An investigation into the relationship between region specific quality of life and adverse tuberculosis treatment outcomes in Istanbul, Turkey.

BACKGROUND AND OBJECTIVE: Istanbul has the highest incidence of tuberculosis (TB) in Turkey. It is also the largest city, with considerable differences in quality of life across its urban regions. The aim of this study is to investigate the relationship between (i) the diverse quality of life across specific urban regions, (ii) TB incidence rates, inclusive of demographic and clinical characteristics of TB patients, and (iii) adverse treatment outcomes. METHODS: This retrospective study included 23,845 new TB patients (recorded in the National TB Registry between 2006 and 2010) in Istanbul. Thirty-nine urban districts of Istanbul were ranked into five groups on the basis of an urban quality of life index. Patient data were matched with these groups, and further categorized according to 'age', 'sex', 'country of birth' and 'antibiotics resistance'. Adverse treatment outcomes and TB incidence rates were extracted from official records. Logistic regression, clustered analyses, 95% CI and p values (STATA) were reported to describe the association between variables. RESULTS: Six per cent of total cases had 'at least one adverse treatment outcome' (default 3.8%, failure 0.5%, death 1.7% in total cases). 'An adverse treatment outcome' was found to be associated with age OR (CI 95%) (1.02 (1.01-1.03)); 'male sex' 1.65 (1.28-2.12); 'other country of birth' 4.82 (3.05-7.62); 100,000 per 'over 60' insidence goups 1.61 (1.32-1.97), the lowest quality of life index 0.65 (0.47-0.83). CONCLUSIONS: Patients with high tuberculosis risk factors living in high incidence regions need to be closely monitored. Patients living in lower ranking regions are more likely to have 'poor treatment outcomes'.

Pharmacokinetics and serum concentrations of antimycobacterial drugs in adult Turkish patients.

OBJECTIVE: To document the pharmacokinetics and serum concentrations of first-line anti-tuberculosis drugs in adult Turkish patients with pulmonary tuberculosis (PTB). DESIGN: Consenting 21 adult patients (aged 38 ± 4 years, 10 female and 11 male) with newly diagnosed active PTB participated in the study. Blood samples were collected 1, 2, 4, 6 and 24 h after simultaneous isoniazid (INH), rifampicin (RMP), pyrazinamide (PZA) and ethambutol (EMB) ingestion. Serum concentration-time profiles, maximum serum concentrations, time to achieve maximum serum concentrations, the half-life and the areas under the serum concentration-time curve for each of the four drugs were determined. RESULTS: Wide variations in pharmacokinetic parameters were observed among patients. In respectively 8 (38%), 17 (81%), 3 (14%) and 1 (5%) patients, the maximum INH, RMP, PZA and EMB serum concentrations were below the accepted therapeutic concentrations. CONCLUSION: Our data show that the serum concentrations of anti-tuberculosis drugs varied considerably in the study patients. Therapeutic drug monitoring is necessary to identify patients with subtherapeutic INH and RMP serum concentrations.