International Journal of Medical Sciences And Clinical Research
37
https://theusajournals.com/index.php/ijmscr
VOLUME
Vol.05 Issue06 2025
PAGE NO.
37-41
10.37547/ijmscr/Volume05Issue06-08
Comparative Analysis of The Frequency of Adverse
Events in Children and Adolescents with Sensitive and
Resistant Forms of Tuberculosis
Abdusalmova Makhliyo Ismailovna
Republican Specialized Scientific and Practical Medical Center of Phthisiology and Pulmonology named after Sh. Alimov, Uzbekistan
Received:
22 April 2025;
Accepted:
18 May 2025;
Published:
20 June 2025
Abstract:
The study examined adverse events (AE) in 182 children and adolescents receiving anti-tuberculosis
treatment. AE were detected in 103 (56.6%) patients. The most common were toxic reactions (79.6%), less
common were toxic-allergic (12.6%) and allergic (7.8%) reactions. In adolescents, allergic (11.1% vs 6.0%) and
toxic-allergic (19.4% vs 9.1%) reactions were significantly more common than in children (P<0.05). In adolescents,
allergic (11.1% vs 6.0%) and toxic-allergic (19.4% vs 9.1%) reactions were significantly more common than in
children (P<0.05). In patients with drug-resistant TB, AEs were observed 1.7 times more often than in patients
with sensitive TB (81.6% vs 47.4%, P<0.05).
Keywords:
Tuberculosis, children, adolescents, anti-tuberculosis therapy, adverse events, toxic reactions, allergic
conditions, toxic-allergic reactions, drug resistance, chemotherapy, Xpert MTB/Rif, HAIN TEST, MGIT.
Introduction:
The problem of tuberculosis (TB) in
children and adolescents has always been of interest,
in modern conditions it is more acute and relevant
[1,17]. The decisive factor determining the occurrence
of TB in children is their cohabitation with a bacteria
excretor in a tuberculosis infection site (TIS) [9,17].
In modern conditions, the drug load on the child's div
has increased during the treatment of TB, which has
contributed to the development of adverse reactions to
anti-tuberculosis drugs (ATD) in most children [2,4,6].
Polychemotherapy
of
TB,
including
various
combinations of ATD, has a negative effect on many of
its organs and systems. Thus, according to the
literature, as a result of intensive chemotherapy in
hospital, patients developed some adverse reactions in
60-80% of cases. However, adverse reactions in this age
group require an individual approach to the sick child,
a clear organization of the chemotherapy regimen, and
the selection of various types of pathogenetic
treatment [6,15].
Adverse reactions to anti-tuberculosis drugs that occur
during chemotherapy significantly limit the possibility
of its implementation and reduce the effectiveness of
treating children and adolescents with tuberculosis
[7,14]. The frequency of adverse events in anti-TB drugs
tends to increase [2,8,10,11,12,13]. The increase in the
frequency of adverse events in children and
adolescents, the expansion of their spectrum, and the
growth in the number of cases of severe drug
complications require a revision of approaches to their
prevention and elimination. In this regard, it seems
relevant to study the frequency of adverse events in
anti-TB drugs in different categories of tuberculosis
patients.
According to literary data, half of children and
adolescents with TB have concomitant diseases: liver,
stomach, nasopharynx pathology, diabetes mellitus,
neuropsychiatric disorders, iron deficiency anemia, and
others. This complicates diagnosis and leads to late
initiation of treatment, development of adverse events
(AE) to anti-tuberculosis chemotherapy (ATC) and
prevents optimal chemotherapy [3,5].
Indications and principles of correction of standard
chemotherapy in children and adolescents with AE
have not been widely covered in the printed literature
[14,15,17,18]. In the literature of recent years, we have
not found any works devoted to the assessment of the
International Journal of Medical Sciences And Clinical Research
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International Journal of Medical Sciences And Clinical Research (ISSN: 2771-2265)
effectiveness of chemotherapy in children and
adolescents with AE on ATC, carried out according to
standardized schemes. A literature search did not
reveal any published studies in Uzbekistan on reported
adverse drug reactions in children and adolescents
treated for tuberculosis.
The problem of treating tuberculosis in children and
adolescents with the development of AE on ATC is still
relevant and requires further improvement. The
literature of recent years does not cover an individual
approach to a sick child, a chemotherapy regimen, or
the selection of various types of pathogenetic
treatment in children and adolescents with the
development of AE on ATC. The issues of treatment
correction were also not reflected in the literature.
These provisions require study.
The purpose of this study
. To evaluate and compare
the frequency and nature of adverse events occurring
during anti-tuberculosis therapy in children and
adolescents, depending on the sensitivity or drug
resistance of the pathogen, and to determine the age-
related characteristics of their manifestations.
METHODS
In accordance with the set goal and objectives, a study
was conducted involving 182 children and adolescents
aged from 1 month to 18 years. Of these, 29 patients
were observed and treated at the Republican
Specialized Scientific and Practical Medical Center of
Phthisiology and Pulmonology (RSSPMCPh&P) named
after Sh. Alimov, and 153 patients were treated at the
Tashkent Regional Children's Phthisiology Hospital
during 2018
–
2019. Among the examined patients, 133
were found to have drug-sensitive forms of
tuberculosis and 49 were found to have drug-resistant
forms of TB. A mandatory condition for selection in the
study groups was the presence of active tuberculosis.
To solve the tasks set in the study, the clinical material
was analyzed in a blinded manner: medical histories,
outpatient observation cards of children and
adolescents with tuberculosis. The main outcome of
the study was the analysis of the incidence of adverse
events in the hospital during chemotherapy of children
and adolescents with various forms of tuberculosis.
RESULTS AND DISCUSSION
The treatment principles for 182 children and
adolescents with TB were the same as those for adults
with TB. The determination of the treatment regimen
for drug-sensitive or drug-resistant TB was based on
the presence of rifampicin resistance, the results of
Xpert MTB/Rif, HAIN TEST, MGIT, and/or close contact
tracing of the patient with drug-resistant TB.
Diagram 1
In order to determine the frequency of adverse
reactions to anti-tuberculosis drugs, their types and
clinical manifestations in children and adolescents with
tuberculosis, we studied 182 patients during
treatment. Anti-tuberculosis therapy was complicated
by adverse events of varying severity in 103 (56.6%)
children and adolescents with tuberculosis out of 182
patients (1). AEs on PTX were detected somewhat more
often among adolescents than among children. Thus,
out of 58 adolescents, AEs on PTX were detected in 36
(62.1%) patients and out of 124 children
–
in 67 (54.0%)
patients.
0%
50%
100%
Total
Children
Teenagers
43.4%
46.0%
37.9%
56.6%
54.0%
62.1%
Frequency of detection of adverse events in children and
adolescents with tuberculosis,
Total patients 182; Children (n=124); Adolescents (n=58)
Without AE
With AE
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International Journal of Medical Sciences And Clinical Research (ISSN: 2771-2265)
Diagram 2
Studying the frequency of adverse reactions from anti-
TB drugs in children and adolescents with tuberculosis
revealed (diagram 2) that toxic reactions (79.6%) were
observed more frequently than toxic-allergic (12.6%)
and allergic reactions (7.8%).
A study of the results of the frequency of occurrence of
adverse reactions from anti-TB drugs between children
and adolescents (Table 1) showed that in adolescents,
allergic reactions occurred 1.9 times more often
(11.1±5.2% and 6.0±2.9%, respectively, P <0.05) and
toxic-allergic reactions 2.1 times more often
(19.4±6.5% and 9.1±3.5%, respectively, P <0.05) than in
children. However, it should be noted that toxic
reactions were somewhat more common in children
than in adolescents (85.1±3.1% and 69.4±7.6%,
respectively, P <0.05).
Table 1
Frequency of adverse reactions to anti-TB drugs in children and adolescents with
tuberculosis, n (%).
Adverse reactions
Total, n=182
Children, n=124
Adolescents, n=58
Allergic
8 (7,8±2,6)
4 (6,0±2,9)*
4 (11,1±5,2)
Toxic
82 (79,6±3,9)
57 (85,1±3,1)*
25 (69,4±7,6)
Toxic-allergic
13 (12,6±3,2)
6 (9,1±3,5)*
7 (19,4±6,5)
Note: * - differences in adverse reactions are significant in children and adolescents with
tuberculosis (p <0.05).
It is of interest to study the frequency of adverse events
among children and adolescents with tuberculosis
taking into account drug resistance (diagram 3). Thus,
during chemotherapy, adverse events from anti-TB
drugs occurred 1.7 times more often in patients with
resistant form TB (RFT) than in patients with sensitive
form TB (SFT) (81.6±5.5% and 47.4±4.3%, respectively,
P <0.05).
12.6%
79.6%
7.8%
Frequency of adverse reactions to anti-TB drugs in children with
tuberculosis, n=103
Toxic-allergic
Toxic
Allergic
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International Journal of Medical Sciences And Clinical Research (ISSN: 2771-2265)
Diagram 3
In diagram 4, when comparing the incidence of various
adverse reactions in children and adolescents with
sensitive and resistant forms of tuberculosis, no
differences were found.
Diagram 4
CONCLUSIONS
In the treatment of 182 children and adolescents with
tuberculosis, adverse events were noted in 103 (56.6%)
patients, more often in adolescents (62.1%) than in
children (54.0%). Toxic reactions were predominant
(79.6%). In adolescents, allergic and toxic-allergic
reactions were more common (P<0.05), while in
children, toxic reactions were predominant. AEs from
anti-TB drugs were 1.7 times more common in resistant
TB (P<0.05).
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