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Pharmacokinetics interaction of calcium on the treatment of sputum positive pulmonary tuberculosis patients

Tuberculosis (TB) in children is a neglected aspect of the TB epidemic despite it constituting 20% or more of all TB cases in many countries with high TB incidence. Tuberculosis constitutes a serious global health problem with nearly 10 million new cases of tuberculosis (2011) and 1.4 million deaths every year. In pharmacokinetic studies, co-administration of various inhibitors of this enzyme (e.g., erythromycin, antifungal substances, protease inhibitors, and grapefruit juice) raised plasma phosphate concentrations by up to 500%. 
Materials and Methods: The study was conducted in Chennai tuberculosis hospital from January 2012 through July 2015 in seven target groups, with consecutive recruitment. The first group consisted of otherwise deselected patients who are presented with suspected tuberculosis to the tuberculosis hospital in Chennai. Blood samples were collected from the subjects of tuberculosis Hospital at Chennai. To non-treatment and treatment variations, fasting blood samples were collected from 8 AM - 9 AM. Experiments were carried out as soon as possible. Whenever there was a delay in experiments, samples were stored at -10° to -15°C for a maximum of 1 day. Blood samples thus collected using standard sampling techniques were centrifuged to get the serum that was analysed phosphorus levels by Phosphomolybdate method. The study protocol was approved by the Institutional ethics committee and was carried out in accordance with the principle of the declaration of Helsinki. 
Results: In the study, mean serum phosphorus level in newly diagnosed patients was 13 ± 3.30 mg/dl, after first month treatment to sixth month treatment the level was 13 ± 3.60mg/dl, 11 ± 3.30 mg/dl, 10.50 ± 3.30 mg/dl, 11 ± 3.30 mg/dl, 11.20 ± 2.80 mg/dl and 10.20 ± 2.80 mg/dl respectively. Six-month treatment 20 patients were get the hyperphosphatemia for include female 9 patients. One study suggests that Estrogen may act directly to suppress sodium-dependent phosphate absorption in the renal proximal tubules inducing phosphaturia and decreased serum phosphate; women who are post-menopausal and Estrogen deficient would be at increased risk for hyperphosphatemia Low serum phosphate levels are associated with reduced cardiac output and also with risk for arrhythmia. 
Conclusion: Our findings offer the possibility that early intervention will help achieve calcium and phosphorus conversion and ultimately a successful treatment outcome. In order for us to update guidelines and optimize patient care, some gaps in the evidence base need to be addressed. Although available data demonstrate the association between hyperphosphatemia and increased risk of mortality, it remains a challenge in the clinic to achieve and maintain recommended serum phosphorus concentrations. 
  
 Keywords: Hyperphosphatemia, Phosphomolybdate Method, Pulmonary Tuberculosis