{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T06:10:10Z","timestamp":1791958210086,"version":"4.3.4"},"reference-count":62,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,3,1]],"date-time":"2022-03-01T00:00:00Z","timestamp":1646092800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Treatment of multi-drug resistant tuberculosis (MDR-TB) for a prolonged period with comparatively less effective and more toxic second-line anti-TB drugs is associated with greater incidence of adverse events.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study aim<\/jats:title><jats:p>This study aimed to evaluate the frequency and factors associated with occurrence of adverse events among patients with MDR-TB attending the Bahawal Victoria Hospital, Bahawalpur, Pakistan.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study design<\/jats:title><jats:p>This retrospective study included all patients with MDR-TB who were registered and treated at the study site between June 2014 and December 2016 and had their treatment outcomes available at the time of data collection (i.e., November 2018).<\/jats:p><\/jats:sec><jats:sec><jats:title>Measures and outcomes<\/jats:title><jats:p>The Electronic Nominal Record System (ERNS) records, medical charts of patients, and laboratory reports were reviewed to obtain the data. Adverse events were reported as per the standard criteria recommended by the WHO. Multivariate binary logistic regression was used to find the independent factors associated with the occurrence of adverse events.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 179 patients with MDR-TB were included in the final analysis. Out of these, 114 (63.7%) patients experienced at least one adverse event during the course of their treatment. Depression was the most common adverse events (33%), followed by nausea and vomiting (27.4%) and arthralgia (27.4%). The factors associated with the occurrence of adverse events included presence of comorbidity (adjusted odds ratio [<jats:italic>AOR<\/jats:italic>] 2.951; 95% <jats:italic>CI<\/jats:italic> 1.423, 6.118) and being employed (<jats:italic>AOR<\/jats:italic> 3.445; 95% <jats:italic>CI<\/jats:italic> 1.188, 9.993).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Adverse events were prevalent in this cohort, however, resolved with the effective management approaches. Patients with identified factors for occurrence of adverse events need special attention and enhanced clinical management.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2021.790718","type":"journal-article","created":{"date-parts":[[2022,3,1]],"date-time":"2022-03-01T11:13:58Z","timestamp":1646133238000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":314,"title":["Frequency and Factors Associated With Adverse Events Among Multi-Drug Resistant Tuberculosis Patients in Pakistan: A Retrospective Study"],"prefix":"10.3389","volume":"8","author":[{"given":"Muhammad","family":"Atif","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Waqar","family":"Ahmed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad","family":"Nouman Iqbal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nafees","family":"Ahmad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wajiha","family":"Ahmad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iram","family":"Malik","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaser Mohammed","family":"Al-Worafi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,3,1]]},"reference":[{"key":"B1","year":"2019","journal-title":"WHO Consolidated Guidelines on DR-TB Treatment"},{"key":"B2","year":"2019","journal-title":"Global Tuberculosis Report"},{"key":"B3","year":"2015","journal-title":"WHO Guidelines for Surveillance of Drug Resistance in TB"},{"key":"B4","first-page":"214","article-title":"Treatment outcomes of multidrug resistance tuberculosis","volume":"35","author":"Jabbar","year":"2019","journal-title":"Pak J Surg"},{"key":"B5","doi-asserted-by":"publisher","first-page":"481","DOI":"10.1017\/S0950268803008367","article-title":"Risk factors for drug resistant tuberculosis in Leicestershire-poor adherence to treatment remains an important cause of resistance","volume":"130","author":"Pritchard","year":"2003","journal-title":"Epidemiol Infect"},{"key":"B6","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1186\/s13756-017-0199-7","article-title":"Investigation of antimicrobial use at a tertiary care hospital in Southern Punjab, Pakistan using WHO methodology","volume":"6","author":"Atif","year":"2017","journal-title":"Antimicrob Resist Infect Control."},{"key":"B7","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1186\/s40545-016-0076-4","article-title":"Assessment of WHO\/INRUD core drug use indicators in two tertiary care hospitals of Bahawalpur, Punjab, Pakistan","volume":"9","author":"Atif","year":"2016","journal-title":"J Pharm Policy Pract."},{"key":"B8","doi-asserted-by":"publisher","first-page":"684","DOI":"10.1186\/s12913-016-1932-2","article-title":"Assessment of core drug use indicators using WHO\/INRUD methodology at primary healthcare centers in Bahawalpur, Pakistan","volume":"16","author":"Atif","year":"2016","journal-title":"BMC Health Serv Res."},{"key":"B9","doi-asserted-by":"publisher","first-page":"1928","DOI":"10.1186\/s40064-016-3615-1","article-title":"WHO\/INRUD prescribing indicators and prescribing trends of antibiotics in the Accident and Emergency Department of Bahawal Victoria Hospital, Pakistan","volume":"5","author":"Atif","year":"2016","journal-title":"Springerplus."},{"key":"B10","doi-asserted-by":"publisher","first-page":"492","DOI":"10.1007\/s43441-019-00081-7","article-title":"Pediatric antibiotic pack size compliance with the dosage regimen: a descriptive study","volume":"54","author":"Malik","year":"2020","journal-title":"Ther Innov Regul Sci."},{"key":"B11","doi-asserted-by":"publisher","first-page":"1041","DOI":"10.1002\/hpm.3016","article-title":"Why is Pakistan vulnerable to COVID-19 associated morbidity and mortality? 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