Pharmacokinetic Drug-Drug Interactions between First Line Anti-TB (Rifampicin, Isoniazid Pyrazinamide) and Ethambutol and Anti-Diabetic Drugs (Metformin and Sulphonlyureas)

Abstract

BACKGROUND: Tuberculosis (TB) remains as a fascinating disease, and illustrates a exclusive laboratory for pathologists, radiologists, respiratory physicians, pediatricians, public-health specialists, immunologists, and chief specialist. TB leads as infectious killer in the world and remains major cause of deaths related to antimicrobial resistance. In 2019, 1.4 million people died from TB which include 2 lakh people with HIV. The main causative agent of TB is Mycobacterium Tuberculosis (MTB), an air borne bacterial infection which infests any body part and mainly the lungs. TB is exposed to the air as droplet nuclei from individuals with pulmonary or laryngeal TB by means of coughing, sneezing, shouting or singing. RATIONALE FOR THE STUDY: Although TB is quite common in diabetic patients, a number of issues remain unanswered that would have a significant impact on the clinical management of the two diseases and therefore merit increased attention: does DM lead to increased susceptibility to initial TB infection, does DM significantly prolong sputum and culture positivity; if so, diabetic patients are at higher risk of relapse than non-diabetic patients and whether this might influence on the duration of treatment? Are the existing doses of anti-TB drugs adequate in patients with TB and DM? Are the existing anti-TB drug doses adequate in patients with TB and DM? Limited information is available on the pharmacokinetic drug-drug interactions between first-line anti-TB drugs and anti-diabetic drugs. It is therefore essential to understand the interactions between these drugs and to ensure that the plasma concentrations of anti-TB and anti-diabetic drugs are maintained within the therapeutic range. There is no impact of anti-diabetic drugs on the PK of anti-TB drugs in DMTB patients. Therefore the NTEP recommended doses were sufficient enough in TB patients in the presence of Diabetes. In contrary, MET concentration was significantly increased in the presence of anti-TB drugs in DMTB patients.