Hepatotoxicity associated with first-line antitubercular drugs in children at a tertiary care facility

Adverse drug reactions in children and adolescents on daily antitubercular regimen: An observational longitudinal study

OBJECTIVES

Subsequent to introduction of daily fixed dose combination (FDC) regimen with increased dosages and inclusion of ethambutol in continuation phase of antitubercular therapy (ATT) in India, this study was done to evaluate adverse drug reactions (ADRs) in children and adolescents.

METHODS

Longitudinal observational study conducted in tertiary teaching hospital. Children (1 month-18 year), with newly diagnosed drug sensitive tuberculosis, started on daily FDC regimen of ATT, were included. Participants were followed up at 2 weeks, 8 weeks and 6 months. Division of AIDS (DAIDS) severity grading and World Health Organization-Uppsala Monitoring Centre (WHO-UMC) causality assessment was done.

RESULTS

In 99 participants, 29 experienced ADRs. Most commonly ADRs involved hepatobiliary (11.1%) and gastrointestinal (8.1%) systems. Grade 3 severity noted in 35.5% ADRs. Certain causality classified in 19.3%. Presence of ADRs was significantly higher in participants with vs without malnutrition [40.5% vs 21.1% (p = 0.036)]. Tendency for more severe ADRs noted in participants with vs without malnutrition [Grade 3 ADRs out of all ADRs: 64.7% vs 0% (p < 0.001)].

CONCLUSION

Incidence and severity of ADRs has increased after introduction of daily FDC of ATT. Most common ADR observed were hepatobiliary. Malnutrition and less weight for age were risk factors for occurrence and severity of ADRs.

Synthesis of New Thiazole Clubbed Imidazo[2,1-b]thiazole Hybrid as Antimycobacterial Agents

Aims:

The study aims to synthesize bioactive hybrid pharmacophores (thiazole ring and imidazo[2,1-b]thiazole system) by incorporating them to one biological assessment molecular system.

Background:

Literature survey revealed that various imidazo[2,1-b]thiazoles, thiazoles and hydrazones have powerful anti-mycobacterial activity.

Objective:

This study demonstrates the effectiveness of molecular hybridization and the scope for imidazo[2,1-b]thiazole-hydrazone-thiazoles to develop as promising anti-mycobacterial agents.

Method:

Several imidazo[2,1-b]thiazole–hydrazine-thiazoles 5a-g, 7a,b, 9a,b, 11a,b, 13, and 15a,b were generated using a molecular hybridization strategy and assessed against Mycobacterium tuberculosis (ATCC 25618) for their in vitro antituberculous activity.

Result:

Derivative 7b (MIC = 0.98 μg/mL) has shown the most promising anti-mycobacterial activity among the series tested. Brief structure-activity relationship studies found that the thiazole of chlorophenyl or pyridine or coumarin had a significant relation with the anti-mycobacterial activity.

Conclusion:

Promising anti-mycobacterial activity of compound 7b compared with reference drug suggests that this compound may contribute as a lead compound in search of new potential anti-mycobacterial agents.