UDC 616.61-002.26-06:616.155.194.8
ANALYSIS OF ADVERSE EVENTS FOR ANTI –TUBERCULOSIS DRUGS IN
TUBERCULOSIS PATIENTS IN THE KHOREZM REGION
Askarova R.I.
Urgench Branch Tashkent Medical Academy, Uzbekistan
Resume
In Uzbekistan tuberculosis is one of the most threatening social and medical problem.Tuberculosis
has become an epidemic in many countries of the world.Almost one and a half million people die
annually from this insidious infection. Tuberculosis can be prevented and cured even with the most
scarce resources.The article analyzes the case histories of patients who received in the threatment in
the Khorezm regional anti- tuberculosis dispensary.
Key words: tuberculosis, the threatment, side effects, anti-tuberculosis drugs;
АНАЛИЗ НЕЖЕЛАТЕЛЬНЫХ ЯВЛЕНИЙ НА ПРОТИВОТУБЕРКУЛЕЗНЫЕ
ПРЕПАРАТЫ У БОЛЬНЫХ ТУБЕРКУЛЕЗОМ В ХОРЕЗМСКОЙ ОБЛАСТИ
Аскарова Р.И.
Ургенчский филиал Ташкентской медицинской академии.
Резюме
В Узбекистане туберкулез одна из наиболее угрожающих социальных и медицинских
проблем. Туберкулез приобрел масштаб эпидемии в многих странах мира. Ежегодно почти
полтора миллион человек умирают от этой коварной инфекции. В большинстве случаев
туберкулез можно предупредить и предотвратить даже при самых скудных ресурсах.
Несмотря на огромный опыт человечества и борьбе с туберкулёзом. ежегодно в мире
регистрируется 9 млн новых случаев заболевания туберкулезом и почти 2 млн умерших от
него.
Ключевые слова: туберкулез, лечение, побочные эффекты, противотуберкулезные
препараты.
ХОРАЗМ ВИЛОЯТИДА СИЛ КАСАЛЛИГИ БИЛАН ОҒРИГАН БЕМОРЛАРДА СИЛГА
КАРШИ ДОРИЛАРНИНГ НОЖЎЯ ҲОЛАТЛАРИ ТАҲЛИЛИ
Аскарова Р.И.
Тошкент тиббиет академия Урганч филиали
Резюме
Ўзбекистонда сил касаллиги энг хавфли ижтимойи ва тиббий муаммолардан бири
ҳисобланади. Ушбу инфекциядан ҳар йили жаҳонда деярли 1,5 миллион киши вафот этади.
Бир миллион сил касаллиги ҳар йили аёлларда қайд этилиб, бу эса оналар орасида учрайдиган
барча ўлим ҳолатларидан ҳам кўп демакдир. Силга қарши курашиш хизмати Ўзбекистонда
бугунги кунда нуфузли давлатлар даражасига кутарилди, бу давлатимиз ушбу муаммога
қаратилган тиббий профилактик сиёсати натижасидир.
Калит сўзлар: туберкулез, сил касаллигини даволаш, ножуя таъсир, силга
қарши дори
воситалари.
Relevance
uberculosis
as
an
insidious
disease
has
accompanied humanity for thousands of
years. People have always
looked for a cute for
tuberculosis. This disease claimed more lives
than all wars combined. The main reason for the
exacerbation of the epidemiological situation
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with tuberculosis is the deterioration of the social
living conditions of the population. In the
Republic of Uzbekistan, a complex of large-scale
anti-tuberculosis measures to combat tuberculosis
is annually carried out.
Tuberculosis can be cured with medication.
The discovery of the antibiotic streptomycin,
which defeated tuberculosis rightfully belongs to
Z.A. Waxman. It took many years of painstaking
work of a large army of chemists, biochemists,
pharmacists, microbiologists, clinicians, botanists
to introduce anti-tuberculosis drugs. But at the
present stage, humanity is worried about the
increase in the number of patients with
multidrug-resistant forms of tuberculosis (MDR).
The Republic of Uzbekistan is one of the 20
priority countries of the WHO in terms of MDR-
TB [1].
Treatment of drug-resistant tuberculosis is
complicated from the point of view of
constructing a DOTS treatment program: it is
long-term,
requiring
patients
to
take
chemotherapy for up to two years or more, while
often enduring side effects of medications. In this
case, adverse reactions caused by reserve drugs
lead to a change in the treatment regimen and a
decrease in the effectiveness of chemotherapy
[1,2]. Therefore, studying the nature of adverse
reactions caused by reserve drugs is a necessary
prerequisite for effective treatment of patients
with MDR-TB. The most important social risk
factors in terms of avoiding treatment by
tuberculosis
patients
are:
alcohol
abuse,
loneliness of a homeless person, homeless, living
alone and unmarried, lack of a permanent place
of work, unemployed and unemployed. Also stay
in the past in places of detention. Medical risk
factors are the presence of bacterial excretion at
registration of the patient and the fact of
treatment in the phase of continuation of
chemotherapy. Men and women interrupt
treatment with the same frequency: 5.6 and 4.0%,
respectively.
Among
men,
treatment
is
interrupted more often by persons aged 31 to 50
years. Moreover, in patients with low efficiency
of treatment, there is a combination of three
factors or more [3,4]. Among patients with low
adherence
to
treatment,
late
detection,
widespread processes in the lung tissue, and
abundant bacterial excretion are more often
noted. multiple decay cavities, multiple drug
resistance of the pathogen [3,10].
Thus, the most significant potential factors of
low adherence to treatment in ineffectively
treated patients with pulmonary tuberculosis are:
demographic - socio-economic status. Social
employment
of
the
patient;
personal
-
understanding the disease and its consequences,
the motivation of the patient and his family.
Despite the efforts of phthisiatricians, there are a
large number of patients who are negatively
disposed towards therapeutic measures, most of
whom undergo, but several repeated, often
defective, courses of chemotherapy. It is in these
patients that drug resistance of MBT is more
often formed [5,6]. From a clinical standpoint,
the main reasons for the spread of drug-resistant
tuberculosis are late diagnosis, incorrect or
incomplete treatment. Failure to adhere to basic
principles contributes to the development of
MBT resistance in combination chemotherapy.
Of great importance was the "indiscipline" of
patients - irregular intake of anti-tuberculosis
drugs, premature discharge from the hospital,
unauthorized care or discharge for violation of
the regimen [9]. This situation, naturally,
prevents the cure of these patients and promotes
the
development
of
drug
resistance
of
mycobacterium to anti-tuberculosis drugs [7,8].
Due to the lack of the effect of chemotherapy,
patients
with
drug-resistant
pulmonary
tuberculosis MBT for a long time remain
bacteriological and can infect others with
resistant pathogens, while the main reason for the
increase in the number of patients with acquired
(secondary) drug resistance is inadequate
chemotherapy for newly diagnosed patients with
tuberculosis ... The larger the number of such
patients, the wider the reservoir of tuberculosis
infection and the higher the risk of spreading it
among healthy individuals and the emergence of
new cases of pulmonary tuberculosis with
primary drug resistance MBT [9,10]. So, in
patients who took less than 50% of the planned
doses during the main course of treatment.
amplification occurred in 20.6% of cases. 60-
70% of doses - at 12.5%. In more "regime"
patients (more than 70% of doses), the expansion
of the spectrum of drug resistance to drugs of the
1st and 2nd rows is reduced to 83%.
Patients with tuberculosis face many problems
that affect their motivation for treatment. The
most important factors that regulate the
motivation of a person are value orientations:
political, ideological, moral convictions of a
person, deep and constant attachments. principles
of behavior. The disease changes the perception
of the present, the perspective for the future,
contains the threat of loss of health and ability to
work, changes in personal and social status, and
the threat of death. As a result, there is a
reassessment of personal values and motivation
[2,1].
Purpose of the study:
To study the
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frequency, nature of adverse reactions caused by
anti-tuberculosis drugs in patients who are in the
regional anti-tuberculosis dispensary of the
Khorezm region of Uzbekistan.
Material and methods
The study of the history of diseases of patients
with pulmonary tuberculosis, an analysis of the
medical records of an inpatient, TB 01, a register
of adverse reactions of drugs, patients with
primary MDR-TB who were treated at the
Khorezm TB dispensary, the department of
therapy for 12 months of 2020.
Result and discussion
In total, 93 medical histories of patients who
were in the department were analyzed. Treatment
of the regional tuberculosis dispensary in
Urgench for 12 months of 2020 with primary
MDR-TB. At the initial stage, in the first 2-3
weeks of treatment, at least one side effect was
observed in 76 (81.7%) cases, these PRs were
temporary and disappeared on their own. 17
(18.3%) patients had no side effects. Visible
adverse reactions to PVR were observed in 48
(51.6%) cases. In 34 (71%) patients, due to
persistent adverse reactions, anti-TB drugs that
caused AR were excluded from the treatment
regimen.
Pas in all 48 (51.6%) cases, Eto / Pto in 6
(12.5%) cases. Latent side effects without clinical
manifestations were reported in the form of
eosinophilia 10 (20.8%) with eosinophil levels
from 8% to 36%, as well as an increase in liver
enzymes 5 (10.4%). The most common
manifestations of PR were nausea, vomiting
(80%), abdominal pain (14.6%), skin rash
(16.6%), diarrhea (12.5%), neurological disorders
(headaches, muscle cramps, insomnia ) 12.5%.
The average age of patients was 47 years (range
22-74), persons of working age accounted for
81.3%, most of them were men 28 (58.3%).
Table 1. Age of patients with tuberculosis observed
Up to 20
years
Up to 30
years
Up to 40
years
Up to 50
years
Up to 60
years
Over 60
years
4
13
12
5
7
7
Table 2. Analysis of patients by forms of tuberculosis, of which 33 are destructive forms
№
Forms
quantity
1
2
2
Cirrhotic pulmonary tuberculosis
10
3
Infiltrative pulmonary tuberculosis
26
4
Infiltrative pulmonary tuberculosis with disintegration
3
5
Fibrous-cavernous pulmonary tuberculosis
2
6
Chronic disseminated tuberculosis
2
7
Disseminated tuberculosis in the phase of infiltration and decay
1
8
Cavernous tuberculosis
3
Table 3. Tuberculosis with concomitant pathology, of 48 patients had 32 (65%)
№
Comorbidity
количество
1
Addiction
1
2
Alcoholism
12
3
HIV infection
3
4
Diabetes
11
5
Hormone-dependent rheumatoid arthritis
1
6
Hormone dependent, bronchial asthma
2
7
Silicosis, occupational diseases
1
8
Stomach ulcer and 12 duodenal ulcer
1
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Table 4. Manifestations of side effects after taking drugs
Adverse reactions from the gastrointestinal tract 44 cases, after taking drugs
Nausea
vomiting
heartburn
Stomach ache
Loose stools
26
2
8
2
6
Adverse reactions from the liver -6 cases
Increased
thymol test
Increased ALT
pain
jaundice
Increased bilirubin
1
1
3
1
2
Side effects from the central nervous system-23 cases
headaches
Sleep disturbance
depression
8
8
5
Skin reactions
Itchy skin in 8 patients
Table 5. Side effects of anti-TB drugs in patients
Side effects
number
Percent
Nausea, vomiting
20
80%
Headache
10
40%
4
16%
Hearing and vision impairment
7
28%
Diarrhea
7
2%
Joint pain
6
24%
Medicinal hepatitis
4
16%
dermatitis
2
8%
Peripheral neuropathy
2
8%
Table 6. Discovery of anti-tuberculosis drugs with publication in the literature
№
Preparation Author, year, publication
1
PASK
Berncheim
1941
2
Streptomycin
Waksman
1944
3
Pyrazinamide
Makcaness, Smith
1950
4
Isoniazid
Fox et al
1952
5
Cycloserine
Hernd, Kropp
1955
6
Kanamycin
Umezawa
1957
7
Ethionamide
Noufland-Guy-Loe
1960
8
Capreomycin
Herr et.al Loe
1961
9
Ethambutol
Thomas, Wilkinson
1966
10
Rifampicin
Maggi et al
1966
11
Fluoroquinolones
Gillepsei, Kennedy
1990
Most often, side effects of anti-TB drugs were
on the gastrointestinal tract [2] (nausea, vomiting,
diarrhea, drug hepatitis) - 30 (90.9%) cases,
neurological disorders (headaches, peripheral
neuropathies) - 12 (36.4 %) cases, atralgia 7
cases (21.2%), allergic reactions in the form of
dermatitis and hearing loss in 4 cases (12.1%).
Conclusions
Thus, interruption of the main course of
chemotherapy and non-compliance with the
treatment regimen by patients lead to the
formation of resistance of MBT to anti-
tuberculosis drugs.
Side effects of anti-tuberculosis drugs limit
the possibility of full chemotherapy. PD
developed in all patients with concomitant
gastrointestinal pathology, cachexia, and a
widespread destructive tuberculosis process.
The
most typical manifestations of PR are nausea,
vomiting,
diarrhea
-
39
(81.2%)
cases,
neurological disorders (headaches, depression,
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insomnia) - 6(12.5%). Adverse reactions were
mainly caused by Pas, Pto / Eto, Cs, Z. In 70% of
cases, it became necessary to exclude one drug
from the treatment regimen.
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Entered 09.04. 2021
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