Outcomes and Use of Therapeutic Drug Monitoring in Multidrug-Resistant Tuberculosis Patients Treated in Virginia, 2009-2014 / 결핵및호흡기질환
Tuberculosis and Respiratory Diseases
;
: 78-84, 2015.
Article
in English
| WPRIM
| ID: wpr-78241
ABSTRACT
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.
Full text:
Available
Index:
WPRIM (Western Pacific)
Main subject:
Aminosalicylic Acid
/
Tuberculosis
/
Tuberculosis, Meningeal
/
Capreomycin
/
Pharmacokinetics
/
Amikacin
/
Virginia
/
Retrospective Studies
/
Cohort Studies
/
Drug Monitoring
Type of study:
Etiology study
/
Incidence study
/
Observational study
/
Risk factors
Limits:
Adult
/
Aged
/
Female
/
Humans
Country/Region as subject:
North America
Language:
English
Journal:
Tuberculosis and Respiratory Diseases
Year:
2015
Type:
Article
Similar
MEDLINE
...
LILACS
LIS