Publication:

Ototoxic effect of anti-tubercular treatment on multi-drug resistant tuberculosis patient

Background Multi-drug resistant tuberculosis (MDR-TB) is defined as tuberculosis caused by Mycobacterium tuberculosis resistant in vitro to the effects of isoniazid and rifampicin, with or without resistance to any other drugs. Regimen for MDR-TB comprises of 6 drugs - kanamycin, levofloxacin, ethionamide, pyrazinamide, ethambutol and cycloserine during 6-9 months of the intensive phase and 4 drugs levofloxacin, ethionamide, ethambutol and cycloserine during the 18 months of the continuation phase. The aim of our study was to document the incidence and severity of ototoxicity in MDR-TB patient receiving category IV treatment under the revised national tuberculosis control program.

Methods Prospective cohort study was carried out on proven case of MDR-TB patients. Total 61 patients were evaluated for the development of ototoxicity, for a period of one year. First three months of study pre-treatment baseline audiogram were recorded by pure tone audiometry, and repeat audiogram was done after six months and nine months.

Results Out of 61 patients 21 patients developed ototoxicity with incidence of 34.42%. Incidence of high frequency hearing loss was 21.31% and flat loss was 13.11%.

Conclusions MDR-TB patients, due to effect of aminoglycoside may develop mild to severe degree of hearing loss. As hearing loss in these patients is permanent, careful audiological monitoring should be done regularly.