Not All Sensitive TB is Simple to treat : A tertiary care experience on the utility of Pharmacokinetics in managing and treating drug sensitive tuberculosis

Abstract

Not All Sensitive TB is Simple to treat : A tertiary care experience on the utility of Pharmacokinetics in managing and treating drug sensitive tuberculosis

Background and Aim:

Tuberculosis  treatment failure or disease progression despite adherence to proper treatment may be due to subtherapeutic drug levels. Pharmacokinetic variability can lead to inadequate drug exposure, necessitating dose optimization. This case series highlights eight patients with persistent or worsening of TB who had low plasma levels of Isoniazid and Rifampicin, requiring high-dose ATT for successful treatment.

Case Description:

Eight patients with drug-sensitive TB demonstrated persistent or progressive disease despite standard ATT.

 Case 1:  A 17-year-old female with cervical lymphadenopathy developed new nodes after 6 months. Case 2:  A24-year-old female showed nodal enlargement at treatment completion.

Case 3:  A 17-year-old male had slow response with new inguinal lymphadenopathy at 9 months.

 Case 4: A 22-year-old female developed new cervical nodes at the end of the continuation phase. Case 5: A 39-year-old male developed a collar-stud abscess at 4 months.

 Case 6: A 29-year-old male with mediastinal and supraclavicular lymphadenopathy had disease progression on PET-CT after 6 months.

Case 7: A 39-year-old female with pulmonary TB had persistent radiological disease and positive GeneXpert at 9 months.

Case 8: A 22-year-old female with fibro-cavitary TB developed pyopneumothorax with pleurocutaneous fistula and persistent air leak.

Conclusion: TDM is crucial for DS-TB patients with disease progression or slow response despite adherence to ATT. Identifying and addressing subtherapeutic drug levels with high-dose therapy can optimize treatment outcomes and prevent drug resistance.

Key words : Pharmacokinetics, Drug Monitoring, High-dose Therapy, Subtherapeutic Drug Levels, Treatment Failure.