A retrospective study conducted in Mumbai to observe how senior citizens suffering from drug-resistant tuberculosis (TB) react to traditional medication, found that the geriatric population suffered more adverse reactions to the drugs than younger patients. This was especially true of those already suffering from diabetes. The study found the geriatric population needs intense counselling and increased monitoring for successful treatment. The study, authored by four health specialists in Mumbai, was published in Journal of Medical Science and Clinical Research this week.
The Group of Tuberculosis (GTB) Hospital admitted 732 patients in 2016. Of these, the study, conducted from January 2016 till December 2016, observed 33 senior citizens and 99 patients under the age of 60 suffering from multi-drug resistant (MDR) and extensively drug resistant (XDR). The results showed that senior citizens suffered from vomiting, giddiness, toxicity and hearing loss more than those aged below 60.
Amongst senior citizens, 63.3 per cent suffered adverse drug reactions. Amongst those aged less than 60, 29.6 per cent suffered drug reaction. “Adverse drug reaction is preventable if proper care and individualised treatment is offered to senior citizens. Senior citizens, we found, contracted TB due to immuno-compromised conditions and not due to malnourishment unlike general population,” said Dr Rajendra Nanavare, lead author of he study who is attached with the International Union Against Tubercular and Lung Diseases. Other authors include Dr Daksha Shah, deputy executive health officer in Brihanmumbai Municipal Corporation; Dr Jagdish Keni, former Sewri hospital superintendent; and Dr Nilima Kshirsagar from the Indian Council of Medical research (ICMR).
At least 64 per cent senior citizens had diabetes and faced more adverse drug reactions compared to population under 60 amongst which 12 per cent had diabetes. Senior citizens were also more prone to developing drug resistance — 90.9 per cent of enrolled patients had multi-drug resistance as compared to 81.3 per cent from younger population. India has the largest number of TB patients with an estimated incidence of 2.8 million, against global incidence of 10.4 million. The International Conference on Harmonization considers older people a “special population as they differ from younger adults in terms of comorbidity, polypharmacy, pharmacokinetics and greater vulnerability to adverse drug reactions”.
Dr Nanavare added that in at least 50 per cent of autopsies of senior citizens, TB bacteria was found in their body, indicating that several went undiagnosed. “Late diagnosis is another reason why we find more drug resistance in senior citizens, although that does not show in this particular study. Senior citizens handle medicines differently, and we need to handle them more cautiously for treatment to succeed,” said co-author Dr Kshirsagar, national chair of clinical pharmacology at ICMR.