Life-threatening cutaneous reactions to thiacetazone-containing antituberculosis treatment in Kumasi, Ghana.

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.

• Authors: S D Lawn, E H Frimpong, J W Acheampong
• Journal: West African journal of medicine (West Afr J Med) 1999 Oct-Dec Vol. 18 Issue 4 Pg. 249-53 ISSN: 0189-160X [Print] Nigeria
• PMID: 10734785 (Publication Type: Journal Article)

Chemical References

• Antitubercular Agents
• Thioacetazone

Topics

• AIDS-Related Opportunistic Infections (drug therapy)
• Adult
• Antitubercular Agents (adverse effects)
• Child
• Drug Eruptions (epidemiology, etiology, 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)