Clinical Case of Using Intravenous Forms of Anti-Tuberculosis Drugs to Improve the Treatment Efficiency of Tuberculosis in Patients with Malabsorption Syndrome

Abstract

Case History: The patient is 47 years old. Pulmonary-TB detected by X-ray examination on complaints of cough, fever, weakness, weight loss of 12kg within 1year, defecation to 2-3times a day. Smoker. History of alcohol abuse over 8 years. Comorbidity was diagnosed with additional examination which revealed chronic pancreatitis(CP). Results and Treatment: According to the sputum examination MTB were found in the patient, sensitivity to all drugs. Ultrasound findings and coprological examination is a typical picture of CP. We use the treatment standard anti-TB drugs (ATD) (H, R, Z, E-orally) and enzyme replacement therapy. On the background of the prescribed treatment in 2 months no clinical and laboratory improvement was noted in the patient (Figure).Extremely low concentrations of R and E were noted in all the blood samples after oral drugs administration. We changed the treatment. I/v were used: H, R, E; orally-Z. After i/v administration of the studied drugs the peak concentrations exceeded the minimum inhibitory concentrations required. Given the pronounced positive clinical and radiological dynamics, absence of MTB in sputum in the examination in terms of control, after receiving 60 doses of combined chemotherapy with some i/v ATD, the patient was transferred to the supporting phase (Figure 1). Conclusions: The absence of a positive response in the application of appropriate ATD may be associated with MS. Compensation of pancreatic function after replacement therapy does not always lead to increased bioavailability of drugs used orally. The use of some i/v of ATD throughout the course of treatment with concomitant malabsorption is the treatment of choice.