Efecto de la capreomicina sobre la función renal en pacientes con tuberculosis multidrogoresistente pulmonar

Abstract

Objetivos: Determinar el efecto de la Capreomicina en la depuración de Creatinina Calculada , en pacientes con Tuberculosis Pulmonar Multidrogoresistente. -Determinar el perfil epidemiológico; la frecuencia de uso de Capreomicina; deterioro de la Depuración de Creatinina; el uso de Fármacos AntiTBC y condición de Egreso de los pacientes. Método : Se realizo un estudio descriptivo, de tipo retrospectivo en pacientes con Tuberculosis Pulmonar Multidrogoresistente; que recibieron la Droga Capreomicina como tratamiento Individualizado complementario; que fueron atendidos en el Servicio de Neumología del Hospital Nacional “Guillermo Almenara Irigoyen “de EsSALUD entre los años 2000-2002; para lo cual se revisaron 358 Historias Clinicas ,de las cuales 105 recibieron la droga ,100 pacientes cumplieron con los criterios de inclusión. Resultados : El 62% de pacientes fueron del género masculino, èl 70 % de la población estuvo comprendido entre los 15 a 45 años, el 59% tuvo educación secundaria, él 79% de pacientes de la serie salió Curado.El Tiempo de Tratamiento Promedio de Capreomicina fue de 18.42 meses y el 59% de la muestra recibió tratamiento entre 12 a 24meses, el l5% recibio tratamiento de 24 a 42 meses .Las Drogas asociadas usadas fueron Cicloserina(100%)Amoxicilina/Clavulanico(94%)Ofloxacina(71%)Pirazinamida(60%)con un promedio de 4.94 drogas, el 73 %de pacientes de la serie recibieron Dosis de Capreomicina entre 150 a 350 grs como dosis total,con un valor promedio de la serie de 273.73 grs, El estudio de sensibilidad de las cepas demostró Resistencia a Drogas de Primera Línea en él 96 %, 94%, 68%, 76% en Rifampicina, Isoniacida, Pirazinamida y Estreptomicina respectivamente, se demostró Sensibilidad a Thioacetazona (33%), Kanamicina (41%), Pirazinamida (28%) y PAS (29%) En él Control Basal el 51 % de la serie tuvo màs del 90% de Depuración Calculada (Normal), el 41 % de la misma serie tuvo una daño Leve, es decir del 60 al 89% de Depuración, 8% tuvo daño Moderado.Ninguno con Falla Renal ó daño Severo.con valores Promedios de toda la serie de Creatinina Sèrica de 79.49 mgs con 92.18% de Promedio de Depuración de Creatinina Calculada y peso promedio de 61.03 Kgs.. En el Control de Depuración de Creatinina Calculada, en general a los 18 meses de iniciado el Tratamiento con Capreomicina, persiste el 51% con valores Normales, 41% con daño Leve ;notándose un 7% que hace Daño Moderado ( Depuración entre 30 a 59%) y 1% de Daño Severo (Depuración entre 15 a 29%), el valor promedio de Creatinina Sérica es de 82.15mgs,con una Depuración de Creatinina Calculada de 90.48% promedio y peso promedio de 62.36 Kgs. CONCLUSIÓN: La Capreomicina no demuestra cambios significativos en la Depuración Calculada de Creatinina ;empleando la Ecuación de Cockcroft-Gault; con dosis elevada y tiempo de administración prolongado de la droga ;siendo tolerada por el paciente TBC-MDR.--- Objective: To determine the effect of Capreomycin in the purification of calculated Creatinine in patients with a diagnose of “Multidrugresistant Tuberculosis”. To determine the epidemic profile; the frequency of use of Capreomycin; if deterioration of purification of calculated Creatinine exists; the use of AntiTBC drugs such as therapy associated with Capreomycin and to establish the condition of discharged patients with “Multidrugresistant Tuberculosis”. Method: A retrospective descriptive study was carried out in patients with “Multidrugreststant Tuberculosis,” that were treated in the Pneumonia Unit of the “HNGAI” between 2000-2002 and who received the Drug Capreomycin as a complementary individualized treatment., 358 Clinical Histories were checked of patients, that received individualized treatment between 2000 and 2002 inclusive; of those, 105 patients received Capreomycin, 100 patients fulfilled the inclusion approaches, which is the total sample Results 62% of patients were men, 70% were aged between 15 and 45 years old, 59% had secondary education, 79% of patients came out cured, the average treatment time for Capreomycin was of 18.42 months, 59% of the sample received treatment for between 12 and 24 months, 15% received treatment from 24 to 42 months, the associated drugs used with more frequency were Capreomycin (100%), Cycloserine(100%) Amoxicillin/Clavulanic Acid (94%) Ofloxacine(71%) Pyrazinamide(60%) with an average of 4.94 drugs, 73% of patients received doses of between 150 to 350 grams of Capreomycin in total , with an average dose of 273.73 grams. The study of sensibility of stumps demonstrated Resistance to First Line Drugs in 96%, 94%, 68%, 76% in Rifampin, Isoniacid, Pyrazinamide and Streptomycin respectively, it demonstrated Sensitivity to Thioacetazona (33%), Kanamycina (41%), Pyrazinamide (28%) and PAS (29%). In the first Control: 51% of the series had more than the 90% of Calculated Purification Cretinine (Normal), 41% of the same series had light damage, that is to say between 60 to 89% of Purification; 8% had Moderate damage, none with Renal failure or Severe damage; with averages values of the whole series of Creatinina Sérica of 79.49 rngs, and with an average of 92.18% Purification of Calculated Creatinina and an average weight of 61.03 Kgs. In the second control of Purification of Calculated Creatinina, in general 18 months into the treatment with Capreomycin, 51% persists with normal values, 41% with light damage; and it was noted that 7% was moderately damaged (Purification between 30 to 59%) and 1% with Severe Damage (Purification between 15 to 29%), the average value of Creatinina Sérica is 82.15mgs, with a calculated Purification average of 90.48% and a weight of 62.36 Kgs. In the studied series it was observed that 16 lobectomias and 5 neumonectomias were carried out in the patients. CONCLUSION: Capreomycin doesn't demonstrate great ,nor in the Calculated Purification of Creatinine; using the Equation of Cockcroft-Gault; with high dose and a prolonged time of administration of the drug; being tolerated by the TBC-MDR patient.