Outcomes and Use of Therapeutic Drug Monitoring in Multidrug-Resistant Tuberculosis Patients Treated in Virginia, 2009-2014 / 결핵및호흡기질환

BACKGROUND: Reports of therapeutic drug monitoring (TDM) for second-line medications to treat multidrug-resistant tuberculosis (MDR-TB) remain limited. METHODS: A retrospective cohort from the Virginia state tuberculosis (TB) registry, 2009-2014, was analyzed for TDM usage in MDR-TB. Drug concentrations, measured at time of estimated peak (Cmax), were compared to expected ranges. RESULTS: Of 10 patients with MDR-TB, 8 (80%) had TDM for at least one drug (maximum 6 drugs). Second-line drugs tested were cycloserine in seven patients (mean C2hr, 16.6+/-10.2 microg/mL; 4 [57%] below expected range); moxifloxacin in five (mean C2hr, 3.2+/-1.5 microg/mL; 1 [20%] below); capreomycin in five (mean C2hr, 21.5+/-14.0 microg/mL; 3 [60%] below); para-aminosalicylic acid in five (mean C6hr, 65.0+/-29.1 microg/mL; all within or above); linezolid in three (mean C2hr, 11.4+/-4.1 microg/mL, 1 [33%] below); amikacin in two (mean C2hr, 35.3+/-3.7 microg/mL; 1 [50%] below); ethionamide in one (C2hr, 1.49 microg/mL, within expected). Two patients died: a 38-year-old woman with human immunodeficiency virus/acquired immune deficiency syndrome and TB meningitis without TDM, and a 76-year-old man with fluoroquinolone-resistant (pre-extensively drug-resistant) pulmonary TB and low linezolid and capreomycin concentrations. CONCLUSION: Individual pharmacokinetic variability was common. A more standardized approach to TDM for MDR-TB may limit over-testing and maximize therapeutic gain.

Extensively drug resistance (XDR) tb is not always fatal.

The chance of incidence of XDR TB is on the rise due to improper use of second line anti-tubercular drugs. XDR-TB is very difficult to treat successfully and is often referred to as "virtually untreatable form of TB". We herein report a case of XDR TB confirmed by bacteriological examination in a WHO recognised laboratory who after 12 months of regular treatment improved both clinically and radiologically with sputum smear conversion. To the best of our knowledge, there has been no previous report of any similar case in literature.

Action and resistance mechanisms of capreomycin: a functional genomic perspective / 药学学报

Last two decades have witnessed the resurging of tuberculosis (TB) and multi-drug resistant TB, even the extensive drug resistant TB. It is urgent to develop novel drug to combat the increasingly worsen TB. Capreomycin is an ideal second-line TB drug. It is also recognized as an attractive template to develop more peptide antibiotics. In this review, the biosynthesis gene cluster of capreomycin, the action mechanism unveiled by transcriptome and novel resistance rational are summarized from the recent functional genomic investigation.

Efecto de la capreomicina sobre la función renal en pacientes con tuberculosis multidrogoresistente / Effect of the capreomycin on the renal function in patients with tuberculosis multidrogoresistent

Objetivos: - Determinar el efecto de la Capreomicina en la depuración de Creatinina Calculada, en pacientes con diagnóstico de Tuberculosis Multidrogoresistente. - Determinar el perfil epidemiológico; la frecuencia de uso de Capreomicina; si existe deterioro de la Depuración de Creatinina Calculada; el uso de fßrmacos AntiTBC como terapia asociada a Capreomicina y establecer la condición de egreso de los pacientes con Tuberculosis MuItidrogoresistente. Método: Se realizó un estudio descriptivo, de tipo retrospectivo en pacientes con Tuberculosis Multidrogoresistente, que fueron atendidos en el Servicio de Neumología del HNGAI entre los a±os 2000-2002, que recibieron la droga Capreomicina como tratamiento Individual izado complementario Resultados: Se revisaron 358 Historias Clínicas de pacientes, que recibieron tratamiento individualizado entre los a±os 2000 al 2002 inclusive, de los cuales 105 pacientes recibieron Capreomicina, 100 pacientes cumplieron con los criterios de inclusión, la cual es la muestra total; el 62 por ciento de pacientes, fueron del género masculino, el 70 por ciento de la población estuvo comprendido entre los 15 a 45 a±os, el 59 por ciento tuvo educación secundaria, el 79 por ciento de pacientes de la serie salió curado. El tiempo de tratamiento promedio de Capreomicina fue de 18.42 meses, el 59 por ciento de la muestra recibió tratamiento entre 12 a 24 meses, el 15 por ciento recibió tratamiento de 24 a 42 meses; las drogas asociadas usadas con mayor frecuencia fueron: Capreomicina (100 por ciento), Cicloserina (100 por ciento), Amoxicilina/Clavulanico (94 por ciento), Ofloxacina (71 por ciento), Pirazinamida (60 por ciento), con un promedio de 4.94 drogas; el 73 por ciento de pacientes de la serie recibieron Dosis de Capreomicina entre 150 a 350 grs como dosis - total, con un valor promedio de la serie de 273.73 grs, El estudio de sensibilidad de las cepas demostró...

Objectives: To determine the effect of Capreomycin in the purification of calculated Creatinine in patients with a diagnose of "Multidrugresistant Tuberculosis". To determine the epidemic profile; the frequency of use of Capreomycin; if deterioration of purification of calculated Creatinine exists; the use of AntiTBC drugs such as therapy associated with Capreomycin and to establish the condition of discharged patients with "Multidrugresistant Tuberculosis". Method: A retrospective descriptive study was carried out in patients with "Multidrugreststant Tuberculosis," that were treated in the Pneumonia Unit of the "HNGAI" between 2000-2002 and who received the Drug Capreomycin as a complementary individualized treatment. Results: 358 Clinical Histories were checked of patients, that received individualized treatment between 2000 and 2002 inclusive; of those, 105 patients received Capreomycin, 100 patients fulfilled the inclusion approaches, which is the total sample; 62 per cent of patients were men, 70 per cent were aged between 15 and 45 years old, 59 per cent had secondary education, 79 per cent of patients came out cured, the average treatment time for Capreomycin was of 18.42 months, 59 per cent of the sample received treatment for between 12 and 24 months, 15 per cent received treatment from 24 to 42 months, the associated drugs used with more frequency...

An Analysis of Antituberculosis Drug Susceptibility Test Results in Kyung Hee Medical Center During Recent Four years / 대한임상미생물학회지

BACKGROUND: Tuberculosis is still one of the most seriously threatening infections in Korea, because of multidrug resistant tuberculosis. Results of antituberculosis drug susceptibility test can provide clinicians very important informations for selection of proper regimens for treatment. METHODS: In this study the results of antituberculosis drug susceptibility test of 298 cases at Kyunghee Medical Center from 2000 to 2003 were retrospectively analysed to evaluate the trend of antituberculosis drug susceptibility. The procedure of drug susceptibility test was based on the absolute concentration method using Lowenstein-Jensen solid media. RESULTS: The resistance rate of Mycobacterium tuberculosis to one or more drugs was increased from 29.3% in 2000 to 48.2% in 2003, and the rates of multiple resistance to two or more drugs increased from 13.3% in 2000 to 20.5% in 2003. The increase in resistance rate to individual drug during study period were 20.0% to 24.1% in isoniazid, 9.3% to 19.3% in rifampicin, 5.3% to 15.7% in ethambutol, 4.0% to 10.8% in para-aminosalicylic acid, 2.7% to 6.0% in kanamycin, 1.3% to 7.2% in ethionamide, 1.3% to 6.0% in capreomycin, 1.3% to 7.2% in prothionamide, 0.0% to 12.1% in ofloxacin, 6.7%to 3.6% in streptomycin, 6.7% to 7.2% in cycloserine, 10.7% to 8.4% in pyrazinamide, respectively. CONCLUSIONS: The resistance rate of M. tuberculosis has been increased with years and multidrug resistant M. tuberculosis was commonly encountered in the specimens from the patients visited Kyunghee Medical center.