Occurrence of serious adverse effects in patients receiving community-based therapy for multidrug-resistant tuberculosis

SETTING: A community-based treatment program for multidrug-resistant tuberc ulosis (MDR-TB) in an urban shantytown of Lima, Peru. OBJECTIVES: To ascertain the occurrence of serious adverse effects associat ed with therapy for MDR-TB in northern Lima, Peru, where therapy was indivi dualized according to drug-susceptibility testing of patients' infecting st rains and delivered through a community-based program. DESIGN: A retrospective record review of 60 patients who had received indiv idualized therapy for MDR-TB between September 1996 and October 1998. RESULTS: Although adverse effects were common, they occurred less frequentl y than previously reported in the literature and were rarely life-threateni ng. Effects occurring most frequently in this population included: mild gas tritis (100%), dermatological effects (43.3%), peripheral neuropathy (16.7% ), depression (18.3%), and anxiety (11.7%). These effects never resulted in the discontinuation of anti-tuberculosis therapy, and only occasionally re sulted in the suspension of an agent (11.7%). CONCLUSION: In young patients with little comorbid disease, multidrug, long -course regimens rarely caused life-threatening adverse effects. Common sid e effects may be managed successfully on an out-patient basis through a com munity-based treatment program in conjunction with MDR-TB experts, even in resource-poor settings. The very low rate of default in this cohort offers hope that strategies to manage the adverse effects may reduce the incidence of abandonment of therapy and increase rates of cure.