Tuberculosis compliance with

Use of PAS has diminished over the years following the introduction of more effective drugs, such as rifampin and ethambutol. At present, therapy with PAS is limited to the treatment of MDR tuberculosis. Problems with primary resistance, poor compliance due to GI intolerance, and lupuslike reactions have further discouraged its use. 

A week later he went home on full anti-tuberculosis drugs with stable liver function tests and carbamazepine and the addition of pyridoxine. The white count does not suggest resistance has emerged during this treatment gap but should be monitored over the full treatment course. Any acute liver insult on top of this treatment would be very difficult to resolve. Compliance with the pyridoxine is very important to prevent any toxicity. 

Multidrug-resistant tuberculosis generally results from inadequate therapy or lack of compliance with therapy. A strain of mycobacteria is called resistant when it is insensitive to one of the first-line drugs. It is called multiresistant when it is insensitive to both isoniazid and rifampicin. In this case other antituberculosis drugs may also be ineffective (35). In practice, at least two second-line antituberculosis drugs, selected on the basis of individual drug susceptibility, are given in combination with a fluoroquinolone (36). 

Note The treatment of mycobacterial infections has become an even more important and challenging problem because of the emergence of multiple-drug-resistant organisms and because of the acquired immunodeficiency syndrome (AIDS) pandemic, which has been associated with a marked increase in tuberculosis and infection caused by the M. avium complex. Because the microorganisms grow slowly and the diseases often are chronic, patient compliance, drug toxicity, and the development of microbial resistance present special therapeutic problems. 

Ziakas PD, Mylonakis E. 4 months of rifampin compared with 9 months of isonia-zid for the management of latent tuberculosis infection a meta-analysis and cost-effectiveness study that focuses on compliance and liver toxicity. Clin Infect Dis 2009 49(12) 1883-9. 

Late episodes of acute rejection are uncommon, and usually relate to poor patient compliance or inadequate levels of immunosuppression. The pathophysiology of chronic rejection is poorly understood, and can lead to graft loss. The incidence of chronic rejection has fallen progressively to approximately 5% over the past 10 years. Over-immunosuppression can lead to opportunistic bacterial infections and increased incidence of malignant disorders. Opportunistic infections such as legionellosis, nocardiosis, and tuberculosis occur between the 1st and I2th month post-transplant. Immunosuppressive treatment can be associated with Epstein Barr virus infection, and the development of post-transplantation lymphoproliferative disorder (Fig. 4.1.8). 

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