ABSTRACT
Background: Four oral anti-tuberculosis drugs are conceived to be the most effective ones to eradicate Mycobacterium tuberculosis bacteria and to obviate the resistant organisms. However, the patients' adherence and medication discrepancies are obstacles to achieving the goal. This study aimed to define the anti-tuberculosis drugs used in the hospitals and to detect the discrepancies in the continuity of the tuberculosis treatment.
Design and Methods: This retrospective cross-sectional study was based on medical records of adult patients, and was conducted in two district tertiary care hospitals. Only 35 out of 136 patient records from Hospital A and 33 out of 85 records from Hospital B met the inclusion criteria.
Results: The most common systemic anti-infective drugs in the study were ceftriaxone (51.80 DDD/100 patient-days) used in Hospital A and isoniazid (59.53 DDD/100 patient-days) used in Hospital B. The number of rifampicin prescriptions was less than that of isoniazid. Each patient received an average of two DDD/100 patient-days, which is an under dosage for an effective treatment.
Conclusion: This study showed a medication discrepancy of Tuberculosis therapy. Tuberculosis patients’ medical histories are not under the full attention of treating physicians wherever they are admitted. Thus, medication reconciliation is needed to accomplish the goal of a Tuberculosis-free world in 2050.
REFERENCES
Chin DP, Hanson CL. Finding the missing tuberculosis patients. J Infect Dis 2017;216:S675–8.
Basnyat B, Caws M, Udwadia Z. Tuberculosis in South Asia: a tide in the affairs of men. Multidiscip Respir Med 2018;13:10. DOI: https://doi.org/10.1186/s40248-018-0122-y
Dean AS, Cox H, Zignol M. Epidemiology of drug-resistant tuberculosis. Adv Exp Med Bio. 2017;1019:209-20. DOI: https://doi.org/10.1007/978-3-319-64371-7_11
World Health Organization. Global tuberculosis report 2019. Geneva: World Health Organization; 2019.
Neshati H, Sheybani F, Naderi H, et al. Diagnostic errors in tuberculous patients: A multicenter study from a developing country. J Environ Public Health 2018;2018:1975931. DOI: https://doi.org/10.1155/2018/1975931
Zão I, Ribeiro AI, Apolinário D, Duarte R. Why does it take so long? The reasons behind tuberculosis treatment delay in Portugal. Pulmonology 2019;25:215-22. DOI: https://doi.org/10.1016/j.pulmoe.2019.02.005
Asyary A, Mahendradhata Y. Unfinished first-line tuberculosis treatment in primary care in Indonesia. Fam Med Prim Care Rev 2019;21:185–8. DOI: https://doi.org/10.5114/fmpcr.2019.84556
Kulkarni P, Akarte S, Mankeshwar R, et al. Non-adherence of new pulmonary tuberculosis patients to anti-tuberculosis treatment. Ann Med Health Sci Res 2013;3:67-74. DOI: https://doi.org/10.4103/2141-9248.109507
Babiarz KS, Suen S, Goldhaber-Fiebert JD. Tuberculosis treatment discontinuation and symptom persistence: an observational study of Bihar, India’s public care system covering >100,000,000 inhabitants. BMC Public Health 2014;14:418. DOI: https://doi.org/10.1186/1471-2458-14-418
Indonesian Ministry of Health. Regulation of the Minister of Health Number 67 Year 2016 on Tuberculosis Control. Jakarta: Ministry of Health Republic of Indonesia; 2016.
Mahendradhata Y, Trisnantoro L, Listyadewi S, et al. The Republic of Indonesia Health System Review. Health Systems in Transition 2017;7:1-235.
World Health Organization. Primary health care systems (PRIMASYS): case study from Indonesia. Abridged version. Geneva: World Health Organization; 2017. Available from: https://www.who.int/alliance-hpsr/projects/alliancehpsr_indonesiaabridgedprimasys.pdf?ua=1
Surya A, Setyaningsih B, Nasution HS, et al. Quality tuberculosis care in Indonesia: using patient pathway analysis to optimize public-private collaboration. J Infect Dis 2017;216:S724-32.
Kurniawati A, Padmawati RS, Mahendradhata Y. Acceptability of mandatory tuberculosis notification among private practitioners in Yogyakarta, Indonesia. BMC Res Notes 2019;12:543. DOI: https://doi.org/10.1186/s13104-019-4581-9
Mahendradhata Y. The case for stronger regulation of private practitioners to control tuberculosis in low- and middle-income countries. BMC Res Notes 2015;8:600. DOI: https://doi.org/10.1186/s13104-015-1586-x
Hanson CL, Osberg M, Brown J, et al. Conducting patient-pathway analysis to inform programming of tuberculosis services: methods. J Infect Dis 2017;216:S679-85.
Ku C, Chen C, Dixon S, et al. Patient pathways of tuberculosis care-seeking and treatment: an individual-level analysis of National Health Insurance data in Taiwan. BMJ Global Health 2020;5:e002187.
Subbaraman R, Jhaveri T, Nathavitharana RR. Closing gaps in the tuberculosis care cascade: an action-oriented research agenda. J Clin Tuberc Other Mycobact Dis 2020;19:100144. DOI: https://doi.org/10.1016/j.jctube.2020.100144
Hu H, Chen J, Sato KD, et al. Factors that associated with TB patient admission rate and TB inpatient service cost: a cross-sectional study in China. Infect Dis Poverty 2016;5:4. DOI: https://doi.org/10.1186/s40249-016-0097-x
Han J, Nam BD, Park SY, et al. Risk factors for delayed isolation of patients with active pulmonary tuberculosis in an acute-care hospital. Sci Rep 2019;9:4849. DOI: https://doi.org/10.1038/s41598-019-41086-4
Schnipper JL, Mixon A, Stein J, Wetterneck TB, et al. Effects of a multifaceted medication reconciliation quality improvement intervention on patient safety: final results of the MARQUIS study. BMJ Qual Saf 2018;27:954-64. DOI: https://doi.org/10.1136/bmjqs-2018-008233
Redmond P, Grimes TC, McDonnell R, et al. Impact of medication reconciliation for improving transitions of care. Cochrane Database Syst Rev 2018;8:CD010791.
Aronson J. Medication reconciliation. BMJ 2017;356:i5336.
WHO International Working Group for Drug Statistics Methodology, WHO Collaborating Centre for Drug Statistics Methodology & WHO Collaborating Centre for Drug Utilization Research and Clinical Pharmacological Services. Introduction to drug utilization research. Geneva: World Health Organization; 2003. Available from: https://apps.who.int/iris/handle/10665/42627.
WHO Collaborating Centre for Drug Statistics Methodology. Guidelines for ATC classification and DDD assignment, 2019. Oslo: WHO Collaborating Centre for Drug Statistics Methodology; 2018.
WHO Guidelines for treatment of tuberculosis. Geneva: World Health Organization; 2010. Available from: http://www.who.int/tb/publications/2010/9789241547833/en/
Shin HJ, Kwon YS. Treatment of drug susceptible pulmonary tuberculosis. Tuberc Respir Dis (Seoul) 2015;78:161–7. DOI: https://doi.org/10.4046/trd.2015.78.3.161
Lin HS, Cheng CW, Lin MS, et al. The clinical outcomes of oldest old patients with tuberculosis treated by regimens containing rifampicin, isoniazid, and pyrazinamide. Clin Interv Aging 2016;11:299-306. DOI: https://doi.org/10.2147/CIA.S95411
Kwon BS, Kim Y, Lee SH, et al. The high incidence of severe adverse events due to pyrazinamide in elderly patients with tuberculosis. PLoS One 2020;15:e0236109.
Shivaraj G, Muralikrishna K, Nijeesh CH, et al. Study on drug related problems in tuberculosis patients with comorbidities in a tertiary care teaching hospital. Eur J Pharm Med Res 2017;4:756-67.
Abrogoua DP, Kamenan BA, Ahui BJ, Doffou E. Pharmaceutical interventions in the management of tuberculosis in a pneumophtisiology department, Ivory Coast. Ther Clin Risk Manag 2016;12:1749-56. DOI: https://doi.org/10.2147/TCRM.S118442
Lima GC, Silva EV, de O. Magalhães P, Navesc JS. Efficacy and safety of a four-drug fixed-dose combination regimen versus separate drugs for treatment of pulmonary tuberculosis: a systematic review and meta-analysis. Braz J Microbiol 2017;48:198–207. DOI: https://doi.org/10.1016/j.bjm.2016.12.003
Abbara A, Chitty S, Roe JK, et al. Drug-induced liver injury from antituberculous treatment: a retrospective study from a large TB centre in the UK. BMC Infect Dis 2017;17:231. DOI: https://doi.org/10.1186/s12879-017-2330-z
Ibrahim OM, Polk RE. Antimicrobial use metrics and benchmarking to improve stewardship outcomes: methodology, opportunities, and challenges. Infect Dis Clin North Am 2014;28:195-214. DOI: https://doi.org/10.1016/j.idc.2014.01.006
Stanic Benic M, Milanic R, Monnier AA, et al. Metrics for quantifying antibiotic use in the hospital setting: results from a systematic review and international multidisciplinary consensus procedure. J Antimicrob Chemother 2018;73:vi50-8.
Almanasreh E, Moles R, Chen TF. The medication reconciliation process and classification of discrepancies: a systematic review. Br J Clin Pharmacol 2016;82:645–58. DOI: https://doi.org/10.1111/bcp.13017
Duke T, Kasa Tom S, Poka H, Welch H. Holistic care of complicated tuberculosis in healthcare settings with limited resources. Arch Dis Child 2017;102:1161-8. DOI: https://doi.org/10.1136/archdischild-2017-313095
Marais F, Kallon II, Dudley LD. Continuity of care for TB patients at a South African hospital: A qualitative participatory study of the experiences of hospital staff. PLoS One 2019;14:e0222421.
Bojovic O, Medenica M, Zivkovic D, et al. Factors associated with patient and health system delays in diagnosis and treatment of tuberculosis in Montenegro, 2015-2016. PLoS One 2018;13:e0193997.
Fujiwara PI, Dlodlo RA, Ferroussier O, et al. Implementing collaborative TB-HIV activities: a programmatic guide. Paris, France: International Union Against Tuberculosis and Lung Disease, 2012. Available from: https://theunion.org/sites/default/files/2020-08/pub_tb-hivguide_eng_web-1.pdf
Samal J. Ways and means to utilize private practitioners for tuberculosis care in India. J Clin Diagn Res 2017;11:LA01-4.
Yang WT, Gounder CR, Akande T, et al. Barriers and delays in tuberculosis diagnosis and treatment services: does gender matter? Tuberc Res Treat 2014;2014:461935.
Bloom BR, Atun R. Back to the future: Rethinking global control of tuberculosis. Sci Transl Med 2016;8:329ps7.
Nurwidya F, Handayani D, Burhan E, Yunus F. Molecular diagnosis of tuberculosis. Chonnam Med J 2018;54:1–9. DOI: https://doi.org/10.4068/cmj.2018.54.1.1
Ali U, Bin Zubair U, Ambreen A, et al. Delay in diagnosis of pulmonary tuberculosis: study of factors related to patients and health care system. J Microbiol Infect Dis 2017;7:119-24. DOI: https://doi.org/10.5799/jmid.367424
Teo AKJ, Singh SR, Prem K, et al. Delayed diagnosis and treatment of pulmonary tuberculosis in high-burden countries: a systematic review protocol. BMJ Open 2019;9:e029807.
Osei E, Akweongo P, Binka F. Factors associated with DELAY in diagnosis among tuberculosis patients in Hohoe Municipality, Ghana. BMC Public Health 2015;15:721. DOI: https://doi.org/10.1186/s12889-015-1922-z
Seid A, Metaferia Y. Factors associated with treatment delay among newly diagnosed tuberculosis patients in Dessie city and surroundings, Northern Central Ethiopia: a cross-sectional study. BMC Public Health 2018;18:931. DOI: https://doi.org/10.1186/s12889-018-5823-9
Martinez L, Xu L, Chen C, et al. Delays and pathways to final tuberculosis diagnosis in patients from a referral hospital in urban China. Am J Trop Med Hyg 2017;96:1060-5. DOI: https://doi.org/10.4269/ajtmh.16-0358
Ku CC, Chen CC, Dixon S, et al. Patient pathways of tuberculosis care-seeking and treatment: an individual-level analysis of National Health Insurance data in Taiwan. BMJ Glob Health 2020;5:e002187.