Interventions for Tuberculosis Control and Elimination 2002

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quent adverse drug events are gastrointestinal (weight loss, nausea, vomiting), 421 central nervous system, 421 and cutaneous adverse drug events. 435 An international investigation in 13 countries into adverse drug events due to thioacetazone was coordinated by the British Medical Research Council. 439 The frequency of adverse drug events in that study was 21% compared to eight per cent of patients who were not receiving thioacetazone. More than half of the adverse drug events were mild. The study confirmed earlier observations that gastrointestinal and neurologic adverse drug events (headache, blurred vision, perioral numbness, mental symptoms, and peripheral nerve symptoms) were the most frequent, followed by cutaneous adverse drug events. Two out of 1,000 patients developed agranulocytosis. 439 The frequency of adverse cutaneous reactions varied in different populations. Differences in nutrition may be a contributor to this observation as, for example, consumption of cheese and fish appear to increase the risk of cutaneous and neurologic adverse drug events. 440 It was recognized relatively early that patients with HIV infection have increased susceptibility to developing toxic epidermal necrolysis when given sulfur-containing medications such as sulfadoxine 441 or sulfamethoxazole. 442 The causal relationship between the occurrence of cutaneous adverse reactions and the use of thioacetazone has been elegantly demonstrated (figure 27). 443 Reactions may present as pruritus without rash, rash without epidermolysis, and most seriously as toxic epidermal necrolysis. 444 The latter has a case fatality rate of 20% to 30%, depending on the selection of cases (figure 28). Both reactions and deaths occur relatively early in the course of administration, with more than half occur- Table 7. Summary of adverse reactions from thioacetazone with estimated frequencies of occurrence. Note that these are estimates of frequencies, which may vary across population groups. Frequent Common Infrequent Rare (� 5 per 100) (� 1 per 100 and (� 1 per 1,000 (< 1 per 1,000) < 5 per 100) and < 1 per 100) Weight loss Toxic epidermal Toxic epidermal Agranulocytosis Nausea necrolysis necrolysis Vomiting (in HIV) (in non HIV) Itching infected patients) infected patients) Mental disturbances Headache Blurred vision Perioral numbness 47
�� Figure 27. Demonstration of the causal relation between cutaneous adverse reaction and thioacetazone, by HIV status and regimen. 443 ring within the first three weeks of treatment (figure 29) (Tanzania National Tuberculosis / Leprosy Programme, IUATLD, unpublished data). Numerous accounts have now been published that confirm the potential seriousness of the utilization of thioacetazone in HIV infected tuberculosis patients. 445-448 While most adverse reactions are toxic effects, cutaneous adverse reactions appear to be largely idiosyncratic, and are not influenced by reducing the dosage. 421 �� Figure 28. Adverse cutaneous reactions and deaths associated with the use of thioacetazone, by severity of reaction. Tanzania National Tuberculosis / Leprosy Programme and IUATLD, unpublished data. 48
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Tuberculosis Interventions Interven
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Editor International Union Against
Page 5 and 6: Isoniazid plus rifampicin plus pyra
Page 7 and 8: 4. Preventive chemotherapy . . . .
Page 10: Acknowledgments It would not have b
Page 13 and 14: This monograph deals with the fourt
Page 15 and 16: ��
Page 17 and 18: ��
Page 19 and 20: contraceptives and anti-retroviral
Page 21 and 22: is scant. However, the limited evid
Page 24 and 25: 1. Chemotherapy The primary interve
Page 26 and 27: ability of the drug in the serum of
Page 28 and 29: emain elusive, 47 the general mecha
Page 30 and 31: ��
Page 32 and 33: Idiosyncratic reactions from isonia
Page 34 and 35: tis risk per 1,000 subjects was zer
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Page 38 and 39: ��
Page 40 and 41: ��
Page 42 and 43: Rifampicin may rarely cause pseudom
Page 44 and 45: • opioids; 292-294 • vitamin K
Page 46 and 47: Table 4. Summary of adverse reactio
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Page 50 and 51: Effect of drug potentiated by etham
Page 52 and 53: orne out by experiments which have
Page 54 and 55: longed respiratory depression follo
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Page 60 and 61: Table 9. Grading of activities of a
Page 62 and 63: ��
Page 64 and 65: Effective or functional monotherapy
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Page 68 and 69: drugs with a high therapeutic margi
Page 70 and 71: Council 122 or the individual trial
Page 72 and 73: article. The experiences in Edinbur
Page 74 and 75: Per cent positive 100 80 60 40 20 0
Page 76 and 77: Based on evidence that the addition
Page 78 and 79: esented a major advance in research
Page 80 and 81: cipal consideration is the prevaili
Page 82 and 83: of six months’ duration with ison
Page 84 and 85: Treatment efficacy As enteropathy i
Page 86 and 87: Influence of isoniazid resistance o
Page 88 and 89: • Patients with sputum smear-posi
Page 90 and 91: medications were taken daily throug
Page 92 and 93: of the disease, as alternative drug
Page 94 and 95: Number of cases per 100,000 populat
Page 96 and 97: number of cases, the health care pr
Page 98 and 99: necessary). If the event occurs in
Page 100 and 101: The patient with acute renal toxici
Page 102: and no association with diarrhea. 5
Page 105 and 106: Schools Contacts of new cases Conta
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too small to allow a meaningful int
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Cases per 1,000 140 120 100 80 60 4
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Pasteur, 1921 Moreau, 1924 Tokyo, 1
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mendation by WHO states that no pri
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the number of person-years of obser
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• protection afforded by vaccinat
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Saskatchewan Saskatchewan Chicago C
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Three retrospective studies among c
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Harm / protection (%) 20 0 -20 -40
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• Differences in virulence of M.
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infected persons may thus mask any
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If environmental mycobacteria do in
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Relative risk (log scale) 10 3 1 0.
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Because BCG vaccination is given ea
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the largest purchaser in the world)
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made here to provide a comprehensiv
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year following commencement of trea
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might be expected, therefore, that
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tionally considered to belong to gr
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Prevention of disease following ces
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��
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��
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� ��
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Table 11. Preventive therapy - effe
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Logistical problems may, however, i
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In an uncontrolled study in Zambia,
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In none of the nine prospective tri
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is not usually an option, this is t
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Like other aminoglycosides, amikaci
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twice rather than once per day, red
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Quinolones Quinolones have a potent
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Rifapentine Rifapentine (cyclopenty
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published a scientific blueprint fo
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to that of isoniazid. 1162 It appea
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Appendix 3 Current vaccine developm
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this type of vaccine may not only p
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15. Goldman AL, Braman SS. Chest 19
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44. Heym B, Alzari PM, Honoré N, C
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76. McCurdy PR, Donohoe RF. Pyridox
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112. Van den Brande P, van Steenber
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147. Murray FJ. Outbreak of unexpec
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183. Acocella G, Conti R, Luisetti
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215. Prazuck T, Fisch A, Simonnet F
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248. Powell-Jackson PR, Jamieson AP
Page 197 and 198:
281. LeBel M, Masson E, Guilbert E,
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310. Yeager RL, Munroe WGC, Dessau
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341. Crowle AJ, Sbarbaro JA, Judson
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376. Graham SM, Daley HM, Salanipon
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410. Paradelis AG, Triantaphyllidis
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443. Nunn P, Kibuga D, Gathua S, Br
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471. Mitchison DA. Basic mechanisms
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501. East African / British Medical
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526. East African / British Medical
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554. Medical Research Council. Five
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580. Nolan CM. Failure of therapy f
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606. Crofton J, Chaulet P, Maher D,
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631. Weis SE, Slocum PC, Blais FX,
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662. Griffith AS. A study of the BC
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695. Horwitz O, Meyer J. The safety
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723. World Health Organization. Rec
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756. Al-Kassimi FA, Al-Hajjaj MS, A
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785. Comstock GW, Webster RG. Tuber
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814. Vynnycky E, Fine PEM. The annu
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843. Talic RF, Hargreve TB, Bishop
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871. Pamra SP, Mathur GP. Effects o
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897. American Thoracic Society, Cen
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924. Elliott AM, Halwiindi B, Bagsh
Page 243 and 244:
957. Escobar JA, Belsey MA, Dueñas
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989. Hoffner SE, Källenius G. Susc
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1021. Helmy B. 220-5. Side effects
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1053. Thomas L, Naumann P, Crea A.
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1083. Perumal VK, Gangadharam PRJ,
Page 253 and 254:
1109. Lucchesi M. L’éthionamide
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1141. Ashtekar DR, Costa-Perira R,
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1165. Oleksijew A, Meulbroek J, Ewi
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1193. Hondalus MK, Bardarov S, Russ
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IMPRESSION, BROCHAGE IMPRIMERIE CHI
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