Pharmaceutical intervention through the provision of a compounding formulation in a pediatric patient with tuberculostatics

Abstract

Introduction: This paper emphasizes the prescriptive nature of the pharmacist in therapeutic decision making which in this case is linked to the health importance of stopping the transmission of tuberculosis.

Tuberculosis is an infectious disease transmitted through the air by inhalation of Mycobacterium tuberculosis (Koch's bacillus). Because of its transmissibility, active pulmonary tuberculosis affects those living with the patient and the community.  

The act of drug preparation is a professional pharmaceutical competence that is linked to the pharmaceutical care process.

The drug Isoniazid indicated is not available for pediatric patients. In order to solve the lack of medicinal specialties according to age and weight, a compounding formulation is used.

The pharmacist intervenes in pharmacological prophylaxis by suggesting to the treating physician the revision of the dosage according to the patient's weight and its duration, as well as in other aspects such as patient monitoring and follow-up, and adherence to treatment.

Case description: In July 2023, an 18-month-old female patient weighing 12 kg presented to the outpatient clinic of a pediatrician of a social insurance company, who reported in her medical history to be the contact of a bacilliferous patient in her care (a teacher at the kindergarten where the contact was attending).

All children under 5 years of age, regardless of the result of the tuberculin test, should be treated. The treating physician prescribed Isoniazid 120 mg daily for 90 days. 

The patient was ruled out for active TB. The patient was classified as close or frequent contact. 

The pharmacist found a magistral liquid oral formulation of Isoniazid in the literature search. Although the excipients present are pharmacologically inactive, they can cause adverse events in special populations such as pediatrics. Therefore, it was dispensed on paper with the corresponding dose of active ingredient.

The pharmacist instructed the patient's mother about possible adverse events of Isoniazid. 

The pediatric patient's adherence to treatment was acceptable.

Discussion: The health importance of stopping TB transmission was adopted by the World Health Assembly in May 2014 under the name End TB Strategy.

In this framework, the pharmacist's intervention through his or her professional competencies makes a fundamental contribution to therapeutic success.

The pharmacist, through the Magistral Pharmacy, fills the therapeutic gap when the industry fails to supply all the drugs that patients need, and thus accompanies the interdisciplinary team of health, patient and community in pursuit of comprehensive health.