Long-Term Experience of Subcutaneous Immunoglobulin Therapy in Pediatric Primary Immunodeficient Patients with Low and Normal Body Weight

Journal of Clinical Immunology - The aim was to review the compliance, side effects and effectiveness of subcutaneous immunoglobulin (SCIG) supplementation in patients with primary...     

The treatment of multidrug-resistant tuberculosis in Turkey.

BACKGROUND: We evaluated the results of treatment in 158 consecutive patients with multidrug-resistant tuberculosis who were treated at our center in Istanbul. METHODS: A total of 21 female patients and 137 male patients (age range, 15 to 68 years) received treatment for multidrug-resistant tuberculosis between March 1992 and October 1999. The patients had previously received a mean of 5.7 antituberculosis drugs and were infected with organisms that were resistant to a mean of 4.4 drugs. All patients were infected with organisms that were resistant to both isoniazid and rifampicin. The regimens we used were selected on the basis of previous treatment protocols and the results of susceptibility tests. All patients received at least three drugs thought to be active; the treatment was continued for at least 18 months after the conversion to a negative culture and for at least 24 months in the absence of first-line drugs. RESULTS: The mean number of drugs given during the study was 5.5 (range, 3 to 9). Surgical resection was performed in 36 patients. Adverse effects led to discontinuation of one or more drugs in 62 patients (39 percent). Cultures became negative in 150 patients (95 percent) after a mean of 1.9 months (range, 1 to 9). The overall success rate of treatment was 77 percent, with cures in 78 patients (49 percent) and probable cures in 43 (27 percent). Treatment failed in 13 patients (8 percent). Seven patients died (4 percent). Seventeen patients (11 percent) did not complete the treatment regimen. The patients with unsuccessful outcomes were older than those with successful outcomes (mean age, 42 years vs. 36 years; P=0.008), had received a larger number of drugs previously (median, six vs. five; P=0.048), were more likely to have been treated previously with ofloxacin (57 percent vs. 30 percent, P=0.004), and were less likely to have received ofloxacin as part of the study protocol (65 percent vs. 84 percent, P=0.018). Thirty-eight percent of the patients with unsuccessful outcomes were infected with organisms that were resistant to more than five drugs. In a step-down logistic-regression analysis, a successful outcome was independently associated with a younger age (P=0.013) and the absence of previous treatment with ofloxacin (P=0.005). CONCLUSIONS: Most patients with multidrug-resistant tuberculosis can be cured with the use of appropriate, intensive treatment regimens.     

Treatment adherence of 717 patients with tuberculosis in a social security system hospital in Istanbul, Turkey.

SETTING: Tuberculosis clinic in a teaching hospital run by the social security system, Istanbul, Turkey. OBJECTIVE: To determine risk factors associated with treatment adherence. DESIGN: Seven hundred and seventeen patients who commenced treatment for tuberculosis in our clinic from May 1991 to May 1997 were evaluated retrospectively with respect to treatment adherence. Factors with an effect on treatment adherence were investigated. RESULTS: Sputum conversion was achieved in 88.9% of the cases within the first 2 months of treatment. Seven patients died during treatment; of the 710 patients remaining, 106 (14.9%) were non-adherent. This rate decreased from 34.4% in 1991 to 2.0% in 1997. In multi-variate logistic regression analysis, only previous treatment history for tuberculosis was related to non-adherence; treatment adherence rate in new cases was 88.9%, while it was 66.7% in previously treated cases (P < 0.001). CONCLUSION: In new cases, a treatment adherence rate of 88.9% can be considered satisfactory. However, in previously treated cases, an adherence rate of 66.4% must be considered unsatisfactory. Previously treated cases in particular should therefore receive directly observed treatment.     

The management of anti-tuberculosis drug-induced hepatotoxicity.

SETTING: A tuberculosis ward in a chest disease teaching hospital. OBJECTIVE: To compare the efficacy of two different retreatment protocols on hepatotoxicity recurrence in tuberculosis treatment. DESIGN: In a prospective, randomised study, 45 patients with new tuberculosis developed hepatotoxicity after anti-tuberculosis treatment. Patients in Group I (n = 20) were retreated with a drug regimen consisting of isoniazid, rifampicin, ethambutol and streptomycin administered by gradually increasing the number and dosage of the drugs. Patients in Group II (n = 25) were retreated with the same regimen (isoniazid, rifampicin, pyrazinamide and ethambutol) in the same dosages throughout. RESULTS: Hepatotoxicity recurred in respectively zero and six (24%) patients in Groups I and II (P = 0.021). Of the six patients with recurrence of hepatitis, one could not be followed up. The other five received the same retreatment protocol as Group I. By the end of retreatment, all patients were cured. CONCLUSION: The recurrence rate of hepatotoxicity in the retreatment of tuberculosis is higher in the reintroduction of a full-dose regimen including pyrazinamide, which causes more hepatotoxicity than gradual reintroduction of a regimen without pyrazinamide.