Approaches to Selection of Optimal Chemotherapy Regimens in Tuberculosis Patients with Concurrent Diabetes Mellitus

The objective: to develop approaches to selection of optimal chemotherapy regimens in tuberculosis patients with concurrent diabetes mellitus (DM), by studying complications of diabetes mellitus and adverse drug reactions to anti-tuberculosis drugs.

Subjects and Methods. 235 adult pulmonary tuberculosis patients with concurrent diabetes were enrolled in the study. Of them, 123 were men (52.3%) and 112 were women (47.7%), and the age of the patients varied from 19 to 78 years old.

Results. Complications of diabetes mellitus (DM) were reported in 190/235 (80.8%) patients. Encephalopathy occurred most often – in 147/190 (77.3%) patients, diabetic macroangiopathy developed less often - in 41 (21.6%), followed by diabetic retinopathy – in 20 (10.5%), diabetic nephropathy - in 11 (5.8%), ketoacidosis – in 4 (2.1%), and diabetic foot – in 4 (2.1%). Diabetic macroangiopathy was significantly more often observed in men (66.7%) versus women (31.7%); p<0.01, and diabetic nephropathy was more common in women (81.8%) than men (18.2%); p<0.01. As the age of patients and duration of diabetes increased, the incidence of complications of diabetes also increased. Adverse drug reactions (ADRs) to anti-tuberculosis drugs (TB drugs) occurred in 168/235 (71.4%) patients. ADRs to two or more TB drugs were registered in 140/168 (83.3%) patients. The most frequent irreversible ADRs were caused by the following drugs (of the number of patients taking them): aminoglycosides (58.8%), capreomycin (54.5%), PAS (50.0%), ethambutol (100.0%), cycloserine (40.0%), levofloxacin (33.3%), pyrazinamide (23.3%), terizidone (28.6%), prothionamide (26.3%), linezolid (21.4% ), and moxifloxacin (20.0%).

Conclusion. When treating pulmonary tuberculosis in patients with diabetes mellitus, chemotherapy regimens containing aminoglycosides, capreomycin, prothionamide, and pyrazinamide should be avoided. If there is even an initial stage of retinopathy, ethambutol should be avoided. Patients with encephalopathy should be switched from cycloserine to terizidone.

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