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Open Access Effect of lidocaine on kanamycin injection-site pain in patients with multidrug-resistant tuberculosis

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SETTING: Reducing pain from intramuscular injection of kanamycin (KM) could improve the tolerability of multidrug-resistant tuberculosis (MDR-TB) treatment. Lidocaine has been shown to be an effective anaesthetic diluent for some intramuscular injections, but has not been investigated with KM in the treatment of adult patients with MDR-TB.

OBJECTIVE AND DESIGN: We performed a randomised single-blinded crossover study to determine if lidocaine reduces KM injection-site pain. We recruited patients aged 18 years on MDR-TB treatment at two TB hospitals in Cape Town, South Africa. KM pharmacokinetic parameters and a validated numeric pain scale were used at intervals over 10 h following the injection of KM with and without lidocaine on two separate occasions.

RESULTS: Twenty participants completed the study: 11 were males, the median age was 36 years, 11 were HIV-infected, and the median body mass index was 17.5 kg/m2. The highest pain scores occurred early, and the median pain score was 0 by 30 min. The use of lidocaine with KM significantly reduced pain at the time of injection and 15 min post-dose. On multiple regression analysis, lidocaine halved pain scores (adjusted OR 0.5, 95%CI 0.3–0.9). The area under the curve at 0–10 h of KM with and without lidocaine was respectively 147.7 and 143.6 μg·h/ml.

CONCLUSION: Lidocaine significantly reduces early injection-site pain and has no effect on KM pharmacokinetics.
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Keywords: TB; adherence; adverse effect; injectable

Document Type: Research Article

Affiliations: 1: Division of Clinical Pharmacology, Department of Medicine 2: Clinical Research Centre, Faculty of Health Sciences, University of Cape Town, Cape Town 3: Brooklyn Chest Hospital, Cape Town 4: D P Marais Hospital, Cape Town, South Africa 5: Center for Infectious Diseases Research and Experimental Therapeutics, Baylor Research Institute, Baylor University Medical Center, Dallas, Texas, USA

Publication date: August 1, 2018

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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