Title: Adverse Drug Reactions (ADRs) and preventability, in elderly DR TB patients admitted at Tuberculosis Hospital in Mumbai, India

Authors: Dr Rajendra Nanavare, Dr Daksha Shah, Dr Jagdish Keni, Dr Nilima Kshirsagar

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i3.172

Abstract

Background: Tuberculosis is a global health problem and emergence of MDR TB is a major threat to tuberculosis care and control. Treatment of MDR TB is challenging due to toxicity of second-line drugs used. Elderly population has several risk factors that can increase their susceptibility to ADR.

Methods: A retrospective analysis of records of MDR TB patients admitted, to Group of T.B. Hospital, a specialized TB hospital in Mumbai, India, during January 2016 – December 2016, was carried out to evaluate ADRs in patients ≥ 60 years of age and compare it with patients < 60 years.  ADRs were assessed for system organ classification, seriousness, severity causality, related suspected drugs, preventability using standard methods, and for possible risk factors.

Results: Out of 732 patients admitted, 33 were ≥ 60 years, 99 (three times) patients < 60 years were randomly identified from the remaining 699 of which 91 with required records were included in the analysis. Patients ≥ 60 years had significantly greater incidence of ADRs compared to<60 years age group. ADRs like vomiting, giddiness, otovestibular toxicity (tinnitus and vertigo) and hearing loss were significantly more in patient ≥ 60 years. Patients ≥ 60 years and with diabetes mellitus had significantly more ADRs as compared to patients < 60 years and with DM. ADRs were found to be possibly preventable by proper preventive measures and management as per guidelines.

Conclusion: Elderly population is increasing worldwide and is vulnerable to more ADRs due to comorbidities, pharmacokinetic, pharmacodynamics changes and social factors. Recognition of this vulnerability, emphasis on careful history, counselling and monitoring will help prevent ADRs and better manage elderly DR TB patients.

References

  1. World Health Organisation. Global TB report 2016. WHO/HTM/TB/2016.13
  2. Yoshikawa Thomasand Shobita Rajagopalan. Tuberculosis and Aging: A Global Health Problem. Clinical Infectious Diseases, Volume 33, Issue 7, 1 October 2001, Pages 1034–1039. https://doi.org/10.1086/322671.
  3. Atal Sood, Rekha Bansal, Aradhna Sharma. Profile of adverse drug reactions in patients on anti-tubercular drugs in a sub Himalayan tertiary care teaching hospital. International Journal of Research in Medicinal Sciences. 2016; 4(10):4465-4471.
  4. Kapadia VK, Tripathi SB. Analysis of 63 patients of MDR TB on DOTS plus regimen: An LG hospital, TB unit, Ahmedabad experience. Guj Med J. 2013; 68(2):52-7.
  5. Laíse Soares Oliveira Resende, Edson Theodoro dos Santos-Neto. Risk factors associated with adverse reactions to antituberculosis drugs. J Bras Pneumol. 2015; 41(1):77-89.
  6. Alomar MJ. Factors affecting the development of adverse drug reactions (Review article). Saudi Pharmaceutical Journal : SPJ. 2014; 22(2):83-94. doi:10.1016/j.jsps.2013.02.003.
  7. Davies EA, O’Mahony MS. Adverse drug reactions in special populations – the elderly. British Journal of Clinical Pharmacology. 2015; 80(4):796-807. doi:10.1111/bcp.12596.
  8. Farazi A. Sofian M, Jabbariasi M, Keshavarz S, Adverse reactions to antituberculosis drugs in Iranian Tuberculosis patients. Tuberculosis research and treatment. 2014, article ID 412893.
  9. Asati A, Indurkar M, Profile of adverse drug reactions in TB patients taking ATT Journal of Medical Science and Clinical Research 2016, 12, 14589 – 14592
  10. Daphne Y, Marthe etal. Incidence of serious side effects from first line antituberculosis drugs among patients treated for active tuberculosis. Am. J. Resp. care Med, 2003,167, 1472-1477
  11. Bezu H, Seifu D, Yimer G, Mebrhatu T, Prevalence and risk factors of adverse drug reactions, associated with multidrug resistant tuberculosis treatment in selected treatment centers in Addis Ababa Ethiopia. Journal of Tuberculosis Research 2014, 2, 144-154
  12. Kshirsagar NA and others, Safer prescriptions for the elderly challenges and solutions from India. The Lancet global heath, 20 Jul 2017, blog. 16669358474- b7 afe 8ba 47 _ 0.jgp.
  13. ICMR and central TB division India :Prevention and management of ADRs to antitubercular drugs . Ready reckoner for medical officers, 2016, https://tbcindia.gov.in.

Corresponding Author

Dr Rajendra Nanavare

International Union against Tubercular and Lung Diseases and Ex. Medical Superintendent,

GTB hospital, Sewri, Mumbai