Outcomes of reintroducing anti-tuberculosis drugs following cutaneous adverse drug reactions
Outcomes of reintroducing anti-tuberculosis drugs following cutaneous adverse drug reactions
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DOI：
10.5588/ijtld.10.0698
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发表时间：
2011-12-01
影响因子：
4
通讯作者：
Dheda, K.
中科院分区：
文献类型：
--
作者：
Lehloenya, R. J.;Todd, G.;Dheda, K.
背景：有关结核病（TB）相关皮肤药物不良反应（CADR）结果的数据有限。 CADR 后重新使用一线抗结核药物存在争议，且管理定义不明确。方法：我们回顾性审查了南非开普敦三级皮肤科病房收治的 298 名 CADR 患者的记录。结果：298 名患者中，有 65 名被诊断为结核相关 CADR。其中，60/65 (92%) 感染了人类免疫缺陷病毒 (HIV)（CD4 计数中位数为 107 个细胞/mm(3)）。 46/65 (71%) 的患者重新服用抗结核药物，其中 23/46 (50%) 出现重新服用反应。最常见的重新引入反应是 11/23 (48%) 患者的瘙痒和 9/23 (39%) 患者的肝炎。在 23 例重新引入反应中，13 例 (57%) 为轻度反应，6 例 (26%) 为中度反应，4 例 (26%) 为重度反应。在出现重新引入反应的患者中，利福平 (RMP) 是违规药物，占 13/23 (57%)，异烟肼占 5/23 (22%)，吡嗪酰胺占 3/23 (13%)，乙胺丁醇、链霉素和氧氟沙星各占 1/23 (4%)。既往缺乏结核病治疗和再次接受 RMP 治疗与重新引入反应的可能性独立相关。结论：在这种高结核病负担环境中，虽然重新引入反应很常见，但大多数不危及生命。所有一线抗结核药物都可能导致 CADR，并且 RMP 比之前报道的更常见。这些数据指导艾滋病毒高流行地区抗结核药物相关 CADR 的管理。
BACKGROUND: Data regarding outcomes of tuberculosis (TB) associated cutaneous adverse drug reactions (CADR) are limited. The re-introduction of first-line anti-tuberculosis drugs after CADR is controversial and management poorly defined.METHODS: We retrospectively reviewed the records of 298 patients with CADR admitted to a tertiary dermatology ward in Cape Town, South Africa.RESULTS: TB-associated CADR was diagnosed in 65 of 298 patients. Of these, 60/65 (92%) were human immunodeficiency virus (HIV) infected (median CD4 count 107 cells/mm(3)). Anti-tuberculosis drugs were reintroduced in 46/65 (71%) patients, of whom 23/46 (50%) developed re-introduction reactions. The most frequent re-introduction reactions were itch in 11/23 (48%) and hepatitis in 9/23 (39%) patients. Of the 23 re-introduction reactions, 13 (57%) were mild, six (26%) moderate and four (26%) severe. Among those with reintroduction reactions, rifampicin (RMP) was the offending drug in 13/23 (57%), isoniazid in 5/23(22%), pyrazinamide in 3/23 (13%), and ethambutol, streptomycin and ofloxacin each in 1/23 (4%) cases. Lack of previous TB treatment and re-challenge with RMP were independently associated with the likelihood of reintroduction reactions.CONCLUSIONS: In this high TB burden setting, although re-introduction reactions are common, the majority are non-life-threatening. All first-line anti-tuberculosis drugs can cause CADR, and RMP is more commonly implicated than previously reported. These data guide the management of anti-tuberculosis drug-associated CADR in high HIV prevalence settings.