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Occurrence of serious adverse effects in patients receiving community-based therapy for multidrug-resistant
J J Furin1, C D Mitnick, S S Shin
1Department of Social Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA. jenfurin@aol.com
Setting:
A community-based treatment program for multidrug-resistant tuberculosis (MDR-TB) in an urban shantytown of Lima, Peru.
Objectives:
To ascertain the occurrence of serious adverse effects associated with therapy for MDR-TB in northern Lima, Peru, where therapy was individualized according to drug-susceptibility testing of patients' infecting strains and delivered through a community-based program.
Design:
A retrospective record review of 60 patients who had received individualized therapy for MDR-TB between September 1996 and October 1998.
Results:
Although adverse effects were common, they occurred less frequently than previously reported in the literature and were rarely life-threatening. Effects occurring most frequently in this population included: mild gastritis (100%), dermatological effects (43.3%), peripheral neuropathy (16.7%), depression (18.3%), and anxiety (11.7%). These effects never resulted in the discontinuation of anti-tuberculosis therapy, and only occasionally resulted in the suspension of an agent (11.7%).
Conclusion:
In young patients with little comorbid disease, multidrug, long-course regimens rarely caused life-threatening adverse effects. Common side effects may be managed successfully on an out-patient basis through a community-based treatment program in conjunction with MDR-TB experts, even in resource-poor settings. The very low rate of default in this cohort offers hope that strategies to manage the adverse effects may reduce the incidence of abandonment of therapy and increase rates of cure.