African Treatment Programs Often Overestimate Tuberculosis Drug Doses

Doses of tuberculosis drugs prescribed by national treatment programs in several African nations are often dangerously inaccurate, researchers warn in a recent issue of International Journal of Tuberculosis and Lung Disease (2002;6;3:215-221). Dr. Aziz H. Diop and colleagues at the National Program to Fight Tuberculosis in Dakar-Fann Senegal; the National Leprosy/Tuberculosis Program in Nairobi, Kenya; the National Tuberculosis Programme in Katmandu, Nepal; and the Paris-based International Union Against Tuberculosis and Lung Disease evaluated the "adequacy of initial prescriptions of dosages of anti-tuberculosis medications in the three national tuberculosis programs" in these countries.

Drugs given to patients treated by these programs are often administered at overdose levels, Diop and coauthors said. The researchers reviewed data from more than 8,600 tuberculosis patients treated by national programs in Senegal, Kenya, and Nepal. The treatment histories of almost 4,000 additional patients were available but did not provide enough information to warrant their inclusion in the study cohort, they noted.

Only a third of patients treated in Kenya received appropriate doses of the anti-TB agent isoniazid, with the proportion of patients treated with recommended doses falling to 15 percent in Senegal and Nepal. Most patients treated with isoniazid were given overdoses of the powerful drug, study data showed. Similar results were seen after examining data on pyrazinamide and (to a lesser extent) rifampicin dosing. "This study shows that over-dosage was a frequent event in all three countries," Diop and colleagues concluded. "It is vital to address these problems to reduce both the risk of unnecessary drug toxicity on one end of the spectrum, and suboptimal drug levels on the other."

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