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\def\makelabel##1{\upshape ##1}}% } {\end{list}\end{raggedright}} \newenvironment{specHead}[2]% {\vspace{20pt}\hrule\vspace{10pt}% \phantomsection\label{#1}\markright{#2}% \pdfbookmark[2]{#2}{#1}% \hspace{-0.75in}{\bfseries\fontsize{16pt}{18pt}\selectfont#2}% }{} \def\TheFullDate{2013-01-15 (revised: 15 January 2013)} \def\TheID{\makeatother } \def\TheDate{2013-01-15} \title{Comparative Analysis of Adverse drug Reactions in Directly Observed Treatment Short Course (DOTS) in TB Patients} \author{}\makeatletter \makeatletter \newcommand*{\cleartoleftpage}{% \clearpage \if@twoside \ifodd\c@page \hbox{}\newpage \if@twocolumn \hbox{}\newpage \fi \fi \fi } \makeatother \makeatletter \thispagestyle{empty} \markright{\@title}\markboth{\@title}{\@author} \renewcommand\small{\@setfontsize\small{9pt}{11pt}\abovedisplayskip 8.5\p@ plus3\p@ minus4\p@ \belowdisplayskip \abovedisplayskip \abovedisplayshortskip \z@ plus2\p@ \belowdisplayshortskip 4\p@ plus2\p@ minus2\p@ 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\setlength{\parindent}{0pt}\raggedright \textcolor{GJMediumGrey}{\rule{\textwidth}{2pt}} \vskip16pt \textcolor{GJBlue}{\large\bfseries\abstractname\space} }{% \vskip8pt \textcolor{GJMediumGrey}{\rule{\textwidth}{2pt}} \vskip16pt } \usepackage[absolute,overlay]{textpos} \makeatother \usepackage{lineno} \linenumbers \begin{document} \author[1]{Md. Motiur Rahman} \affil[1]{ University of Dhaka} \renewcommand\Authands{ and } \date{\small \em Received: 11 December 2012 Accepted: 5 January 2013 Published: 15 January 2013} \maketitle \begin{abstract} This study describes the occurrences of adverse drug reactions (ADRs) caused by anti tubercular (TB) drugs employed in Directly Observed Treatment Short Course (DOTS) from ten years of ADR data (from 2002 to 2012) reported in various articles. The frequency of each type of ADR was analyzed and compared. A total of 10,219 patients were studied. Among them, 8,047 (78.75%) patients demonstrated positive responses to at least one type of ADR. Dermatological reactions predominated among the ADRs which occurred in 4389 (42.95%) patients followed by hepatotoxicity in 1634 (15.99%) cases. Female patients were more prone to ADRs as compared to the male patients. The occurrence of ADRs is mainly attributed to the combination therapy along with the prolonged medication period. A colossal amount of ADRs were observed during the study which must be monitored and managed properly throughout the DOTS therapy in order to prevent life-threatening harmful effects. \end{abstract} \keywords{tuberculosis, adverse drug reactions, dots.} \begin{textblock*}{18cm}(1cm,1cm) % {block width} (coords) \textcolor{GJBlue}{\LARGE Global Journals \LaTeX\ JournalKaleidoscope\texttrademark} \end{textblock*} \begin{textblock*}{18cm}(1.4cm,1.5cm) % {block width} (coords) \textcolor{GJBlue}{\footnotesize \\ Artificial Intelligence formulated this projection for compatibility purposes from the original article published at Global Journals. However, this technology is currently in beta. \emph{Therefore, kindly ignore odd layouts, missed formulae, text, tables, or figures.}} \end{textblock*} \let\tabcellsep& \section[{Introduction}]{Introduction}\par eographically, the burden of TB is highest in Asia and Africa. India and China together account for almost 40\% of the world's TB cases \hyperref[b13]{(WHO, 2012)}. TB is a highly infectious disease caused by Mycobacterium tuberculosis, which is the second leading cause of death d u e t o infection in the world. TB is a major public health problem in Bangladesh. The country ranks 6 th on the list of 22 highest burden TB countries in the world. Each hour eight persons die of the disease for which very effective treatment, free of cost, is available in Bangladesh. Before 1993 TB control was limited to TB clinics and TB hospitals. Field implementation of TB control integrated into the general health services, delivered by Upazila Health Complexes (UHC's), started back in 80s. However, National TB Control Programme (NTP) Bangladesh revised its strategies and adopted DOTS in 1993. NGO's have been involved since 1994 (NTP). detect 70\% of new smear-positive pulmonary TB cases and cure at least 85 \% of them by the year 2005 and be maintained thereafter to reach the Millennium Development Goal (MDG) by 2015 (NTP).\par As the treatment of TB almost always involves combinations of drugs that are to be taken for a prolonged period of time, the occurrence of ADR is quite likely. Moreover, the adverse effect of one drug may be enhanced by the associated drug used which is one of the major reasons for the faulty patient treatment.\par The common ADRs observed in DOTS involved mild gastritis, central nervous system, peripheral nervous system, psychiatric, Thus, a comprehensive understanding of the various ADRs along with their management is mandatory for the prevision, detection, and effectual TB management. It has become quite imperative to monitor the ADRs of patients on DOTS through the monitoring of ADRs and hence, the current study was undertaken. \section[{II.}]{II.} \section[{Materials and Methos}]{Materials and Methos}\par Ten years ADR data (from 2002 to 2012) in the DOTS therapy caused by anti-TB drugs previously reported in various articles were searched from referred sources and observed carefully. The observed cases of different regions are listed in Table \hyperref[tab_0]{1}. \section[{III.}]{III.} \section[{Results and Discussion}]{Results and Discussion}\par A total of 10219 patients were observed from previously studied articles. Among them 8047 (78.75\%) patients showed at least one type of ADR. Dermatological ADRs were predominant (42.95\%) which was followed by hepatotoxic reactions (15.99\%). Different types of ADRs and there prevalence occuraence is depicted in Table \hyperref[tab_1]{2 and Figure1} The overall goal of the NTP is to reduce morbidity, mortality and transmission of TB until the disease is no longer a public health problem. The objectives are to\par The study says that, Isoniazid, rifampicin, and ethambutol are the drugs responsible for the skin reactions (F. \hyperref[b4]{Kurniawati et al., 2012)}. Arthralgia or gout which is prevalent in adults is mainly caused by isoniazid, ethambutol, and pyrazinamide that can be managed by Nonsteroidal Anti-inflammatory Drugs (NSAIDs). Children are less prone to hepatitis as compared to adults, mainly shown by pyrazinamide alone, isoniazid and rifampicin, isoniazid alone, and rifampicin alone. It can be reduced by starting therapy with ethambutol and pyrazinamide (F. \hyperref[b4]{Kurniawati et al., 2012)}.\par The occurrence of ADRs among the female patients was marginally higher as compared to the male patients.This phenomenon is attributed to the alteration of drug responses mainly due to their lower body weight compared to the males. Different phases of life such as, pregnancy, menstruation cycles etc. also contribute to some extent in this regard (J J Furin et al., 2001; D.K. {\ref Tak et al., 2009)}.\par ADR management should involve proper monitoring of the adverse reactions, postponing medication regimens, continuing the medication again without change and finally changing patient's treatment regimens. To reduce GI disorders antiemetic drugs and to alleviate dermatological antihistamines can be administered as add on therapies.\par IV. \section[{Conclusion}]{Conclusion}\par The occurrence of ADRs in the patients with DOTS is highly alarming; and immediate measures should be taken for the prevention of this phenomenon in order to minimize the potential serious health hazards including death. Pharmacists can play a significant role in the management of ADRs through patient counseling and improving their awareness. \begin{figure}[htbp] \noindent\textbf{}\includegraphics[]{image-2.png} \caption{\label{fig_0}}\end{figure} \begin{figure}[htbp] \noindent\textbf{1} \par \begin{longtable}{} \end{longtable} \par \caption{\label{tab_0}Table 1 :}\end{figure} \begin{figure}[htbp] \noindent\textbf{2} \par \begin{longtable}{P{0.10859950859950859\textwidth}P{0.449017199017199\textwidth}P{0.14828009828009828\textwidth}P{0.14410319410319408\textwidth}} Si. No.\tabcellsep Different ADRs\tabcellsep \multicolumn{2}{l}{No. of Patients Percentage}\\ \tabcellsep Total no. of patients observed\tabcellsep 10,219\tabcellsep 100.00\\ 1\tabcellsep Dermatological\tabcellsep 4,389\tabcellsep 42.95\\ 2\tabcellsep Hepatitis\tabcellsep 1,634\tabcellsep 15.99\\ 3\tabcellsep GI disturbance\tabcellsep 1,004\tabcellsep 9.82\\ 4\tabcellsep Musculoskeletal\tabcellsep 166\tabcellsep 1.62\\ 5\tabcellsep Central nervous system\tabcellsep 86\tabcellsep 0.84\\ 6\tabcellsep Headache\tabcellsep 37\tabcellsep 0.36\\ 7\tabcellsep Ocular\tabcellsep 29\tabcellsep 0.28\\ 8\tabcellsep Fever\tabcellsep 13\tabcellsep 0.13\\ 9\tabcellsep Otological\tabcellsep 9\tabcellsep 0.09\\ 10\tabcellsep Peripheral nervous system\tabcellsep 7\tabcellsep 0.07\\ 11\tabcellsep Renal\tabcellsep 7\tabcellsep 0.07\\ 12\tabcellsep Breathlessness\tabcellsep 4\tabcellsep 0.04\\ 13\tabcellsep Psychiatric\tabcellsep 3\tabcellsep 0.03\\ 14\tabcellsep Miscellaneous\tabcellsep 659\tabcellsep 6.45\\ \multicolumn{2}{l}{Total no. of ADRs observed}\tabcellsep 8,047\tabcellsep 78.75\end{longtable} \par \caption{\label{tab_1}Table 2 :}\end{figure} \footnote{© 2013 Global Journals Inc. (US) © 2013 Global Journals Inc. (US)} \backmatter \subsection[{Acknowledgement}]{Acknowledgement}\par Authors are grateful to the Professor Dr. Abu Shara Shamsur Rouf for his prudent suggestions which greatly facilitated the research activity. \subsection[{Global}]{Global} \begin{bibitemlist}{1} \bibitem[December]{b2}\label{b2} \textit{}, December . 1. \bibitem[ NTP]{b9}\label{b9} \textit{}, \url{http://www.ban.searo.who.int/en/Section15/Section16\textunderscore 25.htm} \textit{NTP} \bibitem[Tripathi ()]{b8}\label{b8} \textit{}, K D Tripathi . \textit{Essentials of Medical Pharmacology by Jaypee Brothers Medical Publishers} 2008. (6th edition) \bibitem[Who ()]{b13}\label{b13} \textit{}, Geneva Who . \textit{Global Tuberculosis Control} 2012. 2012. \bibitem[Begum et al. ()]{b1}\label{b1} ‘A comparative study on the adverse effects of two antituberculosis drugs regimen in initial two-month treatment period’. 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