NEPHROTOXIC REACTIONS TO AMINOGLYCOSIDES IN PATIENTS WITH MULTIDRUG-RESISTANT PULMONARY TUBERCULOSIS WITHOUT CONCOMITANT PATHOLOGY
Abstract
Summary. Multidrug-resistant tuberculosis (MDR TB) is a very dangerous form of tuberculosis, for treatment of which anti-inflammatory drugs 2 series are prescribed, including aminoglycosides. One of the most serious adverse events is reactions to nephrotoxic aminoglycosides. Treatment of such patients presents great difficulty.
Purpose. Studying the frequency, nature and timing of the development of nephrotoxic reactions to aminoglycosides in patients with MDR pulmonary tuberculosis without concomitant pathology and assessment of their influence on the effectiveness of treatment.
Materials and methods. A retrospective cohort study. We investigated 64 patients with MDR pulmonary tuberculosis. The patients were divided into two groups: group 1 (n = 38) consisted of patients with MDR TB nephrotoxic reactions (NR) to aminoglycosides, group 2 (n = 26 individuals) — patients without MDR TB NR (control). Groups 1 and 2 were divided into subgroups: 1A (n = 14), 2A (n = 16 patients), — first identified MDR TB patients with NR 1B (n = 24 patients), 2B (n = 10 persons) — «repeated» MDR TB patients with NR, respectively. Under terms of relief of nephrotoxic reactions, patient’s groups 1A and 1B were divided into subgroups of 1.1A (n = 9 people) 1.1b (n = 6 people) — NR cupped up to 2 weeks, 1.2A (n = 5 persons), 1.2 B (n = 18 people) — NR cupped in for more than 2 weeks, respectively. Monitoring treatment MDR TB carried out according to conventional techniques. Statistical processing of the results was carried out by «Microsoft Excel for Windows 2010" package.
Results and discussion. We have found that reactions to nephrotoxic aminoglycosides in patients without concomitant pathology MDR TB and with normal baseline renal function develop in 59,4 ± 6,1 % cases. Total for the first and second months of treatment in the group 1.2A conversion of sputum by direct smear microscopy Ziehl-Nielsen was reached at (20,0 ± 17,9 %) patients, and in group 2A at (85,7 ± 9, 4 %) patients during the 3rd and 4th months 1.2A group — (80,0 ± 17,9 %) patients and in the group 2A at (14,3 ± 9,4 %) patients ( φ * = 2,76, p <0.05). Total for first three months of treatment in the group 1.2B IF conversion was achieved in sputum (41,2 ± 11,9 %) patients in group 2B (88,9 ± 10,5 %) patients during the 4 th and 5th months 1.2B group — (58,8 ± 11,9 %) patients, and in group 2B at (11,1 ± 10,5 %) patients (φ * = 2,59, p < 0,05). Also found that during the first two months of treatment in the group 1.2A conversion sputum expectoration by inoculation of nutrient medium was achieved in (40,0 ± 21,9 %) patients and in the group 2A (93,7 ± 6 ,1 % ) p atients (φ * = 2 ,36, p <0.05) in 1.2B group — (22,2 ± 9,8 %) patients and in the group 2B (70,0 ± 14,5 % ) patients (φ * = 2,54, p <0.05). Positive dynamics of the X-ray to the third month of treatment in the group 1.2A observed in significantly fewer patients (40,0 ± 21,9 %), than in the control group 2A (81,3 ± 9,8 %) people (φ * = 1, 71, p < 0.05). In the group of ”repeated" MDR TB patients — at (33,3 ± 11,1 %) patients in group 1.2B and (70,0 ± 14,5 %) people group 2B (φ * = 1,91, p < 0, 05).
Conclusions. Nephrotoxic reactions to aminoglycosides identified in 59.4 % of patients without lung MDR TB concomitant pathology. In "recurrent" patients they developed in most cases at an earlier stage — during the first two months of treatment than in newly diagnosed patients — during 3–4 months. It was found that patients with lung MDR TB nephrotoxic reactions to aminoglycosides lasting for more than 2 weeks have a negative influence on the effectiveness of treatment.
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