Therapeutic drug monitoring of rifampicin, isoniazid, and pyrazinamide in newly-diagnosed pulmonary tuberculosis outpatients in Denpasar area

Ida Ayu Alit Widhiartini , Made Agus Gelgel Wirasuta, Dewa Made Sukrama, Ida Bagus Ngurah Rai

Ida Ayu Alit Widhiartini
Pharmacology and Therapy Department, Faculty of Medicine, Universitas Udayana. Email: widhiartini@unud.ac.id

Made Agus Gelgel Wirasuta
School of Pharmacy, Faculty of Natural Science, Universitas Udayana

Dewa Made Sukrama
Clinical Microbiology Department, Faculty of Medicine, Universitas Udayana

Ida Bagus Ngurah Rai
Pulmonology Department, Faculty of Medicine, Universitas Udayana
Online First: April 01, 2019 | Cite this Article
Widhiartini, I., Wirasuta, M., Sukrama, D., Rai, I. 2019. Therapeutic drug monitoring of rifampicin, isoniazid, and pyrazinamide in newly-diagnosed pulmonary tuberculosis outpatients in Denpasar area. Bali Medical Journal 8(1): 107-113. DOI:10.15562/bmj.v8i1.1304

Background: Therapeutic drug monitoring (TDM) has the potency to enhance the therapeutic outcome of rifampicin, isoniazid, and pyrazinamide, the backbone of first-line anti-tuberculosis (TB) therapy. The implementation of TDM is understudied for newly-diagnosed lung TB outpatients in the Denpasar area.

Aim: To determine the prevalence of low plasma concentration of three first-line anti-TB drugs (rifampicin, isoniazid, and pyrazinamide).

Methods: Subjects were newly-diagnosed lung TB adult outpatients from the Denpasar area, aged >18 years old, without comorbidity (HIV or diabetes), not pregnant and not using comedications for at least two days before the test. The subjects received daily anti-TB drugs for at least ten days before the test. SGOT, SGPT, and albumin levels were tested at the time before administration of RHZE 4-FDC tablet. Subjects were tested for plasma concentration at 2 and 6 hours after ingestion of RHZE 4-FDC tablet. Plasma levels of rifampicin, isoniazid, and pyrazinamide were analyzed using HPTLC spectrophotodensitometry method.

Results: 28 of 32 subjects had low plasma concentrations of rifampicin, 9 of 24 subjects had low plasma concentrations of isoniazid, 4 of 24 subjects had high plasma concentrations of isoniazid, and 14 of 31 subjects had low levels of pyrazinamide; 3 subjects had plasma concentration of three drugs within the expected range simultaneously.

Conclusion: Almost all subjects had low plasma concentration of rifampicin, isoniazid, and pyrazinamide. Only a limited number of subjects had plasma concentration within the target range of the three drugs simultaneously.


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