Introduction Multi-Drug Resistant Tuberculosis (MDR-TB) is a form of TB that is resistant to the two most powerful first-line anti-tuberculosis antibiotics available, rifampicin and isoniazid. Between 2004 and 2011, the proportion of cases with MDR-TB increased from 1.2% to 1.6%, of which it has remained stable over the past 3 years. Due to the complexity of treatment regimens used for MDR-TB, national monitoring guidelines have been developed to aid monitoring for adverse effects during treatment.¹ A previous study identified that prior to the development of these monitoring guidelines the incidence of adverse effects associated with MDR TB medicines was high.²

Objective To establish whether national guidelines for the monitoring of MDR-TB medicines at a tertiary centre are being adhered to.

Results 9 patients with MDR-TB were included in the audit. The findings (see Table 1) show that baseline monitoring was not undertaken in the majority of patients. Whilst on-going monitoring was predominantly undertaken in over 80% of occasions, the audit standard was not met.

Conclusions Despite the presence of national guidance to support the monitoring of complex regimens for MDR-TB, this audit shows that monitoring of these in a tertiary centre is below the audit standard. Whilst adherence to on-going monitoring parameters were usually undertaken in over 80% of instances, it is of particular concern that baseline monitoring was significantly below the audit standard. Pharmacists are ideally placed to support the safe and effective monitoring of these often toxic medicines. The development of a pharmacist to support the TB clinics and specifically to support the monitoring of patients with MDR-TB could significantly improve this adherence and reduce the risk of adverse effects as a result of sub-optimal monitoring.

References 1 Potter JL, Capstick T. A UK based resource to support the monitoring and safe use of anti-tuberculosis drugs and second line treatment of multi-drug resistant tuberculosis. First published May 2014, Latest update January 2015

2 Keal JL, Khachi H, Hanzaree E, et al. Treatment of multidrug resistant tuberculosis: where are the guidelines for monitoring? Thorax 2011;66(Suppl 4):A91