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Adverse effects and duration of treatment for tuberculosis at Christchurch Hospital

A 2019/2020 Summer Studentship research project

This study will provide information on the outcomes of patients undergoing treatment through the TB service in Christchurch. Our results will provide first lines of evidence regarding the need for new strategies in patient care, such as more common use of therapeutic drug monitoring.

Student: Nisal Kuruppu
Supervisors: Dr Simon Dalton, Dr Michael Maze, Senior Lecturer, Department of Medicine, UOC & Specialist Physician, Respiratory Department, Canterbury District Health Board
Sponsor: Travis Trust

Introduction

Clinicians within the Infectious Diseases and Respiratory Departments at Christchurch Hospital treat approximately 50 patients each year for tuberculosis (TB). World Health Organisation provide recommendations for treatment duration for TB that range from 6 months to 12 months and are based on the site and extent of disease. Although treatment failure and disease relapse are rare in New Zealand, anecdotally treatment duration is sometimes extended due to a slow response to treatment of a patient’s symptoms or radiology. Internationally there is increasing evidence that low serum concentrations of anti-TB medication is an important cause for a slow response to treatment. In addition, adverse effects to anti-TB drugs, such as hepatitis or peripheral neuropathy are common. Some of these adverse effects are dose related and may be mitigated by careful titration of the drug to within a therapeutic range. In New Zealand, therapeutic drug monitoring (TDM) is available for some TB drugs, but is rarely performed. If there was a substantial proportion of patients with prolonged treatment duration or adverse drug reactions then further research to determine if more common use of therapeutic drug monitoring could improve treatment response and minimize adverse effects would be warranted.

Aims

  1. To determine to describe the baseline characteristics and treatment plans of patients treated for TB at Christchurch Hospital
  2. To determine the proportion of patients receiving treatment longer than the minimum recommended
  3. To describe the reasons for prolonged treatment duration
  4. To describe adverse effects from treatment


Method

We will audit all patients treated for TB in Christchurch during 2008-2018 to record their site of disease, initial planned treatment duration, adverse drug reactions during treatment, alterations from the initially planned treatment duration and reasons for the change. Patients will be identified from the existing TB service database. The summer student will collect data from the electronic health record using a standardized data collection sheet and enter it into a database. The student will perform, with supervision, a descriptive analysis of the data.

Student researcher’s component of the study

The student will perform data collection, and a supervised data analysis. They will write a first draft of a manuscript for publication in a peer reviewed journal.

Student Prerequisites

Medical student with reasonable IT skills. Some statistics knowledge is an advantage.

How to apply

Email Simon.Dalton@cdhb.health.nz