1638. Pyrazinamide for pulmonary tuberculosis in elderly patients over 80 years
Session: Poster Abstract Session: Mycobacterial Infections
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • Pyrazinamide therapy for pulmonary tuberculosis in elderly patients.pdf (4.7 MB)
  • Background: The prevalence of tuberculosis (TB) in elderly patients has recently been recognized as a global trend. In Japan, one-third of the patients with TB are aged over 80 years. Age is regarded as a risk factor of drug-induced hepatitis (DIH); therefore, the Japanese guidelines recommend exercising caution when using PZA to treat elderly TB patients. Most of them are empirically treated with a 3-drug regimen not containing pyrazinamide (PZA). However, it is unclear whether PZA is safe for use in elderly TB patients.  

    Methods: In an observational clinical trial, adult smear-positive pulmonary TB patients hospitalized from August 2010–2012 were analyzed. Hospital charts were reviewed retrospectively.

    Results: Of 359 patients, 59 were aged over 80 years and 37 patients received treatment with a PZA-based regimen. Moreover, 31 of these 59 patients developed DIH. The major risk factors of DIH were malnutrition, low-grade activity of daily living (ADL), and elevated liver enzymes in the advance stages of treatment. Using PZA did not increase the risk of DIH. The mortality of DIH was 41.9 %; however, the incidence of DIH which should be needed to change the treatment rejimen did not have the difference in PZA use group and PZA non-use group.

    Conclusion: PZA is safe for use in elderly patients aged over 80 years without malnutrition, low-grade ADL, and previously elevated liver enzymes.

    Ryutaro Tanizaki, MD1, Eriko Morino, MD2, Jun Sugihara, MD1, Yoshiaki Kanno, MD2, Jin Takasaki, MD2, Nobuyuki Kobayashi, MD3 and Haruhito Sugiyama, MD, PhD2, (1)Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan, (2)Respiratory Medicine, National Center for Global Health and Medicine, Tokyo, Japan, (3)Respiratory Center, Tokyo National Hospital, Tokyo, Japan

    Disclosures:

    R. Tanizaki, None

    E. Morino, None

    J. Sugihara, None

    Y. Kanno, None

    J. Takasaki, None

    N. Kobayashi, None

    H. Sugiyama, None

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.