Abstract
Introduction: Previous data has suggested a significantly higher risk of adverse outcomes among patients with drug resistant tuberculosis (TB) and diabetes mellitus (DM). The present study was conducted to assess the adverse reactions to anti-tubercular treatment among diabetic and non-diabetic tuberculosis patients.
Methodology: The present study was conducted to describe the side effects of anti-tubercular therapy in patients of TB with and without diabetes mellitus. Equal number of diabetic and non-diabetic (n=75 each) multi-drug resistant (MDR) TB patients who received at least 3 months of anti-TB treatment at our centre were included in the study. All patients in the diabetic group were diagnosed using Genexpert and Mycobacteria growth indicator tube. Adverse drug reactions were determined based on the clinical presentation.
Results: Most common presenting complaint in both the patient groups was cough was almost universal in both the patient groups. Most common side effect reported by the diabetic tuberculosis patients was nausea (in 45%) which had a median onset time of 6 days after starting tuberculosis treatment. Other common adverse effects reported among diabetics was gastritis (43%), vomiting (32%) and peripheral neuropathy (29%). Most common adverse effect reported by patients without diabetes was gastritis which started at a median time of 14 days. Non-diabetics also reported adverse effects like vomiting (49%), dizziness (28%), nausea (28%), peripheral neuropathy (28%) and joint pain (24%).
Conclusions: Screening of DM in TB patients and TB in DM is suggested as high incidence of adverse effects can affect the treatment compliance.
Keywords: MDR tuberculosis, diabetes mellitus, adverse drug reaction.
References
- Stevenson CR, Critchley JA, Forouhi NG et al. Diabetes and the risk of tuberculosis: a neglected threat to public health. Chronic Illness 2007;3:228–45.
- Jeon CY, Murray MB. Diabetes mellitus increases the risk of active tuberculosis: a systematic review of 13 observational studies. PLoS Med 2008;5:e152.
- Reis-Santos B, Gomes T, Locatelli R, et al. Treatment outcomes in tuberculo- sis patients with diabetes: a polytomous analysis using Brazilian surveillance system. PLOS ONE 2014; 9.
- Magee M J, Kempker R R, Kipiani M, et al. Diabetes mellitus is associated with cavities, smear grade, and multidrug-resistant tuberculosis in Georgia. Int J Tuberc Lung Dis 2016; 19: 685–692.
- Edwards IR, Aronson JK. Adverse drug reactions: definitions, diagnosis, and management. The lancet. 2000;356 (9237):1255-9.
- Fiorentino TV, Prioletta A, Zuo P, et al. Hyperglycemia-induced oxidative stress and its role in diabetes mellitus related cardiovascular diseases. Curr Pharm Des 2013; 19: 5695–5703.
- Ahadpour M, Eskandari MR, Mashayekhi V, et al. Mitochondrial oxidative stress and dysfunction induced by isoniazid: study on isolated rat liver and brain mitochondria. Drug ChemToxicol 2016; 39: 224–232.
- Song T, Lee M, Jeon HS, et al. Linezolid trough concentrations correlate with mitochondrial toxicity-related adverse events in the treatment of chronic extensively drug-resistant tuberculosis. E Bio Medicine 2015; 2: 1627–1633.
- Varga ZV, Ferdinandy P, Liaudet L, et al. Drug-induced mitochondrial dysfunction and cardiotoxicity. Am J Physiol Heart CircPhysiol 2015; 309: H1453–H1467.
- Chang KC, Yew WW, Cheung SW, et al. Can intermittent dosing optimize prolonged linezolid treatment of difficult multidrug-resistant tuberculosis. Antimicrob Agents Chemother 2013; 57: 3445–3449.
- Alsultan A, Peloquin CA. Therapeutic drug monitoring in the treatment of tuberculosis: an update. Drugs 2014; 74: 839–854.
- Siddiqui AN, Khayyam KU, Sharma M. Effect of diabetes mellitus on tuberculosis treatment outcome and adverse reactions in patients receiving directly observed treatment strategy in India: a prospective study. BioMed research international. 2016;2016.
- Gholami K, Kamali E, Hajiabdolbaghi M, Shalviri G. Evaluation of anti-tuberculosis induced adverse reactions in hospitalized patients. Pharmacy Practice. 2006 Jul;4(3):134.
Corresponding Author
Dr Sandhya Kulkarni
Assistant Professor, Dept. of Pulmonary Medicine, Dr D. Y. Patil Hospital, Nerul, Navi Mumbai, Maharashtra, India
DOI: https://dx.doi.org/10.18535/jmscr/v7i1.53
