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Annual Congress of Malaysian Thoracic Society
PP 6
Are tuberculosis treatment outcome categories missing something?
A case report from Malaysia
Atif M 1 , Sulaiman S A S 1 , Ali I 2 , Muttalif A R 3 , Shafie A A 1
1
University Sains Malaysia, Penang, Malaysia
2
Hospital Pulau Penang, Penang, Malaysia
3
Institute of Respiratory Medicine, Kuala Lumpur, Malaysia
Objective
This case report necessitates elaboration of World Health Organisation (WHO) recommended tuberculosis
(TB) treatment outcome categories and points out rational use of antihistamines.
Case description
A 24 year university student with history of productive cough was registered as sputum smear positive case of
pulmonary tuberculosis. During treatment, patient suffered from itchiness associated with anti-tuberculosis
drugs, which was treated with chlorpheniramine (4mg) tablet. Patient missed 28 doses of anti-tuberculosis
drugs in the continuation phase claiming that he was very busy in his studies and assignments. Upon
questioning, he further explained that he was quite healthy after five months and unable to concentrate on his
studies after taking he prescribed medicines. His treatment was stopped after six months, based on clinical
improvement.
Discussion
Two major reasons, false perception of being completely cured and side effects associated with anti-TB drugs,
might be responsible for non-adherence. Non-sedative antihistamines like fexofenadine, cetirizine or loratadine
should be preferred over first generation antihistamines (chlorpheniramine) in patients with a lifestyle that
requires concentration during the day. This patient had not completed the full course of chemotherapy, which
is preliminary requirement for a case to be classified as “cured” or “treatment completed”. However, this
patient had not defaulted for two consecutive months. Therefore, according to WHO outcome classification,
this patient can neither be classified as “cured”, “treatment completed” nor as “defaulter”.
Conclusion
By applying WHO recommended “Patient Centered Approach”, we can reduce the risk of of non-adherence.
A close friend, classmate or family member may be selected as a treatment supporter to ensure adherence
to treatment. Antihistamines must be used rationally according to patient’s lifestyle. Further elaboration
of WHO treatment outcome categories is required for appropriate classification of patients with similar
characteristics.
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