RESEARCH ARTICLE

Department of Pharmacy

COMMUNITY PHARMACIST IN THE PREVENTION OF CONTAGIOUS DISEASE MYCOBACTERIUM TUBERCULOSIS

AS KEY PART OF HEALTHCARE ASSOCIATES

infectious disease caused by MYCOBACTERIUM TUBERCULOSIS, TB is multi-systemic disease with myriad manifestations. The rate of TB is increasing day by day in many parts of the world [1]. M tuberculosis is obligate anaerobe slowly growing and facultative curved intracellular rod parasite which is non-motile, and non-spore forming [2]. According to the Robert Koch M Tuberculosis is a microorganism as a causative agent of disease [3] Globally the mycobacterium tuberculosis have ability to persist long time period unrecognized by human immune system[4] Recent study's shows that Tuberculosis is the leading reason of death in those individuals who are infected with HIV and

Tuberculosis (TB),is the most common

INTRODUCTION

HIV-TB. There are many different situations that may leads to a greater risk for Mycobacterium tuberculosis infections susceptibility such as hyperglycemia, aging, use of corticosteroids for long period of time, TNF-á blockers, Vitamin D receptor polymorphism, INF-á genes, and polymorphism in IL-12 [5]. The greater prevalence of tobacco exposure and use increases the chances of tuberculosis [6]. Tuberculosis has become the world wide problem. WHO considerers a general health emergency. Pneumonia and community acquired Pneumonia may also lead to development of tuberculosis, symptoms can be include shiver, chronic cough, phlegm excretion, pleurisy chest pain, increased respiratory rate, bronchial lung sound etc [7].

Maria Ayub*, Bushra Riaz Khan, Uzma Bano, Falak khalil

Department of Pharmacy, Jinnah University for Women, Karachi 74600, PAKISTAN

www.ujpsr.com 6

ARTICLE INFO:Article history: Received:20 October 2015Received in revised form:23 October 2015Accepted: 1 November 2015Available online: 10 November 2015

AbstractTuberculosis is a wide spread infectious disease that usually caused by mycobacterium tuberculosis (MTB). It typically attack the lungs and also affect other body parts and leading to severe cough, chest pain, sneeze and fever. TB affect the strains on public health and causing high mortality ratio to the HIV/AIDS. The effect of M tuberculosis only prevent by the vaccine that is bacillus camette guerins for adult. M bacterium tuberculosis from sputum specimen may very helpful in early diagnosis and also very effective for the early treatment of TB particularly those patient who have acid fast negative sputum.In this study we observed the worse situation of community pharmacies especially in TB prevention .for the purpose of eradication of TB completely or overcome this disease from PAKISTAN too like other developed countries. We found that pharmacist need to be trained or should be the part of community pharmacy where they can aware patient easily gain trust of the patient , and patient can also understand them . without any difficulty can easily communicate with pharmacist regarding to their problems side effect and pharmacist can also aware the patient about the drug management, regimen what happened if the dose miss all information which may be helpful for the TB patient also pharmacist should force the patient to follow their physician advices and pharmacist physician should cooperate with each other this healthy relationship may be helpful for both patient and pharmacist.

Mycobacterium tuberculosis, vaccination, community pharmacist, HIV/AIDS, strains.

Key words

Corresponding Author:

Maria AyubLecturer, Faculty of Pharmacy, Jinnah University for Women,Karachi 74600, PAKISTAN E-mail: maria.ayub2000@gmail.comPhone: +92331-3119160

nd2 Issue

Maria Ayub et.al / UJPSR / 1 (2), 2015, 6-11e ISSN: 2454-3764

Print ISSN: 2454-3756

RESEARCH ARTICLE

Department of Pharmacy

Tuberculosis remains a disease with unknown cause and death among where the areas endemic and the rate of progression of disease is variable [8]. TB patient sera they had a greatly abundance in factor with chemo tactic and also effect on activate monocytes, macrophages, & neutrophillis as compare to healthy individuals [9]. The risk of tuberculosis progression also consist upon age and co-morbid conditions. [10]. The early diagnosis and proper treatment are effective to reduce the risk of TB and also reduces the mortality, morbidity and TB transmission in-spite of low sensitivity detection of Mycobacterium tuberculosis, The main and most common method of diagnosis is acid fast sputum [11]. Sometime culture of sputum and gastric fluid test was not considered as useful to detect TB specially in Pneumonia [12]. In people living with human immunodeficiency virus (HIV) infection, the Antiretroviral therapy (ART) is main intervention for the prevention of TB [13]. Rifampicin, isoniazid, ethambutanol and pyrazinamide for 2months and 4months followed by isoniazid & rifampicin. A 6 month therapy regimen in which combination of four drugs are used with cure rate 90% [14]. Drug resistant tuberculosis (DR-TB) currently treatment is not good enough as compare to susceptible TB [15].

Sometime to change the epidemiology of the disease, social and behavioral research on patients is important [16].

Untreated TB patient are better than partially treatment TB patient it is accepted universally. Pakistan is a country included in the list where extremely high rate of defaulter for the complication of TB treatment [17].

As a pharmacist it is our duty to providing treatment information and can help alleviate barriers to adherence [18]. Its important that the community pharmacist must counsel the patients who are taking TB medication to make the treatment successful they also provide the stress to complete the antibiotic treatment even patient feel better [19].

It is responsibility of Pharmacist and public health sector to notified cases of TB. Counseling about primary care, internal medicine, or counsel about that the initiating therapy is useful to reduce the TB infection and may be appropriate for manage the anti-tuberculosis chemotherapy. Individual who are infected with TB are knowledgeable about their

disease, patients must received counseling before pre-treatment, educated with prevalence of various symptoms associated with TB, identify the factors that leads to fail the treatment, also suggest the ways of improving the treatment efficacy [20]. The objective of the study is to evaluate an effective role of community pharmacist to prevention and counseling against awareness of Tuberculosis.

METHODOLOGY

For the desire to realize the need of community pharmacist to prevent spreading of TB this study was conducted among TB's patients and private practitioners in and near hospitals. During data collection found that there was lacking of strong relationship between patient and pharmacist and this relation is of great concern in this study. Most of Community pharmacist was found just to supply medicines by consultant due to lack of rights. For prevention of TB or to beat this disease were directed to pay great attention to evaluate effective role of pharmacist to serve the patient best and also to save the countrymen from these circumstances by providing awareness.

RESULT

According to the survey from different communities of Karachi we observed that the 50% of pharmacies create awareness against TB, but there is no particular programs to cure TB, as shown in (TABLE # 1). There is no proper establishment of community pharmacies and also poor counseling were seen. Mostly answers of the pharmacist were negative to prevent TB ( FIG.1) there is also a need to counsel the patients to complete there treatment even if they feel better to avoid antibiotic resistance. We also observed that according to poor counseling patient do no aware about side effects of drug and transmission of TB, which would, increases the ratio of TB in our nation there is a poor management and establishment of health care system, awareness programs, also government do not full fill requirement of training programs, lack of trained pharmacist there is no particular community pharmacies thats why pharmacist do no play their role to prevent the diseases, Government do not give the authority and importance of pharmacist to perform their requirements.

www.ujpsr.com 7nd2 Issue

Maria Ayub et.al / UJPSR / 1 (2), 2015, 6-11e ISSN: 2454-3764

Print ISSN: 2454-3756

RESEARCH ARTICLE

Department of Pharmacy

www.ujpsr.com 8

Pharmacists have an slot turn to monitor their patients with chronic and severe type of disease condition and give information about the use of combined medications, also pass along information about possible sign and symptoms of tuberculosis, aware about vaccination with proper counseling for all of these purposes there is a need of communities to aware and protect population against chronic types of diseases. Pharmacist raising the awareness about tuberculosis by using different methods such as by organizing programs against awareness, counseling about TBLHIV vaccination, consequences of TB, to complete proper treatment to avoid many infectious diseases and also to prevent against drug resistance. The world health organization developed the Stop TB Strategy to increase worldwide awareness for superior and valuable treatment, prevention, and mastery of

tuberculosis and all nations should be follow to cure people and nation against tuberculosis and many other severe type of infections and diseases.

DISCUSSION

Tuberculosis has become the world wide problem. All developed countries like USA has overcome this problem but under developed countries like Pakistan, India, and many other countries is deprived to reduce prevention and prevalence of TB. With Physician, Nurses, private practitioners can also play a vital role to decreasesthe proliferation of TB by providing awareness, education, patient counseling, and information about the risk factor of TB being a part of pharmacist duty. Pharmacist need greater efforts can towards treating infection of TB. These effort

Table 1: Role of Community Pharmacists

Figure 1: Percent respondent of Tuberculosis prevention measures

nd2 Issue

Maria Ayub et.al / UJPSR / 1 (2), 2015, 6-11e ISSN: 2454-3764

Print ISSN: 2454-3756

RESEARCH ARTICLE

Department of Pharmacy

www.ujpsr.com 9

can be accommodating for control of TB in Pakistan

by community sector, Health care including

pharmacist and well developed community

pharmacies can play an effective role in prevention

and cure of Tuberculosis. Plenty of peoples do not

follow their prescribed medicine and direction

related to their diseaseso counseling is necessary

here. Pharmacist should provide basic information

and utility of TB vaccination that is Bacillus

calmette Guerins (BCG). They must knowledgeable

them that vaccine does not fight against all TB

strains. Pharmacist should counsel the infected the

patient to wear special surgical mask known as

respirator to prevent the spreading of TB particles

through the air Community pharmacist can play a

vital role to prevent peoples from different type of

diseases, during counseling pharmacist should

motivate the patient to take additional test if needed

by developing mutual trust and respect as well.

There is a need of clinical and community

pharmacies at compartment level to improve the

patient compliance to therapy and treatment as well

as to control illogical prescription. 45% pharmacist

should choose community pharmacy profession

because it holds the actual pharmacy practice and

also business benefits. Community/Retail

pharmacists have a duty to create awareness among

the people about TB by distributing leaflets,

booklets, pamphlet, and displaying posters at

prominent places in local languages which are

easily understand by everyone. Pharmacist should

counsel the patient with infected TB in various

manners of treatment therapy like how to take dose,

stress that should complete their coarse, which food

to be taken in TB etc. Community pharmacist

should arrange the National Tuberculosis Programs.

In order to control TB and perform essential roles

trained pharmacists are required to understand

disease well and to manage the undesired effect of

drug therapy and this can be possible with the

support of our Government & society for the social

performing activity Government should motivate

pharmacist to organized training programs.

Pharmacist should encourage rational use of anti-

tuberculosis medicines additionally dispensing

anti-tuberculosis medicines that should not be safe

and effective and sale of other combination of drug

can be stop to avoiding misuse and without

prescription medication should not be given to the

patient. Moreover by following and established the

community pharmacy, pharmacist should cure,

prevent and aware peoples about tuberculosis and

it's also a basic need of our country. Pharmacies are

often the first support and can play a key role in TB

control and its eradication.

CONCLUSION

In conclusion, our survey and studied designate that

the tuberculosis is necessary to reduce in all local

and national scales. We also concluded that in our

nation there is a lack of particular communities and

retail pharmacies and we need to establish them to

sort out the patient compliance as well as to stop the

prevalence of TB and many other infected diseases.

In community pharmacies pharmacist should have

opportunity to counsel the patient about their

disease, and should also aware the patient about the

transmission, symptoms, pretreatment, proper

regimen. Pharmacist must counsel the patient to

complete their antibiotic treatment to avoid the

eradication of infection as well as reduces the risk

of developing of antibiotic drug resistance. If these

things can be measure properly so it can expand the

awareness of TB in among all the nation.

nd2 Issue

Maria Ayub et.al / UJPSR / 1 (2), 2015, 6-11e ISSN: 2454-3764

Print ISSN: 2454-3756

RESEARCH ARTICLE

Department of Pharmacy

www.ujpsr.com 10

REFERENCES

1. Sterling TR, Villarino ME,Borisov

AS,etal.three months of rifapentine and

isoniazid for latent tuberculosis infection.N

E n g l a n d j o u r n a l m e d . D e c 8

2011;365(23):2155-66.

2. Verhagen LM, van den Hof S, van

Deutekom H, Herman's PW, Kremar K,

Borgdorff MW, et al. Mycobacterial factor

relevant for transmission of tuberculosis. J

infect Dis. may 2011;203(9):1249-55.

3. Neil W. Schluger "The Pathogenesis of

Tuberculosis", American Journal of

Resp i r a to ry Ce l l and Molecu la r

Biology,(2005) VOL 32(4), pp. 251-256.

4. Yukari C. Manabe and William R.bishai,

latent Mycobacterium tuberculosis

persistence, patience and winning by

waiting, journal of nature medicine.2000, 6,

1327-1329.

5. Nicole fogel, Tuberculosis: A disease

without boundaries, Int J tuberculosis and

lung Dis. 2015. 95. 527-531.

6. K.Salma, C-Y. Chiang,D.A Enarson,

K.hassmiller,A.fanning, p.gupta,C.ray

.Tobacco and tuberculosis;a qualitative

systemic review and meta-analysis.INT J

T U B E R C U L O S I S A N D L U N G

DIS.2007.11(10);1049-1061..

7. Zhinus baryat makoo, Haleh rezaee and

Fatemeh Ravanbakhs Ghavghani, labo

ratory finding of patient with respiratory

Infection in Infectious disease ward of

Tabriz, Iran, International journal of current

research and academic Review. August

2015.vol 3(8) p:437-442 ISSN.2347-3215.

8. Carlos M. Pervez-velez. M.D& Ben J.

mavais,M.D ph.D, TB children. N ENG

med 2012,367: 345-361.

9. Jeroen maerzdorf, Torsten Bauer, Antje jo

achium Muller-quernheim & stefan H.E

Kaufmonn, common pattern and disease-

related signatures in TB and sarcoidosis,

May 2012 Vol 109(20),7853-7858.

10. Horsburgh CR Jr. Priorities for the

treatment of latent tuberculosis infection in

the united state. N ENGL J Med .May 13

2004;350(20):2060-7.

11. M.J.Reid & N.S.Shah, Approaches to

tuberculosis screening and diagnosis in

people with HIV in recource limited

setting.Open acess journal of lancet

infectious diseases. 2009.Vol 9(3) pg:173-

184.

12. Yamamoto J, Shimanouchi M, Hushizume

T, Suitto T, Aquired bronchial atresia due to

endobronchial tuberculosis . The japness

J o u r n a l o f T h o r a c i c s u r g e r y .

2015.68(10);836-839.

13. Stephen D. Lawn, preventing HIV-

associated tuberculosis with antoretroviral

therapy shut the stable door early, INT J

TUBERCULOSIS Disease.2015,19(1);3-

4.

14. Chiristian lienhardt, Mario raviglione,

melspigelman,richard hafner, ernesto

jaramillo, michael hoelscher alimuddin

zumla and jan gheuens. New drug for the

treatment of tuberculosis: needs,

challenges, promise and prospects for the

future. The journal of infectious disease,

2012.VOL 205 ISSUE 12.

nd2 Issue

Maria Ayub et.al / UJPSR / 1 (2), 2015, 6-11e ISSN: 2454-3764

Print ISSN: 2454-3756

RESEARCH ARTICLE

Department of Pharmacy

www.ujpsr.com 11

15. COX ,H.FORD, N,linezolid for the

treatment of comlicated drug resistant TB; a

systemic review and meta analysis. the

international journal of TB and lung

DIS.2012.vol 16,4;pp;447-454 (8).

16. Esther Sumartojo "When Tuberculosis

Treatment Fails: A Social Behavioral

Account of Patient Adherence, ATS

JOURNAL.1993. vol. 147, No. 5 (1993),

pp. 1311-1320.

17. J.A Khan, A.malik, tuberculosis in pakistan

are we losing better?.JPMA(journal of pak

med. association.2003.

18. Gail mkele, the role of the pharmacist in tb

m a n a g e m e n t . S A p h a r m a c e u t i c a l

journal.2010.18-21.

19. Yvette C. Terrie,RPH THE role of

oharmacists in multi-drug resistance

tuberculosis, J pharmacy time 2003 pp;1.

Isabirye C. Charles, Physician: Madinah

N, Namaata, A preliminary survey of pre-

treatment counseling of patients with

tuberculosis in mulago hospital, uganda.

American Chest journal.2003;124

pg:211-212.

nd2 Issue

Maria Ayub et.al / UJPSR / 1 (2), 2015, 6-11e ISSN: 2454-3764

Print ISSN: 2454-3756