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Negative implications may be an elevated use of third line antibiotics.
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A weaker association was observed between risk of CDSI and use of second line therapy (p = 0.014).
The studies from Italy and Argentina both reported that second line treatment was not adequate, while the use of second line drugs was not reported in the study from Spain.
Unfortunately, due to the long and complex nature of TB treatment, inappropriate use of first line antituberculous drugs is common, leading to the emergence of drug-resistant bacilli, especially MDR strains.
Many people have persistent symptoms despite use of first line treatments.
In the first study [ 52] there was improvement in use of second line uterotonics and escalation of care.
Costs associated with drug acquisition, treatment delivery, disease complications, and the use of second line chemotherapy were included.
Inappropriate use of second line drugs used in the treatment of TB leads to amplification of resistance and development of XDR-TB [ 10].
It has been hypothesised that the use of second line drugs leads to re-emergence of drug susceptible strains in patients with mixed infections [ 15].
For the more complicated cases (20%), it is important to use a multidimensional approach that includes a careful re-assessment of the pain syndrome and use of second line agents and/or non-pharmacological interventions (Zech et al, 1995).
High rates of toxicity, increasing use of second line antiretroviral drugs, and difficult dosing schedules of previously recommended antiretroviral regimens are leading to changes in the mix in favour of clinically superior, but also more expensive, drugs.
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