A PROSPECTIVE OBSERVATIONAL STUDY ON DRUG UTILISATION OF ANTITUBERCULAR DRUGS AND ITS ADHERENCE AT TERTIARY CARE TEACHING HOSPITAL

Aims and Objectives: To determine whether the prescription is as per WHO standard drug regimen for Tuberculosis management and to assess the adherence of the patient's to prescribed drug regimen. Materials and Methods A Prospective observational study carried out in a tertiary care teaching hospital for a period of six-month. Study carried out in department of General Medicine and Outpatient Department (TB centre). Subjects of >12 yr. age groups with tubercular infection were enrolled in the study. Patients with severe comorbid conditions, pediatric patients (<12yrs), pregnant and lactating women were excluded. Data collection form (proforma), Questionnaire form for assessment of patients knowledge and Morisky Medication adherence scale (MMAS scale) were the materials used. Statistical analysis was performed using SPSS for windows. Results During the study period a total 100 TB patients were enrolled out of which 70% were males and 30% were females. The maximum numbers of patients were in the age group of 40-49 (middle age group). Previously diagnosed TB patients were (46%) and newly diagnosed TB patients were (54%).Patients of Pulmonary Tuberculosis were more (75%) in comparison with extra pulmonary Tuberculosis. In extra pulmonary Tuberculosis majority of patients were of pleural effusion (12%), TB Meningitis (10%), TB Spine (2%), TB Abdomen (11%) and Neuro TB (1%). Amongst all the patients, majority were given Category I regimen (81%)in which patients of PTB receiving Category I were (56%) and extra PTB were (25%) followed by category II regimen (22%) in which patients of PTB were (16%) and extra PTB were (6%). Out of 100 patients, 72 were adherent to treatment with the MMAS score >11 and patients with low adherence to treatment were 28 with 5-8 MMAS score. In Present Study, 75 patients were associated with out adverse drug event (ADE) were as 25 patients were associated with ADE. Adverse Drug Event reported were mild which includes nausea, vomiting (25%), and abdominal pain (14%).Major ADRs reported were in few patients including Hepatotoxicity, Isoniazid Neurotoxicity and Anaemia. Conclusion: All the prescriptions were found to be as per WHO standard drug regimen for TB management. Tuberculosis was observed more in adults, predominantly males. HTN & DM was most common comorbidity in TB patients. Newly diagnosed TB cases were more than known cases. Category I drug regimen was given to 81% of patients as majority of cases collected were new cases so first CAT-I are prescribed. & Category II drug regimen was given to 22% of patients. Significant differences was observed in knowledge assessment of patients on the data collected pre & post counselling. Assessment of medication adherence is made by MMAS scale questionnaire which resulted in improvement of patient compliance