Abstract

A 22 year hotel waitress with history of productive cough was registered as sputum smear confirmed case of pulmonary tuberculosis. Time delay between onset of symptoms and start of treatment was two months. During the first month of treatment, patient suffered from itchiness and skin rashes associated with anti tuberculosis drugs, which were treated with chlorpheniramine (oral; 4 mg), citrizine (oral; 5 mg) and betamethasone (local application; 0.122% w/w).  Patient missed 16 (out of 32) doses of anti TB drugs in continuation phase claiming that she was very busy at work place and forgot to take medication. Although, at the end of treatment, patient’s perception of mental and physical health was improved but ‘social functioning’ and ‘role emotion’ scores were still below Malaysian norms suggesting perceived stigma and lack of tuberculosis knowledge. Patient was classified as cured, though, she did not complete full course of chemotherapy, which is the preliminary requirement for a case to be classified as “cured” or “treatment completed”. Patients working in crowded areas like restaurants, bus stations or market should be isolated from community until they are non-infectious. Use of non sedative anti histamines like fexofenadine, or loratidine should be preferred over first generation anti histamines (chlorpheniramine) in patients with such a lifestyle. Anti tuberculosis treatment should be stopped until rashes are completely resolved. World Health Organization (WHO) has recommended applying “Patient Centered Approach” to cope with the defaulters. There is need for more inclusive efforts of National Tuberculosis Control Programs to improve health related quality of the life of tuberculosis patients.

Key words: Tuberculosis, chlorpheniramine, patients, treatment.