Life-threatening cutaneous reactions to thiacetazone-containing antituberculosis treatment in Kumasi, Ghana.
Identifieur interne : 001644 ( Main/Exploration ); précédent : 001643; suivant : 001645Life-threatening cutaneous reactions to thiacetazone-containing antituberculosis treatment in Kumasi, Ghana.
Auteurs : S D Lawn [Ghana] ; E H Frimpong ; J W AcheampongSource :
- West African journal of medicine [ 0189-160X ]
Descripteurs français
- KwdFr :
- Adulte, Adulte d'âge moyen, Antituberculeux (effets indésirables), Enfant, Femelle, Ghana (épidémiologie), Humains, Hôpitaux d'enseignement, Incidence, Indice de gravité médicale, Infections opportunistes liées au SIDA (traitement médicamenteux), Mâle, Politique de santé, Sélection de patients, Thioacétazone (effets indésirables), Toxidermies (), Toxidermies (épidémiologie), Toxidermies (étiologie), Tuberculose pulmonaire (traitement médicamenteux), Études rétrospectives.
- MESH :
- effets indésirables : Antituberculeux, Thioacétazone.
- traitement médicamenteux : Infections opportunistes liées au SIDA, Tuberculose pulmonaire.
- épidémiologie : Ghana, Toxidermies.
- étiologie : Toxidermies.
- Adulte, Adulte d'âge moyen, Enfant, Femelle, Humains, Hôpitaux d'enseignement, Incidence, Indice de gravité médicale, Mâle, Politique de santé, Sélection de patients, Toxidermies, Études rétrospectives.
- Wicri :
- geographic : Ghana.
English descriptors
- KwdEn :
- AIDS-Related Opportunistic Infections (drug therapy), Adult, Antitubercular Agents (adverse effects), Child, Drug Eruptions (epidemiology), Drug Eruptions (etiology), Drug Eruptions (prevention & control), Female, Ghana (epidemiology), Health Policy, Hospitals, Teaching, Humans, Incidence, Male, Middle Aged, Patient Selection, Retrospective Studies, Severity of Illness Index, Thioacetazone (adverse effects), Tuberculosis, Pulmonary (drug therapy).
- MESH :
- chemical , adverse effects : Antitubercular Agents, Thioacetazone.
- geographic , epidemiology : Ghana.
- drug therapy : AIDS-Related Opportunistic Infections, Tuberculosis, Pulmonary.
- epidemiology : Drug Eruptions.
- etiology : Drug Eruptions.
- prevention & control : Drug Eruptions.
- Adult, Child, Female, Health Policy, Hospitals, Teaching, Humans, Incidence, Male, Middle Aged, Patient Selection, Retrospective Studies, Severity of Illness Index.
Abstract
Antituberculosis treatment containing thiacetazone is associated with a high incidence of life-threatening cutaneous drug reactions in patients infected with the human immunodeficiency virus (HIV). In order to develop a local policy concerning the use of this drug, a study was undertaken to determine the incidence of such reactions in a total of 1063 Ghanaian adult patients treated for pulmonary tuberculosis (PTB) with thiacetazone-containing regimens. The incidence was retrospectively determined in 3 different treatment groups, comparing: (A) unselected use of thiacetazone; (B) exclusion of thiacetazone from all patients with positive HIV serology; (C) selective exclusion of thiacetazone from patients with clinical criteria suggesting HIV infection plus education of health workers and patients. Of the 408 patients in group A receiving thiacetazone, 9 (2.2%) developed life-threatening cutaneous reactions and 7 of these were HIV-positive. Overall, 6.8% of HIV-positive patients compared to 0.65% of HIV-negative patients developed severe reactions (P < 0.01; relative risk = 10.5). Six of the 9 patients with reactions died. All 379 patients in group B were screened for HIV antibodies and positive cases (23%) received a regimen in which thiacetazone was substituted by ethambutol. In contrast to Group A, only one HIV-negative patient (0.26%) developed a severe cutaneous reaction (P = 0.02). Among 276 patients in group C, thiacetazone was substituted with ethambutol only in those with clinical evidence of HIV infection (8%) and staff and patients were educated about early recognition of the side-effect. With this policy, these were no admissions with severe cutaneous reactions compared to 2.2% of those in group A (P = 0.01). In conclusion, a policy of selective use of thiacetazone in the treatment of PTB based on clinical criteria combined with patient and staff education was found to be a practical and cost-effective strategy combating severe cutaneous reactions to thiacetazone.
PubMed: 10734785
Affiliations:
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Le document en format XML
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thiacetazone is associated with a high incidence of life-threatening cutaneous drug reactions in patients infected with the human immunodeficiency virus (HIV). In order to develop a local policy concerning the use of this drug, a study was undertaken to determine the incidence of such reactions in a total of 1063 Ghanaian adult patients treated for pulmonary tuberculosis (PTB) with thiacetazone-containing regimens. The incidence was retrospectively determined in 3 different treatment groups, comparing: (A) unselected use of thiacetazone; (B) exclusion of thiacetazone from all patients with positive HIV serology; (C) selective exclusion of thiacetazone from patients with clinical criteria suggesting HIV infection plus education of health workers and patients. Of the 408 patients in group A receiving thiacetazone, 9 (2.2%) developed life-threatening cutaneous reactions and 7 of these were HIV-positive. Overall, 6.8% of HIV-positive patients compared to 0.65% of HIV-negative patients developed severe reactions (P < 0.01; relative risk = 10.5). Six of the 9 patients with reactions died. All 379 patients in group B were screened for HIV antibodies and positive cases (23%) received a regimen in which thiacetazone was substituted by ethambutol. In contrast to Group A, only one HIV-negative patient (0.26%) developed a severe cutaneous reaction (P = 0.02). Among 276 patients in group C, thiacetazone was substituted with ethambutol only in those with clinical evidence of HIV infection (8%) and staff and patients were educated about early recognition of the side-effect. With this policy, these were no admissions with severe cutaneous reactions compared to 2.2% of those in group A (P = 0.01). In conclusion, a policy of selective use of thiacetazone in the treatment of PTB based on clinical criteria combined with patient and staff education was found to be a practical and cost-effective strategy combating severe cutaneous reactions to thiacetazone.</div></front></TEI><affiliations><list><country><li>Ghana</li></country></list><tree><noCountry><name sortKey="Acheampong, J W" sort="Acheampong, J W" uniqKey="Acheampong J" first="J W" last="Acheampong">J W Acheampong</name><name sortKey="Frimpong, E H" sort="Frimpong, E H" uniqKey="Frimpong E" first="E H" last="Frimpong">E H Frimpong</name></noCountry><country name="Ghana"><noRegion><name sortKey="Lawn, S D" sort="Lawn, S D" uniqKey="Lawn S" first="S D" last="Lawn">S D Lawn</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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