Get Permission Yadav: Electrolyte disruption in drug-resistant tuberculosis: Managing risks for improved treatment outcomes


Editorial

Tuberculosis (TB), has affected mankind for centuries, remaining as a significant global health issue. 1 The emergence of drug-resistant strains of the Mycobacterium tuberculosis, particularly multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB), has further complicated treatment regimens and outcomes. 2 Beyond the resistance mechanisms themselves, another critical concern in the management of drug-resistant TB is the impact on electrolyte balance.

Electrolytes are essential minerals in the body that carry an electric charge, crucial for various physiological functions, including nerve conduction, muscle contraction, and maintaining fluid balance. 3 When tuberculosis becomes resistant to first-line drugs like isoniazid and rifampicin, patients often require longer and more complex treatment with second-line drugs, which can lead to electrolyte imbalances due to their pharmacological properties and side effects.

One of the primary challenges in managing electrolyte imbalances in drug-resistant TB lies in the medications themselves. Second-line drugs such as aminoglycosides (e.g., amikacin), and certain other agents like linezolid can disrupt electrolyte levels. 4, 5, 6, 7 Further, aminoglycosides can cause both hypokalemia and hypomagnesemia. These disturbances can lead to serious complications if not promptly identified and managed. Moreover, vomiting, diarrhea, and sweating also potentiates the electrolyte imbalances. This ultimately have a direct effect in the mechanism of other anti-tuberculous drugs. Newer drugs like bedaquiline and delamanid could result in the prolongation of QTcF levels but this could be attributed to the underlying electrolyte imbalances which can be corrected. 4, 8

Moreover, the extended duration of treatment required for drug-resistant TB increases the risk of cumulative electrolyte disturbances over time. Patients may also face challenges in maintaining adequate nutrition and hydration during treatment, which further potentiates the risk of electrolyte imbalance.

Beyond pharmacological considerations, the disease itself can contribute to electrolyte imbalances. Tuberculosis often leads to systemic inflammation and metabolic alterations, which can further disrupt electrolyte homeostasis. 9 For instance, increased levels of pro-inflammatory cytokines may affect renal function and electrolyte handling. 10

The management of electrolyte imbalances in drug-resistant TB requires a multidisciplinary approach. Close monitoring of electrolyte levels, particularly potassium, magnesium, and calcium, is essential throughout the treatment course.11 Regular renal function tests are also crucial to detect early signs of kidney damage, which can exacerbate electrolyte disturbances.

Healthcare providers must be vigilant in educating patients about the signs and symptoms of electrolyte imbalances, emphasizing the importance of adherence to treatment and dietary recommendations. Nutritional support, including supplementation when necessary, plays a vital role in maintaining electrolyte balance and supporting overall health during TB treatment.11

Research into novel treatment regimens for drug-resistant TB should also prioritize minimizing the impact on electrolyte balance. This includes exploring new drug combinations or formulations that are less likely to cause significant electrolyte disturbances.

In conclusion, while drug-resistant tuberculosis poses formidable challenges to global health, the management of electrolyte imbalances represents a critical aspect of patient care. Healthcare providers must remain proactive in monitoring and addressing these imbalances to optimize treatment outcomes and minimize complications. Through continued research and clinical vigilance, we can advance our understanding and management of this complex interplay between tuberculosis and electrolyte balance, ultimately improving the quality of life and prognosis for patients worldwide.

Source of Funding

None.

Conflicts of Interest

None declared.

Acknowledgements

None.

References

1 

BR Bloom R Atun T Cohen C Dye H Fraser GB Gomez KK Holmes S Bertozzi BR Bloom TuberculosisMajor Infectious Diseases. 3rd edn.Washington (DC): The International Bank for Reconstruction and Development / The201710.1596/978-1-4648-0524-0_ch11https://www.ncbi.nlm.nih.gov/books/NBK525174/

2 

PK Shanmuga AP Mani S Geethalakshmi S Yadav Advancements in Artificial Intelligence for the Diagnosis of Multidrug Resistance and Extensively Drug-Resistant Tuberculosis: A Comprehensive ReviewCureus20241656028010.7759/cureus.60280

3 

I Shrimanker S Bhattarai Electrolytes Electrolytes. [Updated 2023 Jul 24]StatPearls [Internet]Treasure Island (FL): StatPearls Publishing2024https://www.ncbi.nlm.nih.gov/books/NBK541123/[Last accessed 2024, Jun 7]

4 

Guidelines for programmatic management of drug resistant tb in India 2021https://tbcindia.gov.in/WriteReadData/l892s/8368587497Guidelines%20for%20PMDT%20in%20India.pdf.Lastaccessed2024[Last accessed 2024, Jun 7]

5 

R Prasad A Singh N Gupta Adverse drug reactions in tuberculosis and managementIndian J Tuberc20196645203210.1016/j.ijtb.2019.11.005

6 

C Roger JA Roberts L Muller Clinical pharmacokinetics and pharmacodynamics of oxazolidinonesClin Pharmacokinet201857555975

7 

R Tanaka Y Suzuki Y Morinaga A retrospective test for a possible relationship between linezolid-induced thrombocytopenia and hyponatraemiaJ Clin Pharm Ther202146234351

8 

Guidelines for use of delamanid in the tteatment of drug resistant tb in India 2018https://tbcindia.gov.in/WriteReadData/l892s/8131480597Guidelines%20for%20use%20of%20Delamanid%20for%20treatment%20of%20DR-TB%20in%20India.pdf[Last accessed 2024, Jun 7]

9 

L D’Attilio N Santucci B Bongiovanni ML Bay O Bottasso Tuberculosis, the Disrupted Immune-Endocrine Response and the Potential Thymic Repercussion As a Contributing Factor to Disease PhysiopathologyFront Endocrinol (Lausanne)2018921410.3389/fendo.2018.00214

10 

GR Kathamuthu K Moideen R Sridhar D Baskaran S Babu Systemic levels of pro-inflammatory cytokines and post-treatment modulation in tuberculous lymphadenitisTrop Med Infect Dis20238315010.3390/tropicalmed8030150

11 

Companion handbook to the WHO guidelines for the programmatic management of drug-resistant tuberculosis. Geneva: World Health Organization; 2014. ANNEX 7, Management of electrolyte disturbances2014https://www.ncbi.nlm.nih.gov/books/NBK247438/[Last accessed 2024, Jun 7]



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Received : 04-06-2024

Accepted : 24-06-2024


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https://doi.org/10.18231/j.ijirm.2024.010


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