Director.

2, Yauzskaya Alleya, Moscow, 107564, Phone: +7 (499) 785-90-19



References

1. Аbdullaev R.Yu., Vaniev E.V., Kaminskaya G.O., Vasilyeva I.А., Komissarova O.G. Evaluation of functional liver state in patients suffering from new pulmonary tuberculosis when using I and IIB chemotherapy regimens. Probl. Tub., 2009, no. 2, pp. 57-61. (In Russ.)

2. Ivanova D.А., Borisov S.E., Ryzhov А.M. et al. Frequency and risk of severe adverse reactions during treatment of newly detected tuberculosis patients. Tuberculosis and Lung Diseases, 2012, vol. 90, no. 12, pp. 15-22. (In Russ.)

3. Samoylova А.G., Burakova M.V., Vasilyeva I.А., Lenskaya V.V., Vaniev E.V. The impact of express rifampicin susceptibility testing on chemotherapy efficiency in those suffering from multiple drug resistant tuberculosis. Tuberculosis and Lung Diseases, 2016, vol. 94, no. 9, pp. 18-23. (In Russ.)

4. Federalnye klinicheskie rekomendatsii po diagnostike i lecheniyu tuberkuleza organov dykhaniya. [Federal recommendations for diagnostics and treatment of respiratory tuberculosis]. Moscow, Tver, OOO Triada Publ., 2014, 56 p.

5. Ergeshov А.E., Komissarova O.G. Podkhody k lecheniyu bolnykh tuberkulezom legkikh s mnozhestvennoy i shirokoy lekarstvennoy ustojchivostyu vozbuditelya. Federalny spravochnik. Zdravookhranenie Rossii. [Approaches to treatment of pulmonary tuberculosis patients with multiple or extensive drug resistance. Federal reference book. Healthcare of Russia]. 2017, Issue 17, pp. 175-179.

6. Common Terminology Criteria for Adverse Events v4.0 (CTCAE). Publish Date: May 28, 2009. http://www.meddramsso.com

7. Weyer K. Mirzayev F., Migliori G. et al. Rapid molecular TB diagnosis: evidence, policy making and global implementation of Xpert MTB/RIF. Eur. Respir. J., 2013, vol. 42, pp. 252-271.


Review

For citations:


Аbdullаev R.Yu., Komissаrovа O.G., Chumаkovа E.S., Odinets V.S., Ergeshov A.E. Hepatotoxic reactions during treatment of newly diagnosed patients with pulmonary multiple drug resistant tuberculosis. Tuberculosis and Lung Diseases. 2019;97(7):21-27. (In Russ.) https://doi.org/10.21292/2075-1230-2019-97-7-21-27

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ISSN 2075-1230 (Print)
ISSN 2542-1506 (Online)