Tuberculosis monitoring

Etanercept (Enbrel) 25 mg twice weekly or 50 mg once weekly SC injection 1 -4 weeks ISR Monitor for infection ISR—topical corticosteroids, antipruritics, analgesics, rotate injection sites Screen for tuberculosis... 

Infliximab (Remicade) 3-1 0 mg/kg at 0, 2, and 6 weeks then q 8 weeks IV infusion 1 -4 weeks IR (rash, urticaria, flushing, HA, fever, chills, nausea, tachycardia, dyspnea) Monitor for infection Screen for tuberculosis... 

Peloquin CA. Therapeutic drug monitoring in the treatment of tuberculosis. Drugs 2002 62 2169-2183. 

Monitoring Perform baseline measurements of hepatic enzymes, bilirubin, serum creatinine, CBC, and platelet count (or estimate) in adults treated for tuberculosis with P.1009... 

Clinical improvement, especially the disappearance of fever or defervescence, is the best parameter to judge the response to therapy. However, clinical improvement can be difficult to monitor objectively in critically ill patients with multi-system disease. Also, clinical improvement can be very slow for certain infections, e.g. tuberculosis. The peripheral blood leukocyte count including the presence of early stages in leucocyte differention and the level of serum C-Reactive Protein (CRP, an acute phase protein) are parameters that can be sequentially determined to monitor improvement. For monitoring the effect of treatment of chronic infections such as endocarditis or osteomyelitis, weekly determination of the erythrocyte sedimentation rate has been proven useful. 

Serious life-threatening infections, including sepsis and pneumonia, have been reported with the use of TNF inhibitors. Patients should be evaluated for tuberculosisrisk factors and tested for latent tuberculosis infection prior to starting therapy. Concurrent use with other immunosuppressive therapy should be avoided. In clinical trials of all TNF-blocking agents more cases of lymphoma were observed compared with control patients. Patients with a prior history of prolonged phototherapy treatment should be monitored for nonmelanoma skin cancers. 

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. 

AZATHIOPRINE LEFLUNOMIDE T risk of serious infections (sepsis) and of opportunistic infections (Pneumocystis jiroveci pneumonia, tuberculosis, aspergillosis) Additive immunosuppression Monitor platelets, white bloods cell, haemoglobin and haematocrit at baseline and regularly - weekly, during concomitant therapy. With evidence of bone marrow suppression, discontinue leflunomide and administer colestyramine or charcoal to T elimination of leflunomide - For signs and symptoms of immunosuppression, see Qinical Features of Some Adverse Drug Interactions, Immunosuppression and blood dyscrasias... 

The severe fiver dysfunction also seemed to be more common in slow metabofizers, and it was proposed that this due to a deficiency in detoxication of a metabolite. Monitoring patients with fiver function tests is one way to avoid this adverse effect. There may be other factors as well as the acetylator phenot5rpe that are important, such as other drugs being taken at the same time. Excessive and sustained alcohol intake may also be a factor, as this is quite commonly associated with the occurrence of tuberculosis. Apart from weakening the fiver it will also increase the amount of the enzyme that produces the toxic metabolite of isoniazid. 

Careful monitoring and the addition of pyridoxine to isoniazid have reduced the number of adverse drug effects in tuberculosis. Awareness of potentially severe hepato-toxic reactions is vital, because hepatic failure may be a devastating and often fatal condition. Fulminant hepatic failure caused by rifampicin, isoniazid, or both has been described (2). 

Others consider that this combination is useful for high-risk, traditionally non-adherent patients, such as alcoholics and the homeless, but have also emphasized the need for careful monitoring for toxicity (15). This suggestion is based on the presumption that the combination regimen, although toxic, is more likely to be completed by high-risk patients than 6 months of isoniazid alone. However, others observed similar completion rates for the two regimens in a multicenter study (61% and 57%) (16), and the safety and cost-effectiveness of this combination in the treatment of latent tuberculosis has been questioned (17). 

The combination of pyrazinamide plus levofloxacin is first-line treatment for multidrug-resistant latent tuberculosis. In 17 Canadian patients there were important adverse reactions affecting the musculoskeletal and central nervous systems hyperuricemia, gastrointestinal effects, and dermatological effects were also common (3). This combination may be used with careful monitoring for adverse effects. 

Data on drug pharmacokinetics and drug interactions in patients taking treatment for HIV infection and tuberculosis are scanty, and the current recommendations are almost certain to be modified in the near future. Furthermore, it may be prudent to monitor rifampicin concentrations in the event of intolerance or adverse drug reactions. 

Duggal P, Sarkar M (2007) Audiologic monitoring of multi-drug resistant tuberculosis patients on aminoglycoside treatment with long term follow-up. BMC Ear Nose Throat Disord 7 5... 

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