Exposição a rifampicina e adesão ao tratamento da tuberculose pulmonar
Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis, generally affecting the lungs and leading to death. The Ministry of Health recommends for the treatment of new cases of pulmonary tuberculosis the association of chemotherapy drugs administered in two phases: the...
| Autor principal: | ELIAS, Gisely France Abrantes |
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| Grau: | Dissertação |
| Idioma: | por |
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Universidade Federal do Pará
2022
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http://repositorio.ufpa.br:8080/jspui/handle/2011/14277 |
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ir-2011-142772022-08-30T13:45:26Z Exposição a rifampicina e adesão ao tratamento da tuberculose pulmonar Exposure to rifampicin and adherence to the treatment of pulmonary tuberculosis ELIAS, Gisely France Abrantes VASCONCELOS, Flávio de http://lattes.cnpq.br/3695753129639448 VIEIRA , José Luiz Fernandes http://lattes.cnpq.br/2739079559531098 https://orcid.org/ 0000-0001-9568-6268 https://orcid.org/ 0000-0003-4842-8762 Tuberculose pulmonar Exposição a rifampicina Adesão ao tratamento Teste de Morisky-Green Medidas antropométricas Pulmonary tuberculosis Exposure to rifampicin Adherence to treatment Morisky-Green test Anthropometric measurements CNPQ::CIENCIAS BIOLOGICAS::FARMACOLOGIA AVALIAÇÃO BIOLÓGICA DE PRINCÍPIOS ATIVOS, NATURAIS E SINTÉTICOS FÁRMACOS E MEDICAMENTOS Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis, generally affecting the lungs and leading to death. The Ministry of Health recommends for the treatment of new cases of pulmonary tuberculosis the association of chemotherapy drugs administered in two phases: the intensive one, which lasts two months, and Rifampicin (600 mg), Isoniazid (300 mg), Pyrazinamide (1600 mg) and Ethambutol (1100 mg) (2RHZE) and maintenance, for four months, when Rifampicin (600 mg) and Isoniazid (300 mg) (4RH) are administered. The full dose of medication is indicated for patients over 50 kg. A determinant of therapeutic success is the exposure of the bacillus for a certain period of time to effective concentrations of chemotherapeutic agents, that is, above the minimum inhibitory concentration (MIC), which in this case of rifampicin ranges from 0.05 µg / ml to 0.5 µg / ml, in addition, studies have shown that maximum plasma drug concentrations above 8.0 µg / ml are associated with a high rate of therapeutic success. However, there is a high intra and interindividual variation in the plasma concentrations of rifampicin in the usual therapeutic doses, caused by factors related to the patient and the drug dispensed, which can interfere with exposure, as well as the administered doses and anthropometric measurements of the patients. The aim of the present study was to investigate the factors that influence plasma concentration when exposed to rifampicin in the treatment of pulmonary tuberculosis in a Basic Health Unit in Belém / Pa. A cross-sectional and observational study was carried out of 70 cases of subjects of both sexes, with clinical, radiological and laboratory diagnosis of tuberculosis by M. tuberculosis, distributed in the intensive and maintenance phases of treatment. Plasma concentrations of rifampicin were determined, as well as anthropometric measurements of weight, height, fat percentage and abdominal circumference of each individual and the application of the Morisky-Green Test to assess adherence. Thus, the sample included in the study was composed mainly of adult men with low education and income. Plasma concentrations of rifampicin were above the minimum inhibitory concentration of M. tuberculosis indicating adequate exposure to the drug, which can be measured by the high proportion of patients who had smear conversion at the end of the first month of treatment. Sex was not a predictor of variation in plasma rifampin concentrations. The treatment phase was considered to be a predictor of variation in plasma drug concentrations. The concentrations of rifampicin were not associated with the Body Mass Index, waist circumference and fat percentage both in patients in the intensive phase and in those in maintenance of treatment. Adherence to tuberculosis treatment was 88.1% and 82.14% in patients in the intensive and maintenance phases, respectively. Plasma concentrations of rifampicin were not associated with the Morisky-Green Test. A Tuberculose (TB) é uma doença infectocontagiosa causada pelo Mycobacterium tuberculosis, afetando geralmente os pulmões e levando ao óbito. O Ministério da Saúde recomenda para o tratamento dos casos novos de tuberculose pulmonar a associação de quimioterápicos administrados em duas fases: a intensiva, que dura dois meses, e são administrados Rifampicina (600 mg), Isoniazida (300 mg), Pirazinamida (1600 mg) e Etambutol (1100 mg) (2RHZE) e a de manutenção, por quatro meses, quando são administrados Rifampicina (600 mg) e Isoniazida (300 mg) (4RH). A dose plena de medicamentos é indicada para pacientes acima de 50 Kg. Um determinante do sucesso terapêutico é a exposição do bacilo por determinado intervalo de tempo a concentrações efetivas dos quimioterápicos, isto é, acima da concentração inibitória mínima (CIM), que no caso da rifampicina varia entre 0,05 ug/ml a 0,5 ug/ml, além disso, estudos mostraram que concentrações plasmáticas máximas do fármaco acima de 8,0 ug/ml estão associadas a elevada taxa de sucesso terapêutico. Entretanto, há uma alta variação intra e interindividual nas concentrações plasmáticas de rifampicina nas doses terapêuticas usuais, causada por fatores relacionados ao paciente e ao medicamento dispensado, as quais podem interferir na exposição, bem como as doses administradas e as medidas antropométricas dos pacientes. O objetivo do presente estudo foi investigar os fatores que influenciam a concentração plasmática quando da exposição à rifampicina no tratamento da tuberculose pulmonar em uma Unidade Básica de Saúde de Belém/Pa. Foi realizado um estudo transversal e observacional de 70 casos de sujeitos de ambos os sexos, com diagnóstico clínico, radiológico e laboratorial de tuberculose por M. tuberculosis, distribuídos nas fases intensiva e de manutenção do tratamento. Foram determinadas as concentrações plasmáticas de rifampicina, bem como aferidas as medidas antropométricas de peso, altura, percentual de gordura e circunferência abdominal de cada indivíduo e a aplicação do Teste de Morisky-Green para avaliar a adesão. Dessa forma, a casuística incluída no estudo foi composta principalmente de homens adultos com baixa escolaridade e renda. As concentrações plasmáticas de rifampicina foram acima da concentração inibitória mínima do M. tuberculosis indicando exposição adequada ao fármaco, o que pode ser aferido pela elevada proporção de pacientes que apresentaram conversão da baciloscopia ao final do primeiro mês de tratamento. O sexo não foi um preditor da variação das concentrações plasmáticas de rifampicina. A fase de tratamento foi considerada um preditor de variação das concentrações plasmáticas do fármaco. As concentrações de rifampicina não se associaram ao Índice de Massa Corporal, circunferência abdominal e percentual de gordura tanto em pacientes na fase intensiva, quanto naqueles na manutenção do tratamento. A adesão ao tratamento da tuberculose foi de 88.1% e 82.14% nos pacientes nas fases intensiva e de manutenção, respectivamente. As concentrações plasmáticas de rifampicina não se associaram ao Teste de Morisky-Green. 2022-05-16T18:28:39Z 2022-05-16T18:28:39Z 2020-08-28 Dissertação ELIAS, Gisely France Abrantes. Exposição a rifampicina e adesão ao tratamento da tuberculose pulmonar. Orientador: Flávio de Vasconcelos. 2020. 78 f. Dissertação (Mestrado em Ciências Farmacêuticas) - Universidade Federal do Pará, Instituto de Ciências da Saúde, Belém, 2020. Disponível em:http://repositorio.ufpa.br:8080/jspui/handle/2011/14277. Acesso em:. http://repositorio.ufpa.br:8080/jspui/handle/2011/14277 por Acesso Aberto application/pdf Universidade Federal do Pará Brasil Instituto de Ciências da Saúde UFPA Programa de Pós-Graduação em Ciências Farmacêuticas 1 CD-ROM |
| institution |
Repositório Institucional - Universidade Federal do Pará |
| collection |
RI-UFPA |
| language |
por |
| topic |
Tuberculose pulmonar Exposição a rifampicina Adesão ao tratamento Teste de Morisky-Green Medidas antropométricas Pulmonary tuberculosis Exposure to rifampicin Adherence to treatment Morisky-Green test Anthropometric measurements CNPQ::CIENCIAS BIOLOGICAS::FARMACOLOGIA AVALIAÇÃO BIOLÓGICA DE PRINCÍPIOS ATIVOS, NATURAIS E SINTÉTICOS FÁRMACOS E MEDICAMENTOS |
| spellingShingle |
Tuberculose pulmonar Exposição a rifampicina Adesão ao tratamento Teste de Morisky-Green Medidas antropométricas Pulmonary tuberculosis Exposure to rifampicin Adherence to treatment Morisky-Green test Anthropometric measurements CNPQ::CIENCIAS BIOLOGICAS::FARMACOLOGIA AVALIAÇÃO BIOLÓGICA DE PRINCÍPIOS ATIVOS, NATURAIS E SINTÉTICOS FÁRMACOS E MEDICAMENTOS ELIAS, Gisely France Abrantes Exposição a rifampicina e adesão ao tratamento da tuberculose pulmonar |
| topic_facet |
Tuberculose pulmonar Exposição a rifampicina Adesão ao tratamento Teste de Morisky-Green Medidas antropométricas Pulmonary tuberculosis Exposure to rifampicin Adherence to treatment Morisky-Green test Anthropometric measurements CNPQ::CIENCIAS BIOLOGICAS::FARMACOLOGIA AVALIAÇÃO BIOLÓGICA DE PRINCÍPIOS ATIVOS, NATURAIS E SINTÉTICOS FÁRMACOS E MEDICAMENTOS |
| description |
Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis,
generally affecting the lungs and leading to death. The Ministry of Health
recommends for the treatment of new cases of pulmonary tuberculosis the
association of chemotherapy drugs administered in two phases: the intensive one,
which lasts two months, and Rifampicin (600 mg), Isoniazid (300 mg), Pyrazinamide
(1600 mg) and Ethambutol (1100 mg) (2RHZE) and maintenance, for four months,
when Rifampicin (600 mg) and Isoniazid (300 mg) (4RH) are administered. The full
dose of medication is indicated for patients over 50 kg. A determinant of therapeutic
success is the exposure of the bacillus for a certain period of time to effective
concentrations of chemotherapeutic agents, that is, above the minimum inhibitory
concentration (MIC), which in this case of rifampicin ranges from 0.05 µg / ml to 0.5
µg / ml, in addition, studies have shown that maximum plasma drug concentrations
above 8.0 µg / ml are associated with a high rate of therapeutic success. However,
there is a high intra and interindividual variation in the plasma concentrations of
rifampicin in the usual therapeutic doses, caused by factors related to the patient
and the drug dispensed, which can interfere with exposure, as well as the
administered doses and anthropometric measurements of the patients. The aim of
the present study was to investigate the factors that influence plasma concentration
when exposed to rifampicin in the treatment of pulmonary tuberculosis in a Basic
Health Unit in Belém / Pa. A cross-sectional and observational study was carried out
of 70 cases of subjects of both sexes, with clinical, radiological and laboratory
diagnosis of tuberculosis by M. tuberculosis, distributed in the intensive and
maintenance phases of treatment. Plasma concentrations of rifampicin were
determined, as well as anthropometric measurements of weight, height, fat
percentage and abdominal circumference of each individual and the application of
the Morisky-Green Test to assess adherence. Thus, the sample included in the study
was composed mainly of adult men with low education and income. Plasma
concentrations of rifampicin were above the minimum inhibitory concentration of M.
tuberculosis indicating adequate exposure to the drug, which can be measured by
the high proportion of patients who had smear conversion at the end of the first
month of treatment. Sex was not a predictor of variation in plasma rifampin
concentrations. The treatment phase was considered to be a predictor of variation
in plasma drug concentrations. The concentrations of rifampicin were not associated
with the Body Mass Index, waist circumference and fat percentage both in patients
in the intensive phase and in those in maintenance of treatment. Adherence to
tuberculosis treatment was 88.1% and 82.14% in patients in the intensive and
maintenance phases, respectively. Plasma concentrations of rifampicin were not
associated with the Morisky-Green Test. |
| author_additional |
VASCONCELOS, Flávio de |
| author_additionalStr |
VASCONCELOS, Flávio de |
| format |
Dissertação |
| author |
ELIAS, Gisely France Abrantes |
| title |
Exposição a rifampicina e adesão ao tratamento da tuberculose pulmonar |
| title_short |
Exposição a rifampicina e adesão ao tratamento da tuberculose pulmonar |
| title_full |
Exposição a rifampicina e adesão ao tratamento da tuberculose pulmonar |
| title_fullStr |
Exposição a rifampicina e adesão ao tratamento da tuberculose pulmonar |
| title_full_unstemmed |
Exposição a rifampicina e adesão ao tratamento da tuberculose pulmonar |
| title_sort |
exposição a rifampicina e adesão ao tratamento da tuberculose pulmonar |
| publisher |
Universidade Federal do Pará |
| publishDate |
2022 |
| url |
http://repositorio.ufpa.br:8080/jspui/handle/2011/14277 |
| _version_ |
1787149075006619648 |
| score |
11.755432 |