SETTING: National tuberculosis programs in Kenya, Nepal, and Senegal. OBJECTIVES: To ascertain adequacy of initial prescriptions of dosages of anti-tuberculosis medications in the three national tuberculosis programs. METHODS: Collection of patient treatment cards in a representative sample of treatment centers in Kenya, Nepal, and Senegal. Calculation of drug dosages in milligram per kilogram body weight of isoniazid, rifampicin, and pyrazinamide and comparison with international recommendations for dosage of these medications. RESULTS: A total of 12,346 patient treatment cards were available. Yet of these only 8640 were analyzed: 5575 (65% of total) from Kenya, 612 (53% of total) from Nepal, and 2453 (95% of total) from Senegal had the patient's weight recorded and were given a nationally recommended treatment regimen. The proportions of patients receiving an internationally recommended isoniazid dosage were 34%, 15%, and 15%, respectively in Kenya, Nepal and Senegal; the corresponding figures for rifampicin were 77%, 77%, and 93% and for pyrazinamide 25%, 3% and 75%, respectively, in the three countries. The majority of errors were over-dosage, but some cases of under-dosage were also identified. CONCLUSIONS: This study shows that over-dosage was a frequent event in all three countries. Two major reasons for this error are inadequate drug combinations in Kenya and Senegal, and in all three countries recommendations for weight brackets that did not ideally fit internationally recommended dosages. It is vital to address these problems to reduce both the risk of unnecessary drug toxicity on one end of the spectrum, and suboptimal drug levels on the other.
SETTING: National tuberculosis programs in Kenya, Nepal, and Senegal. OBJECTIVES: To ascertain adequacy of initial prescriptions of dosages of anti-tuberculosis medications in the three national tuberculosis programs. METHODS: Collection of patient treatment cards in a representative sample of treatment centers in Kenya, Nepal, and Senegal. Calculation of drug dosages in milligram per kilogram body weight of isoniazid, rifampicin, and pyrazinamide and comparison with international recommendations for dosage of these medications. RESULTS: A total of 12,346 patient treatment cards were available. Yet of these only 8640 were analyzed: 5575 (65% of total) from Kenya, 612 (53% of total) from Nepal, and 2453 (95% of total) from Senegal had the patient's weight recorded and were given a nationally recommended treatment regimen. The proportions of patients receiving an internationally recommended isoniazid dosage were 34%, 15%, and 15%, respectively in Kenya, Nepal and Senegal; the corresponding figures for rifampicin were 77%, 77%, and 93% and for pyrazinamide 25%, 3% and 75%, respectively, in the three countries. The majority of errors were over-dosage, but some cases of under-dosage were also identified. CONCLUSIONS: This study shows that over-dosage was a frequent event in all three countries. Two major reasons for this error are inadequate drug combinations in Kenya and Senegal, and in all three countries recommendations for weight brackets that did not ideally fit internationally recommended dosages. It is vital to address these problems to reduce both the risk of unnecessary drug toxicity on one end of the spectrum, and suboptimal drug levels on the other.
Authors: A M V Kumar; S Satyanarayana; S Dar Berger; S S Chadha; R J Singh; P Lal; J Tonsing; A D Harries Journal: Public Health Action Date: 2015-03-21
Authors: Brittney J van de Water; Susan G Silva; Janet Prvu Bettger; Janice Humphreys; Coleen K Cunningham; Jason E Farley Journal: PLoS One Date: 2018-11-05 Impact factor: 3.240