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Mebrahtom G, Hailay A, Aberhe W, Zereabruk K, Haile TG, Tadesse DB. Admission and outcomes of COVID-19 among chronic obstructive pulmonary diseases patients in Africa: protocol for a systematic review and meta-analysis. Int Health 2025; 17:245-250. [PMID: 39360405 PMCID: PMC12045080 DOI: 10.1093/inthealth/ihae062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 05/03/2024] [Accepted: 09/18/2024] [Indexed: 10/04/2024] Open
Abstract
When the coronavirus case was originally reported in Wuhan, China, in December 2019, it quickly spread throughout the world and became a global public health problem. Evidence of the admission and outcomes of coronavirus disease among patients with chronic obstructive pulmonary disease (COPD) has not been reported in Africa. Consequently, this research protocol uses a systematic review and meta-analysis of the admission and outcomes of COVID-19 in patients with COPD in Africa. All observational studies published in the English language and reporting on the prevalence, admission and outcomes of COVID-19 among patients with COPD in Africa will be included. A search strategy will be implemented using electronic databases and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocol recommendations. The findings of this review will be reported to health program designers, decision-makers and healthcare providers.
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Affiliation(s)
- Guesh Mebrahtom
- Department of Adult Health Nursing, School of Nursing, College of Health Science, Aksum University, Aksum, Ethiopia
| | - Abrha Hailay
- Department of Adult Health Nursing, School of Nursing, College of Health Science, Aksum University, Aksum, Ethiopia
| | - Woldu Aberhe
- Department of Adult Health Nursing, School of Nursing, College of Health Science, Aksum University, Aksum, Ethiopia
| | - Kidane Zereabruk
- Department of Adult Health Nursing, School of Nursing, College of Health Science, Aksum University, Aksum, Ethiopia
| | - Teklehaimanot Gereziher Haile
- Department of Maternity and Neonatal Nursing, School of Nursing, College of Health Science, Aksum University, Aksum, Ethiopia
| | - Degena Bahrey Tadesse
- Department of Adult Health Nursing, School of Nursing, College of Health Science, Aksum University, Aksum, Ethiopia
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Marais BJ, Coleman M, Larsson L, Kranzer K. Timeliness and value of individual participant data meta-analyses in paediatric tuberculosis research. THE LANCET. CHILD & ADOLESCENT HEALTH 2025; 9:78-79. [PMID: 39855754 DOI: 10.1016/s2352-4642(24)00357-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2024] [Accepted: 12/30/2024] [Indexed: 01/27/2025]
Affiliation(s)
- Ben J Marais
- The Sydney Infectious Diseases Institute, University of Sydney, Sydney, NSW 2145, Australia.
| | - Mikaela Coleman
- The Sydney Infectious Diseases Institute, University of Sydney, Sydney, NSW 2145, Australia; Institute of Infectious Diseases and Tropical Medicine, Ludwig Maximilian University, Munich, Germany; Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Leyla Larsson
- Institute of Infectious Diseases and Tropical Medicine, Ludwig Maximilian University, Munich, Germany; Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK; The Health Research Unit, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Katharina Kranzer
- Institute of Infectious Diseases and Tropical Medicine, Ludwig Maximilian University, Munich, Germany; Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK; The Health Research Unit, Biomedical Research and Training Institute, Harare, Zimbabwe
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Ahmad Khosravi N, Sirous M, Khosravi A, Saki M. A Narrative Review of Bedaquiline and Delamanid: New Arsenals Against Multidrug-Resistant and Extensively Drug-Resistant Mycobacterium tuberculosis. J Clin Lab Anal 2024; 38:e25091. [PMID: 39431709 PMCID: PMC11492330 DOI: 10.1002/jcla.25091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 07/12/2024] [Accepted: 07/30/2024] [Indexed: 10/22/2024] Open
Abstract
BACKGROUND The treatment of multidrug-resistant (MDR-) and extensively drug-resistant tuberculosis (XDR-TB) is a formidable challenge. Treatment of MDR- and XDR-TB using bedaquiline (BDQ) and delamanid (DLM), two newly introduced medications, is steadily increasing. This narrative review aimed to present a concise overview of the existing information regarding BDQ and DLM, and elucidate their antimicrobial characteristics, resistance mechanisms, synergism with other drugs, and side effects. METHODS To collect the required information about the antimicrobial properties, a search for scientific evidence from the Scopus, PubMed, and Embase databases was performed, and all recently published articles up to May 2024 were considered. RESULTS BDQ had potent antimicrobial effects on various types of nontuberculous mycobacteria (NTM), including rapid-growing and slow-growing species, and MDR/XDR Mycobacterium tuberculosis. The mechanisms of BDQ resistance in M. tuberculosis primarily involve mutations in three genes: atpE, mmpR (Rv0678) and pepQ. BDQ may have synergistic effects when combined with DLM, pyrazinamide, and pretomanid/linezolid. BDQ has a low incidence of side effects. The use of BDQ may prolong the QTc interval. Similarly, DLM showed potent antimicrobial effects on NTM and MDR/XDR M. tuberculosis. The main resistance mechanisms to DLM are induced by mutations in fbiA, fbiB, fbiC, fgd1, and ddn genes. The DLM had synergistic effects with BDQ and moxifloxacin. The DLM also has few side effects in some patients including QTc prolongation. CONCLUSION BDQ and DLM are suitable antibiotics with few side effects for the treatment of MDR/XDR-TB. These antibiotics have synergistic effects when combined with other antituberculosis drugs.
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Affiliation(s)
- Nazanin Ahmad Khosravi
- Infectious and Tropical Diseases Research Center, Health Research InstituteAhvaz Jundishapur University of Medical SciencesAhvazIran
- Department of Microbiology, Faculty of MedicineAhvaz Jundishapur University of Medical SciencesAhvazIran
| | - Mehrandokht Sirous
- Department of Microbiology and Parasitology, Faculty of MedicineBushehr University of Medical SciencesBushehrIran
| | - Azar Dokht Khosravi
- Infectious and Tropical Diseases Research Center, Health Research InstituteAhvaz Jundishapur University of Medical SciencesAhvazIran
- Department of Microbiology, Faculty of MedicineAhvaz Jundishapur University of Medical SciencesAhvazIran
| | - Morteza Saki
- Infectious and Tropical Diseases Research Center, Health Research InstituteAhvaz Jundishapur University of Medical SciencesAhvazIran
- Department of Microbiology, Faculty of MedicineAhvaz Jundishapur University of Medical SciencesAhvazIran
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Sun WW, Yang M, Chen XH, Fan LC, Wu HY, Zhang SJ, Chen Y, Fan L. Efficacy and safety of the all-oral bedaquiline-containing regimen as treatment for pediatric multidrug/rifampicin-resistant tuberculosis: a multicenter, retrospective, cohort study. Expert Rev Anti Infect Ther 2024; 22:219-227. [PMID: 37982155 DOI: 10.1080/14787210.2023.2285917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 11/03/2023] [Indexed: 11/21/2023]
Abstract
OBJECTIVE The study aimed to observe the efficacy and safety of an all-oral bedaquiline (BDQ)-containing regimen for pediatric multidrug/rifampicin-resistant tuberculosis (MDR/RR-TB) through a multicenter, retrospective study in China. METHODS In the study, pediatric patients receiving all-oral BDQ-containing regimen (BDQ group) with clinical matched control group were included, the control group received an injection-containing regimen. The treatment outcomes and the incidence of adverse events (AEs) were compared and analyzed. RESULTS 79 pediatric patients were enrolled, including 37 cases in BDQ group and 42 cases in the control group, the median age was 12 {8-16} and 11 {9-15} in both groups respectively. Favorable treatment outcome and cure rate in BDQ group were significantly higher than those in control group (100%vs 83.3%, p 0.03; 94.6%vs 63.3%, p 0.00). Median time of sputum culture conversion in BDQ group was significantly shorter than that in the control group (4 weeks vs 8 weeks, p 0.00). The incidence of AEs in the BDQ group was significantly less than that in the control group (48.6% vs 71.4%, p 0.03). No AEs leading to treatment discontinuation of BDQ occurred. CONCLUSIONS The all-oral BDQ-containing regimens may be effective and safe in the Chinese pediatric population.
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Affiliation(s)
- Wen-Wen Sun
- Department of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai Clinic and Research Center of Tuberculosis, Shanghai Key Laboratory of Tuberculosis, Shanghai, China
| | - Ming Yang
- Department of Tuberculosis, Chengdu Public Health Center, Chengdu, Sichuan Province, China
| | - Xiao-Hong Chen
- Department of Tuberculosis, Fuzhou Pulmonary Hospital, Fuzhou, Fujian Province, China
| | - Li-Chao Fan
- Department of Tuberculosis, Shenyang Tenth People's Hospital, Shenyang Chest Hospital, Shenyang, Liaoning Province, China
| | - Hao-Yu Wu
- Department of Tuberculosis, Shenyang Tenth People's Hospital, Shenyang Chest Hospital, Shenyang, Liaoning Province, China
| | - Shao-Jun Zhang
- Department of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai Clinic and Research Center of Tuberculosis, Shanghai Key Laboratory of Tuberculosis, Shanghai, China
| | - Yu Chen
- Department of Tuberculosis, Shenyang Tenth People's Hospital, Shenyang Chest Hospital, Shenyang, Liaoning Province, China
| | - Lin Fan
- Department of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai Clinic and Research Center of Tuberculosis, Shanghai Key Laboratory of Tuberculosis, Shanghai, China
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Nair A, Greeny A, Nandan A, Sah RK, Jose A, Dyawanapelly S, Junnuthula V, K V A, Sadanandan P. Advanced drug delivery and therapeutic strategies for tuberculosis treatment. J Nanobiotechnology 2023; 21:414. [PMID: 37946240 PMCID: PMC10634178 DOI: 10.1186/s12951-023-02156-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 10/11/2023] [Indexed: 11/12/2023] Open
Abstract
Tuberculosis (TB) remains a significant global health challenge, necessitating innovative approaches for effective treatment. Conventional TB therapy encounters several limitations, including extended treatment duration, drug resistance, patient noncompliance, poor bioavailability, and suboptimal targeting. Advanced drug delivery strategies have emerged as a promising approach to address these challenges. They have the potential to enhance therapeutic outcomes and improve TB patient compliance by providing benefits such as multiple drug encapsulation, sustained release, targeted delivery, reduced dosing frequency, and minimal side effects. This review examines the current landscape of drug delivery strategies for effective TB management, specifically highlighting lipid nanoparticles, polymer nanoparticles, inorganic nanoparticles, emulsion-based systems, carbon nanotubes, graphene, and hydrogels as promising approaches. Furthermore, emerging therapeutic strategies like targeted therapy, long-acting therapeutics, extrapulmonary therapy, phototherapy, and immunotherapy are emphasized. The review also discusses the future trajectory and challenges of developing drug delivery systems for TB. In conclusion, nanomedicine has made substantial progress in addressing the challenges posed by conventional TB drugs. Moreover, by harnessing the unique targeting abilities, extended duration of action, and specificity of advanced therapeutics, innovative solutions are offered that have the potential to revolutionize TB therapy, thereby enhancing treatment outcomes and patient compliance.
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Affiliation(s)
- Ayushi Nair
- Department of Pharmaceutics, Amrita School of Pharmacy, Amrita Vishwa Vidyapeetham, AIMS Health Sciences Campus, Kochi, 682 041, Kerala, India
| | - Alosh Greeny
- Amrita School of Pharmacy, Amrita Vishwa Vidyapeetham, AIMS Health Sciences Campus, Kochi, 682 041, Kerala, India
| | - Amritasree Nandan
- Amrita School of Pharmacy, Amrita Vishwa Vidyapeetham, AIMS Health Sciences Campus, Kochi, 682 041, Kerala, India
| | - Ranjay Kumar Sah
- Amrita School of Pharmacy, Amrita Vishwa Vidyapeetham, AIMS Health Sciences Campus, Kochi, 682 041, Kerala, India
| | - Anju Jose
- Department of Pharmacology, Amrita School of Pharmacy, Amrita Vishwa Vidyapeetham, AIMS Health Sciences Campus, Kochi, 682 041, Kerala, India
| | - Sathish Dyawanapelly
- Department of Pharmaceutical Sciences and Technology, Institute of Chemical Technology, Mumbai, 400019, India
| | | | - Athira K V
- Department of Pharmacology, Amrita School of Pharmacy, Amrita Vishwa Vidyapeetham, AIMS Health Sciences Campus, Kochi, 682 041, Kerala, India.
| | - Prashant Sadanandan
- Department of Pharmaceutical Chemistry, Amrita School of Pharmacy, Amrita Vishwa Vidyapeetham, AIMS Health Sciences Campus, Kochi, 682 041, Kerala, India.
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Abebaw Y, Abebe M, Tola HH, Mehammed Z, Getahun M, Gamtesa DF, Diriba G, Hailu M, Yirgu H, Sheth AN, Argaw R, Abegaz WE. Pulmonary tuberculosis case notification and burden of drug resistance among children under 15 years of age in Ethiopia: sub-analysis from third-round drug resistance tuberculosis survey. BMC Pediatr 2023; 23:418. [PMID: 37620787 PMCID: PMC10463301 DOI: 10.1186/s12887-023-04240-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 08/09/2023] [Indexed: 08/26/2023] Open
Abstract
INTRODUCTION Data on the burden of bacteriologically confirmed childhood Tuberculosis (PTB) and drug-resistant TB in Ethiopia is limited due to difficulties related to its diagnosis in this population. Therefore, this study aimed to assess bacteriologically confirmed childhood PTB Case Notification Rates (CNRs) and the burden of Drug Resistant-Tuberculosis among children in Ethiopia. METHOD Retrospective secondary clinical and laboratory data were obtained from 3rd round national DR-TB survey which was conducted between August 2017 and January 2019. We used IBM SPSS 24 for sub-analysis of 3rd round Drug Resistant-Tuberculosis data. Descriptive statistics were used in computing the association between the sociodemographic characteristics and PTB CNRs, and the strength of the associations was determined using binary logistic regression with Odds ratios (OR) with a 95% confidence interval (CI). RESULT Overall, 102 bacteriologically confirmed childhood PTB cases were identified with a median age of 12 (range 1-14) years. Of these, 54 (52.9%) were females and 81 (79.4%) lived in rural areas. HIV-TB co-infection cases were 5/102 (4.3%) and the majority (98%) of cases were newly diagnosed children. Nationally, the incidence of bacteriologically confirmed childhood PTB was calculated to be 5.1 per 100,000 children. The burden of Drug Resistant-Tuberculosis to at least one of the five first-line anti-TB drugs tested was five (6.5%) cases and one (1.3%) was found to be a Multi-drug resistant tuberculosis case. Drug-resistant tuberculosis was significantly associated with the age group 10-14 years (P = 0.002; [AOR] 29.76; [95% CI, 3.51-252.64]) and children living in urban areas (P = 0.027; [AOR] 5.76; 95% CI, 1.22-27.09). CONCLUSION Bacteriologically confirmed childhood PTB cases increased as the age of the children increased. Most of the bacteriologically confirmed childhood PTB and the identified drug Resistant-Tuberculosis cases were new cases. Also, rural children were more affected by TB than their urban, counterparts Drug Resistant-Tuberculosis was higher in urban resident children.
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Affiliation(s)
- Yeshiwork Abebaw
- Department of Microbiology, Immunology and Parasitology, College of Health Sciences, Addis Ababa University and Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
| | - Markos Abebe
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | | | | | | | | | - Getu Diriba
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Michael Hailu
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | - Anandi Nayan Sheth
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Rahel Argaw
- Department of Pediatrics and Child Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Woldaregay Erku Abegaz
- Department of Microbiology, Immunology and Parasitology, College of Health Sciences, Addis Ababa University and Ethiopian Public Health Institute, Addis Ababa, Ethiopia
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Patankar S, Cruz AT, Douglas-Jones B, Garcia-Prats A, Kay A, Reuter A, Schaaf HS, Seddon JA, Sharma S, Starke J, Tommasi M, Triasih R, Furin JJ. Making the Case for All-Oral, Shorter Regimens for Children with Drug-Resistant Tuberculosis. Am J Respir Crit Care Med 2023; 208:130-131. [PMID: 37276531 PMCID: PMC10395497 DOI: 10.1164/rccm.202304-0670vp] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 06/01/2023] [Indexed: 06/07/2023] Open
Affiliation(s)
- Sayalee Patankar
- College of Arts and Sciences, Harvard University, Cambridge, Massachusetts
| | - Andrea T. Cruz
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Bianca Douglas-Jones
- Faculty of Medicine and Health Sciences, Department of Pediatrics and Child Health, Desmond Tutu TB Centre, Stellenbosch University, Cape Town, South Africa
| | - Anthony Garcia-Prats
- Faculty of Medicine and Health Sciences, Department of Pediatrics and Child Health, Desmond Tutu TB Centre, Stellenbosch University, Cape Town, South Africa
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Alexander Kay
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Anja Reuter
- The Sentinel Project on Pediatric Drug-Resistant Tuberculosis, Cape Town, South Africa
| | - H. Simon Schaaf
- Faculty of Medicine and Health Sciences, Department of Pediatrics and Child Health, Desmond Tutu TB Centre, Stellenbosch University, Cape Town, South Africa
| | - James A. Seddon
- Faculty of Medicine and Health Sciences, Department of Pediatrics and Child Health, Desmond Tutu TB Centre, Stellenbosch University, Cape Town, South Africa
- Department of Infectious Disease, Imperial College London, London, United Kingdom
| | - Sangeeta Sharma
- Department of Pediatrics, National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
| | - Jeffrey Starke
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Marcela Tommasi
- The Sentinel Project on Pediatric Drug-Resistant Tuberculosis, Maputo, Mozambique
| | - Rina Triasih
- Department of Child Health, Faculty of Medicine, Public Health, and Nursing, Dr. Sardjito Hospital, Universitas Gadjah Mada, Yogyakarta, Indonesia; and
| | - Jennifer J. Furin
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
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Zhu H, Zhou X, Zhuang Z, Li L, Bi J, Mi K. Advances of new drugs bedaquiline and delamanid in the treatment of multi-drug resistant tuberculosis in children. Front Cell Infect Microbiol 2023; 13:1183597. [PMID: 37384221 PMCID: PMC10293792 DOI: 10.3389/fcimb.2023.1183597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 05/30/2023] [Indexed: 06/30/2023] Open
Abstract
Tuberculosis (TB) is a major public health problem, with nearly 10 million new cases and millions of deaths each year. Around 10% of these cases are in children, but only a fraction receive proper diagnosis and treatment. The spread of drug-resistant (DR) strain of TB has made it difficult to control, with only 60% of patients responding to treatment. Multi-drug resistant TB (MDR-TB) is often undiagnosed in children due to lack of awareness or under-diagnosis, and the target for children's DR-TB treatment has only been met in 15% of goals. New medications such as bedaquiline and delamanid have been approved for treating DR-TB. However, due to age and weight differences, adults and children require different dosages. The availability of child-friendly formulations is limited by a lack of clinical data in children. This paper reviews the development history of these drugs, their mechanism of action, efficacy, safety potential problems and current use in treating DR-TB in children.
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Affiliation(s)
- Hanzhao Zhu
- Chinese Academy of Science (CAS) Key Laboratory of Pathogen Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China
- Savaid Medical School, University of Chinese Academy of Sciences, Beijing, China
| | - Xintong Zhou
- Chinese Academy of Science (CAS) Key Laboratory of Pathogen Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China
| | - Zengfang Zhuang
- Chinese Academy of Science (CAS) Key Laboratory of Pathogen Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China
- Savaid Medical School, University of Chinese Academy of Sciences, Beijing, China
| | - Lianju Li
- Chinese Academy of Science (CAS) Key Laboratory of Pathogen Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China
- School of Basic Medicine, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Jing Bi
- Baoding Hospital of Beijing Children’s Hospital, Capital Medical University, Baoding Key Laboratory for Precision Diagnosis and Treatment of Infectious Diseases in Children, Baoding, China
| | - Kaixia Mi
- Chinese Academy of Science (CAS) Key Laboratory of Pathogen Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China
- Savaid Medical School, University of Chinese Academy of Sciences, Beijing, China
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Litjens CHC, Verscheijden LFM, Svensson EM, van den Broek PHH, van Hove H, Koenderink JB, Russel FGM, Aarnoutse RE, te Brake LHM. Physiologically-Based Pharmacokinetic Modelling to Predict the Pharmacokinetics and Pharmacodynamics of Linezolid in Adults and Children with Tuberculous Meningitis. Antibiotics (Basel) 2023; 12:antibiotics12040702. [PMID: 37107064 PMCID: PMC10135070 DOI: 10.3390/antibiotics12040702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 03/23/2023] [Accepted: 03/30/2023] [Indexed: 04/07/2023] Open
Abstract
Linezolid is used off-label for treatment of central nervous system infections. However, its pharmacokinetics and target attainment in cranial cerebrospinal fluid (CSF) in tuberculous meningitis patients is unknown. This study aimed to predict linezolid cranial CSF concentrations and assess attainment of pharmacodynamic (PD) thresholds (AUC:MIC of >119) in plasma and cranial CSF of adults and children with tuberculous meningitis. A physiologically based pharmacokinetic (PBPK) model was developed to predict linezolid cranial CSF profiles based on reported plasma concentrations. Simulated steady-state PK curves in plasma and cranial CSF after linezolid doses of 300 mg BID, 600 mg BID, and 1200 mg QD in adults resulted in geometric mean AUC:MIC ratios in plasma of 118, 281, and 262 and mean cranial CSF AUC:MIC ratios of 74, 181, and 166, respectively. In children using ~10 mg/kg BID linezolid, AUC:MIC values at steady-state in plasma and cranial CSF were 202 and 135, respectively. Our model predicts that 1200 mg per day in adults, either 600 mg BID or 1200 mg QD, results in reasonable (87%) target attainment in cranial CSF. Target attainment in our simulated paediatric population was moderate (56% in cranial CSF). Our PBPK model can support linezolid dose optimization efforts by simulating target attainment close to the site of TBM disease.
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Affiliation(s)
- Carlijn H. C. Litjens
- Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
- Department of Pharmacology and Toxicology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Laurens F. M. Verscheijden
- Department of Pharmacology and Toxicology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Elin M. Svensson
- Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
- Department of Pharmacy, Uppsala University, 75123 Uppsala, Sweden
| | - Petra H. H. van den Broek
- Department of Pharmacology and Toxicology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Hedwig van Hove
- Department of Pharmacology and Toxicology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Jan B. Koenderink
- Department of Pharmacology and Toxicology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Frans G. M. Russel
- Department of Pharmacology and Toxicology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Rob E. Aarnoutse
- Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Lindsey H. M. te Brake
- Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
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Pediatric Tuberculosis Management: A Global Challenge or Breakthrough? CHILDREN 2022; 9:children9081120. [PMID: 36010011 PMCID: PMC9406656 DOI: 10.3390/children9081120] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/19/2022] [Accepted: 07/23/2022] [Indexed: 12/17/2022]
Abstract
Managing pediatric tuberculosis (TB) remains a public health problem requiring urgent and long-lasting solutions as TB is one of the top ten causes of ill health and death in children as well as adolescents universally. Minors are particularly susceptible to this severe illness that can be fatal post-infection or even serve as reservoirs for future disease outbreaks. However, pediatric TB is the least prioritized in most health programs and optimal infection/disease control has been quite neglected for this specialized patient category, as most scientific and clinical research efforts focus on developing novel management strategies for adults. Moreover, the ongoing coronavirus pandemic has meaningfully hindered the gains and progress achieved with TB prophylaxis, therapy, diagnosis, and global eradication goals for all affected persons of varying age bands. Thus, the opening of novel research activities and opportunities that can provide more insight and create new knowledge specifically geared towards managing TB disease in this specialized group will significantly improve their well-being and longevity.
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11
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Wu HY, Tian Y, Wang XD, Sun JS, Fan LC, Chen MX, Li R, Chen Y. Twenty-four-week interim outcomes of bedaquiline-containing regimens in treatment of adolescents with rifampicin-resistant tuberculosis: A retrospective cohort study in China. J Paediatr Child Health 2022; 58:116-121. [PMID: 34323328 DOI: 10.1111/jpc.15672] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/19/2021] [Accepted: 07/21/2021] [Indexed: 12/23/2022]
Abstract
AIM To evaluate the 24-week interim outcomes of bedaquiline-containing regimens in the treatment of adolescents with rifampicin-resistant tuberculosis (RR-TB) in China. METHODS Adolescents with RR-TB from two hospitals were included in this retrospective study. All patients received the longer regimen containing bedaquiline. Sputum culture, chest computed tomography, blood tests and electrocardiography were performed regularly, and the outcomes after 24 weeks of treatment were reported. RESULTS Four male and six female adolescents aged 11 to 17 years old were included. Among them, four (40.0%), four (40.0%) and two (20.0%) were confirmed to have RR-TB, multidrug-resistant TB and extensively drug-resistant TB, respectively. The most common companion drugs included linezolid (100.0%), cycloserine (90.0%), pyrazinamide (80.0%), moxifloxacin (50.0%) and levofloxacin (40.0%). Culture conversion rates of 80.0%, 100.0% and 100.0% were observed at weeks 2, 4 and 24, respectively. The mean maximum drug concentration of bedaquiline at weeks 2, 12 and 24 was 3.29 ± 0.66, 1.78 ± 0.81 and 1.93 ± 0.74 μg/mL, respectively. Six adverse events including leukopenia (50.0%), Fridericia-corrected QT (QTcF) interval prolongation (16.7%), anaemia (16.7%) and peripheral neuropathy (16.7%) were observed in five (50.0%) patients. No patient discontinued bedaquiline owing to QTcF interval prolongation. Meanwhile, no deaths, reversions or serious adverse events were reported during 24 weeks of treatment. CONCLUSION A longer regimen containing bedaquiline was effective and well tolerated in Chinese adolescents with RR-TB. The combination of bedaquiline and linezolid may be a favourable choice for this population.
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Affiliation(s)
- Hao-Yu Wu
- Department of Tuberculosis, Shenyang Tenth People's Hospital (Shenyang Chest Hospital), Shenyang, China
| | - Yao Tian
- Department of Tuberculosis, Shenyang Tenth People's Hospital (Shenyang Chest Hospital), Shenyang, China
| | - Xiao-Dan Wang
- Department of Tuberculosis, Shenyang Tenth People's Hospital (Shenyang Chest Hospital), Shenyang, China
| | - Ji-Si Sun
- Department of Tuberculosis, Changchun Infectious Disease Hospital, Changchun, China
| | - Li-Chao Fan
- Department of Tuberculosis, Shenyang Tenth People's Hospital (Shenyang Chest Hospital), Shenyang, China
| | - Mo-Xin Chen
- Department of Tuberculosis, Shenyang Tenth People's Hospital (Shenyang Chest Hospital), Shenyang, China
| | - Ran Li
- Department of Tuberculosis, Shenyang Tenth People's Hospital (Shenyang Chest Hospital), Shenyang, China
| | - Yu Chen
- Department of Tuberculosis, Shenyang Tenth People's Hospital (Shenyang Chest Hospital), Shenyang, China
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12
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Nataprawira HM, Septiane I, Sudarwati S, Wulandari DA. Two cases of pre-extensively drug resistant tuberculosis in children in Indonesia. Respir Med Case Rep 2021; 34:101544. [PMID: 34824970 PMCID: PMC8605226 DOI: 10.1016/j.rmcr.2021.101544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 05/18/2021] [Accepted: 11/07/2021] [Indexed: 11/16/2022] Open
Abstract
Few reports are available on children with pre-extensively drug-resistant tuberculosis (pre-XDR-TB), which is defined as Mycobacterium tuberculosis resistant to both isoniazid and rifampicin plus resistance to either a fluoroquinolone or a second-line injectable drug. Pre-XDR-TB treatment for children usually has been individualized based on drug susceptibility test (DST) results, but treatment remains challenging due to the lack of studies based on existing treatment guidelines in children and lack of availability of the new drugs. We report two cases of pre-XDR-TB in children who have responded well to individualized treatment regimens. Because toxic drugs are used for long duration, close monitoring of adverse drug reactions is important.
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Affiliation(s)
- Heda Melinda Nataprawira
- Department of Child Health, Hasan Sadikin General Hospital/Faculty of Medicine, Universitas Padjadjaran, Indonesia
| | - Indah Septiane
- Department of Child Health, Hasan Sadikin General Hospital/Faculty of Medicine, Universitas Padjadjaran, Indonesia
| | - Sri Sudarwati
- Department of Child Health, Hasan Sadikin General Hospital/Faculty of Medicine, Universitas Padjadjaran, Indonesia
| | - Diah Asri Wulandari
- Department of Child Health, Hasan Sadikin General Hospital/Faculty of Medicine, Universitas Padjadjaran, Indonesia
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13
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Moodliar R, Aksenova V, Frias MVG, van de Logt J, Rossenu S, Birmingham E, Zhuo S, Mao G, Lounis N, Kambili C, Bakare N. Bedaquiline for multidrug-resistant TB in paediatric patients. Int J Tuberc Lung Dis 2021; 25:716-724. [PMID: 34802493 PMCID: PMC8412106 DOI: 10.5588/ijtld.21.0022] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND: TMC207-C211 (NCT02354014) is a Phase 2, open-label, multicentre, single-arm study to evaluate pharmacokinetics, safety/tolerability, antimycobacterial activity and dose selection of bedaquiline (BDQ) in children (birth to <18 years) with multidrug-resistant-TB (MDR-TB). METHODS: Patients received 24 weeks’ BDQ with an anti-MDR-TB background regimen (BR), followed by 96 weeks of safety follow-up. Results of the primary analysis are presented based on data up to 24 weeks for Cohort 1 (≥12–<18 years; approved adult tablet at the adult dosage) and Cohort 2 (≥5–<12 years; age-appropriate 20 mg tablet at half the adult dosage). RESULTS: Both cohorts had 15 patients, of whom respectively 53% and 40% of Cohort 1 and Cohort 2 children had confirmed/probable pulmonary MDR-TB. Most patients completed 24 weeks’ BDQ/BR treatment (Cohort 1: 93%; Cohort 2: 67%). Geometric mean BDQ area under the curve 168h values of 119,000 ng.h/mL (Cohort 1) and 118,000 ng.h/mL (Cohort 2) at Week 12 were within 60–140% (86,200–201,000 ng.h/mL) of adult target values. Few adverse event (AE) related discontinuations or serious AEs, andnoQTcF >460 ms during BDQ/BR treatment or deaths occurred. Of MGIT-evaluable patients, 6/8 (75%) Cohort 1 and 3/3 (100%) Cohort 2 culture converted. CONCLUSION: In children and adolescents aged ≥5–<18 years with MDR-TB, including pre-extensively drug-resistant-TB (pre-XDR-TB) or XDR-TB, 24 weeks of BDQ provided a comparable pharmacokinetic and safety profile to adults.
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Affiliation(s)
- R Moodliar
- Tuberculosis and HIV Investigative Network, King Dinuzulu Hospital, Sydenham, Durban, South Africa
| | - V Aksenova
- National Medical Research Center for Phthisiopulmonology and Infectious Diseases, Moscow, Russian Federation
| | - M V G Frias
- De La Salle Health Sciences Institute, Dasmariñas City, Cavite, the Philippines
| | - J van de Logt
- Janssen Research & Development, Leiden, The Netherlands
| | - S Rossenu
- Janssen Pharmaceutica, Beerse, Belgium
| | | | - S Zhuo
- Janssen Research & Development, Titusville, NJ, IQVIA, NC
| | - G Mao
- Janssen Research & Development, Titusville, NJ
| | - N Lounis
- Janssen Pharmaceutica, Beerse, Belgium
| | - C Kambili
- Johnson & Johnson Global Public Health, New Brunswick, NJ, USA
| | - N Bakare
- Janssen Research & Development, Titusville, NJ
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14
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Cameron LH, Peloquin CA, Hiatt P, Mann M, Starke JR, Faircloth J, McNeil JC, Patel A, Ruiz F. Administration and monitoring of clofazimine for NTM infections in children with and without cystic fibrosis. J Cyst Fibros 2021; 21:348-352. [PMID: 34479810 DOI: 10.1016/j.jcf.2021.08.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 06/30/2021] [Accepted: 08/13/2021] [Indexed: 11/30/2022]
Abstract
Few studies have evaluated clofazimine (CLOF) drug monitoring and safety in children. We treated 10 children, 8 with CF, for NTM infection with multiple antimicrobials, including CLOF. All had serial blood CLOF concentrations measured and were followed for adverse events. Despite CLOF dose escalation, most children with CF did not reach a target CLOF concentration. Our data suggest that children with CF may require earlier initiation of CLOF at higher doses than is currently recommended.
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Affiliation(s)
- L H Cameron
- Baylor College of Medicine, Department of Pediatrics, United States; Section of Pediatric Infectious Diseases, United States.
| | - C A Peloquin
- University of Florida, Department of Pharmacy, United States
| | - P Hiatt
- Baylor College of Medicine, Department of Pediatrics, United States; Section of Pediatric Pulmonology, United States
| | - M Mann
- Baylor College of Medicine, Department of Pediatrics, United States; Section of Pediatric Pulmonology, United States
| | - J R Starke
- Baylor College of Medicine, Department of Pediatrics, United States; Section of Pediatric Infectious Diseases, United States
| | - J Faircloth
- Section of Pediatric Pulmonology, United States; Texas Children's Hospital, Department of Pharmacy, United States
| | - J C McNeil
- Baylor College of Medicine, Department of Pediatrics, United States; Section of Pediatric Infectious Diseases, United States
| | - A Patel
- Baylor College of Medicine, Department of Pediatrics, United States; Section of Pediatric Pulmonology, United States
| | - F Ruiz
- Baylor College of Medicine, Department of Pediatrics, United States; Section of Pediatric Pulmonology, United States
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15
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Summary for Clinicians: 2019 Clinical Practice Guideline Summary for the Treatment of Drug-Resistant Tuberculosis. Ann Am Thorac Soc 2021; 17:911-917. [PMID: 32464069 DOI: 10.1513/annalsats.202004-318cme] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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16
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Chan WYK, Ho PL, To KKW, Lam AYL, Ho KWY, Lau TW, So NLW, Ha SY. A child with acute myeloid leukemia complicated by calcaneal osteomyelitis due to Mycobacterium abscessus infection after induction chemotherapy successfully salvaged with bedaquiline and clofazimine. Int J Infect Dis 2021; 103:9-12. [DOI: 10.1016/j.ijid.2020.10.102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 10/29/2020] [Accepted: 10/30/2020] [Indexed: 11/28/2022] Open
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17
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Seddon JA, Johnson S, Palmer M, van der Zalm MM, Lopez-Varela E, Hughes J, Schaaf HS. Multidrug-resistant tuberculosis in children and adolescents: current strategies for prevention and treatment. Expert Rev Respir Med 2020; 15:221-237. [PMID: 32965141 DOI: 10.1080/17476348.2021.1828069] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
INTRODUCTION An estimated 30,000 children develop multidrug-resistant (MDR) tuberculosis (TB) each year, with only a small proportion diagnosed and treated. This field has historically been neglected due to the perception that children with MDR-TB are challenging to diagnose and treat. Diagnostic and therapeutic developments in adults have improved pediatric management, yet further pediatric-specific research and wider implementation of evidence-based practices are required. AREAS COVERED This review combines the most recent data with expert opinion to highlight best practice in the evaluation, diagnosis, treatment, and support of children and adolescents with MDR-TB disease. A literature search of PubMed was carried out on topics related to MDR-TB in children. This review provides practical advice on MDR-TB prevention and gives updates on new regimens and novel treatments. The review also addresses host-directed therapy, comorbid conditions, special populations, psychosocial support, and post-TB morbidity, as well as identifying outstanding research questions. EXPERT OPINION Increased availability of molecular diagnostics has the potential to aid with the diagnosis of MDR-TB in children. Shorter MDR-TB disease treatment regimens have made therapy safer and shorter and further developments with novel agents and repurposed drugs should lead to additional improvements. The evidence base for MDR-TB preventive therapy is increasing.
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Affiliation(s)
- James A Seddon
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University , Stellenbosch, South Africa.,Section of Paediatric Infectious Diseases, Department of Infectious Diseases, Imperial College London , London, UK
| | - Sarah Johnson
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University , Stellenbosch, South Africa.,Section of Paediatric Infectious Diseases, Department of Infectious Diseases, Imperial College London , London, UK
| | - Megan Palmer
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University , Stellenbosch, South Africa
| | - Marieke M van der Zalm
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University , Stellenbosch, South Africa
| | - Elisa Lopez-Varela
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University , Stellenbosch, South Africa.,ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic - Universitat De Barcelona , Barcelona, Spain
| | - Jennifer Hughes
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University , Stellenbosch, South Africa
| | - H Simon Schaaf
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University , Stellenbosch, South Africa
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18
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Potential anti-TB investigational compounds and drugs with repurposing potential in TB therapy: a conspectus. Appl Microbiol Biotechnol 2020; 104:5633-5662. [PMID: 32372202 DOI: 10.1007/s00253-020-10606-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 03/27/2020] [Accepted: 04/05/2020] [Indexed: 02/07/2023]
Abstract
The latest WHO report estimates about 1.6 million global deaths annually from TB, which is further exacerbated by drug-resistant (DR) TB and comorbidities with diabetes and HIV. Exiguous dosing, incomplete treatment course, and the ability of the tuberculosis bacilli to tolerate and survive current first-line and second-line anti-TB drugs, in either their latent state or active state, has resulted in an increased prevalence of multidrug-resistant (MDR), extensively drug-resistant (XDR), and totally drug-resistant TB (TDR-TB). Although a better understanding of the TB microanatomy, genome, transcriptome, proteome, and metabolome, has resulted in the discovery of a few novel promising anti-TB drug targets and diagnostic biomarkers of late, no new anti-TB drug candidates have been approved for routine therapy in over 50 years, with only bedaquiline, delamanid, and pretomanid recently receiving tentative regulatory approval. Considering this, alternative approaches for identifying possible new anti-TB drug candidates, for effectively eradicating both replicating and non-replicating Mycobacterium tuberculosis, are still urgently required. Subsequently, several antibiotic and non-antibiotic drugs with known treatment indications (TB targeted and non-TB targeted) are now being repurposed and/or derivatized as novel antibiotics for possible use in TB therapy. Insights gathered here reveal that more studies focused on drug-drug interactions between licensed and potential lead anti-TB drug candidates need to be prioritized. This write-up encapsulates the most recent findings regarding investigational compounds with promising anti-TB potential and drugs with repurposing potential in TB therapy.
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19
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Pierson E, Haufroid M, Gosain TP, Chopra P, Singh R, Wouters J. Identification and Repurposing of Trisubstituted Harmine Derivatives as Novel Inhibitors of Mycobacterium tuberculosis Phosphoserine Phosphatase. Molecules 2020; 25:E415. [PMID: 31963843 PMCID: PMC7024313 DOI: 10.3390/molecules25020415] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 01/14/2020] [Accepted: 01/15/2020] [Indexed: 12/12/2022] Open
Abstract
Mycobacterium tuberculosis is still the deadliest bacterial pathogen worldwide and the increasing number of multidrug-resistant tuberculosis cases further complicates this global health issue. M. tuberculosis phosphoserine phosphatase SerB2 is a promising target for drug design. Besides being a key essential metabolic enzyme of the pathogen's serine pathway, it appears to be involved in immune evasion mechanisms. In this work, a malachite green-based phosphatase assay has been used to screen 122 compounds from an internal chemolibrary. Trisubstituted harmine derivatives were found among the best hits that inhibited SerB2 activity. Synthesis of an original compound helped to discuss a brief structure activity relationship evaluation. Kinetics experiments showed that the most potent derivatives inhibit the phosphatase in a parabolic competitive fashion with apparent inhibition constants ( K i ) values in the micromolar range. Their interaction modes with the enzyme were investigated through induced fit docking experiments, leading to results consistent with the experimental data. Cellular assays showed that the selected compounds also inhibited M. tuberculosis growth in vitro. Those promising results may provide a basis for the development of new antimycobacterial agents targeting SerB2.
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Affiliation(s)
- Elise Pierson
- Laboratoire de Chimie Biologique Structurale (CBS), Namur Medicine and Drug Innovation Center (NAMEDIC), Namur Research Institute for Life Sciences (NARILIS), University of Namur (UNamur), B-5000 Namur, Belgium
| | - Marie Haufroid
- Laboratoire de Chimie Biologique Structurale (CBS), Namur Medicine and Drug Innovation Center (NAMEDIC), Namur Research Institute for Life Sciences (NARILIS), University of Namur (UNamur), B-5000 Namur, Belgium
| | - Tannu Priya Gosain
- Tuberculosis Research Laboratory, Translational Health Science and Technology Institute, Faridabad 121001, Haryana, India
| | - Pankaj Chopra
- Tuberculosis Research Laboratory, Translational Health Science and Technology Institute, Faridabad 121001, Haryana, India
| | - Ramandeep Singh
- Tuberculosis Research Laboratory, Translational Health Science and Technology Institute, Faridabad 121001, Haryana, India
| | - Johan Wouters
- Laboratoire de Chimie Biologique Structurale (CBS), Namur Medicine and Drug Innovation Center (NAMEDIC), Namur Research Institute for Life Sciences (NARILIS), University of Namur (UNamur), B-5000 Namur, Belgium
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20
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Soman R, Singhal T, Shetty A, Rodrigues C. For drug resistant (DR) TB is there any strength in the old warriors yet? Indian J Tuberc 2019; 66:496-498. [PMID: 31813438 DOI: 10.1016/j.ijtb.2019.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 03/18/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Rajeev Soman
- Infectious Disease Specialist, Jupiter Hospital, Pune, India
| | - Tanu Singhal
- Consultant- Paediatrics and Infectious Disease, Kokilaben Dhirubhai Ambani Hospital & MRC, Andheri, Mumbai, India
| | - Anjali Shetty
- P. D. Hinduja Hospital & Medical Research Centre, Dept. of Microbiology, Veer Sarvarkar Marg, Mahim, Mumbai, India
| | - Camilla Rodrigues
- P. D. Hinduja Hospital & Medical Research Centre, Dept. of Microbiology, Veer Sarvarkar Marg, Mahim, Mumbai, India.
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22
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Nahid P, Mase SR, Migliori GB, Sotgiu G, Bothamley GH, Brozek JL, Cattamanchi A, Cegielski JP, Chen L, Daley CL, Dalton TL, Duarte R, Fregonese F, Horsburgh CR, Ahmad Khan F, Kheir F, Lan Z, Lardizabal A, Lauzardo M, Mangan JM, Marks SM, McKenna L, Menzies D, Mitnick CD, Nilsen DM, Parvez F, Peloquin CA, Raftery A, Schaaf HS, Shah NS, Starke JR, Wilson JW, Wortham JM, Chorba T, Seaworth B. Treatment of Drug-Resistant Tuberculosis. An Official ATS/CDC/ERS/IDSA Clinical Practice Guideline. Am J Respir Crit Care Med 2019; 200:e93-e142. [PMID: 31729908 PMCID: PMC6857485 DOI: 10.1164/rccm.201909-1874st] [Citation(s) in RCA: 270] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background: The American Thoracic Society, U.S. Centers for Disease Control and Prevention, European Respiratory Society, and Infectious Diseases Society of America jointly sponsored this new practice guideline on the treatment of drug-resistant tuberculosis (DR-TB). The document includes recommendations on the treatment of multidrug-resistant TB (MDR-TB) as well as isoniazid-resistant but rifampin-susceptible TB.Methods: Published systematic reviews, meta-analyses, and a new individual patient data meta-analysis from 12,030 patients, in 50 studies, across 25 countries with confirmed pulmonary rifampin-resistant TB were used for this guideline. Meta-analytic approaches included propensity score matching to reduce confounding. Each recommendation was discussed by an expert committee, screened for conflicts of interest, according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology.Results: Twenty-one Population, Intervention, Comparator, and Outcomes questions were addressed, generating 25 GRADE-based recommendations. Certainty in the evidence was judged to be very low, because the data came from observational studies with significant loss to follow-up and imbalance in background regimens between comparator groups. Good practices in the management of MDR-TB are described. On the basis of the evidence review, a clinical strategy tool for building a treatment regimen for MDR-TB is also provided.Conclusions: New recommendations are made for the choice and number of drugs in a regimen, the duration of intensive and continuation phases, and the role of injectable drugs for MDR-TB. On the basis of these recommendations, an effective all-oral regimen for MDR-TB can be assembled. Recommendations are also provided on the role of surgery in treatment of MDR-TB and for treatment of contacts exposed to MDR-TB and treatment of isoniazid-resistant TB.
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23
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Zhang Z, Cheng Z, Liu Q, Shang T, Jiang L, Fu Z, Zhu K, Wang X, Chen J, Xu H. Safety of longer linezolid regimen in children with drug-resistant tuberculosis and extensive tuberculosis in Southwest China. J Glob Antimicrob Resist 2019; 21:375-379. [PMID: 31593796 DOI: 10.1016/j.jgar.2019.09.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 09/12/2019] [Accepted: 09/27/2019] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVES Linezolid (LNZ) has recently been listed by the World Health Organization (WHO) as a Group A agent for the treatment of multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) in longer regimens (18-20 months). However, little is known about the safety of LNZ in longer TB treatment regimens in children. METHODS Here we report 31 children who received LNZ treatment for drug-resistant tuberculosis (DR-TB) and extensive tuberculosis in the Children's Hospital of Chongqing Medical University, China, during September 2016 to March 2019. The mean duration of LNZ treatment was 8.56 months (range, 1-24 months). RESULTS Of the 31 patients, 13 (42%) had suspected or confirmed adverse events (AEs) related to LNZ treatment, including digestive symptoms, haematological toxicity, neuropathy and lactic acidosis. Haematological toxicity was the most frequent AE, presenting as leukopenia (9/13) and anaemia (5/13). No hepatotoxicity or nephrotoxicity was observed. Two patients suffered from life-threatening lactic acidosis when the LNZ dose was increased to 1.2 g daily, however they recovered following LNZ withdrawal. CONCLUSION A high rate of AEs of LNZ treatment was observed in children receiving a longer regimen, which might relate to the treatment course and dose. Haematological toxicity was the most frequent AE in children. It is necessary to regularly monitor the blood chemistry and lactic acid concentration during LNZ treatment.
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Affiliation(s)
- ZhenZhen Zhang
- Department of Infectious Diseases, Children's Hospital of Chongqing Medical University, Chongqing, China; Ministry of Education Key Laboratory of Child Development and Disorders, Key Laboratory of Pediatrics in Chongqing, Chongqing, China
| | - ZhenLi Cheng
- Department of Cardiology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - QuanBo Liu
- Department of Infectious Diseases, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - TingTing Shang
- Department of Infectious Diseases, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Li Jiang
- Department of Infectious Diseases, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Zhou Fu
- Department of Respiratory Diseases, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Kun Zhu
- Department of Radiology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Xiao Wang
- Department of Infectious Diseases, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Juan Chen
- Department of Infectious Diseases, Children's Hospital of Chongqing Medical University, Chongqing, China; The Key Laboratory of Molecular Biology of Infectious Diseases Designated by the Chinese Ministry of Education, Chongqing, China
| | - HongMei Xu
- Department of Infectious Diseases, Children's Hospital of Chongqing Medical University, Chongqing, China; Ministry of Education Key Laboratory of Child Development and Disorders, Key Laboratory of Pediatrics in Chongqing, Chongqing, China.
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Reuter A, Hughes J, Furin J. Challenges and controversies in childhood tuberculosis. Lancet 2019; 394:967-978. [PMID: 31526740 DOI: 10.1016/s0140-6736(19)32045-8] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 07/29/2019] [Accepted: 08/06/2019] [Indexed: 01/03/2023]
Abstract
Children bear a substantial burden of suffering when it comes to tuberculosis. Ironically, they are often left out of the scientific and public health advances that have led to important improvements in tuberculosis diagnosis, treatment, and prevention over the past decade. This Series paper describes some of the challenges and controversies in paediatric tuberculosis, including the epidemiology and treatment of tuberculosis in children. Two areas in which substantial challenges and controversies exist (ie, diagnosis and prevention) are explored in more detail. This Series paper also offers possible solutions for including children in all efforts to end tuberculosis, with a focus on ensuring that the proper financial and human resources are in place to best serve children exposed to, infected with, and sick from all forms of tuberculosis.
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Affiliation(s)
- Anja Reuter
- Médecins Sans Frontières, Khayelitsha, South Africa
| | - Jennifer Hughes
- Desmond Tutu Tuberculosis Center, Stellenbosch University, Stellenbosch, South Africa
| | - Jennifer Furin
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
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Newer Drugs for Tuberculosis Prevention and Treatment in Children. Indian J Pediatr 2019; 86:725-731. [PMID: 30707347 DOI: 10.1007/s12098-018-02854-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 12/26/2018] [Indexed: 01/01/2023]
Abstract
Children suffer a huge and often an unrecognized burden of tuberculosis (TB) in endemic countries like India. Better data have improved the visibility of childhood TB, but the establishment of functional TB prevention and treatment programs for children remains challenging. Barriers to TB prevention include: 1) non-implementation of existing guidelines, 2) perceived inability to rule out active TB with fear of creating drug resistance and 3) limited local guidance on the use of preventive therapy after close contact with drug resistant TB. Barriers to TB treatment include: 1) diagnostic challenges in resource-limited settings, 2) presentation to maternal and child health (MCH) services with poor linkage to the TB control program and 3) limited local guidance on the treatment of children with likely drug resistant TB. The authors provide an overview of newer drugs used for TB prevention and treatment in children. They discuss new options for the treatment of latent TB infection (LTBI) and new or repurposed drugs used in the treatment of children with multidrug resistant (MDR)-TB. The background information provided describes the benefits, risks and feasibility of various treatment options, which should assist treatment decisions until updated World Health Organization (WHO) guidance becomes available.
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Bahuguna A, Rawat DS. An overview of new antitubercular drugs, drug candidates, and their targets. Med Res Rev 2019; 40:263-292. [PMID: 31254295 DOI: 10.1002/med.21602] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 05/16/2019] [Accepted: 05/17/2019] [Indexed: 12/15/2022]
Abstract
The causative agent of tuberculosis (TB), Mycobacterium tuberculosis and more recently totally drug-resistant strains of M. tuberculosis, display unique mechanisms to survive in the host. A four-drug treatment regimen was introduced 40 years ago but the emergence of multidrug-resistance and more recently TDR necessitates the identification of new targets and drugs for the cure of M. tuberculosis infection. The current efforts in the drug development process are insufficient to completely eradicate the TB epidemic. For almost five decades the TB drug development process remained stagnant. The last 10 years have made sudden progress giving some new and highly promising drugs including bedaquiline, delamanid, and pretomanid. Many of the candidates are repurposed compounds, which were developed to treat other infections but later, exhibited anti-TB properties also. Each class of drug has a specific target and a definite mode of action. These targets are either involved in cell wall biosynthesis, protein synthesis, DNA/RNA synthesis, or metabolism. This review discusses recent progress in the discovery of newly developed and Food and Drug Administration approved drugs as well as repurposed drugs, their targets, mode of action, drug-target interactions, and their structure-activity relationship.
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Affiliation(s)
| | - Diwan S Rawat
- Department of Chemistry, University of Delhi, Delhi, India
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Tucker EW, Dooley KE. Preclinical tools for the evaluation of tuberculosis treatment regimens for children. Int J Tuberc Lung Dis 2019; 22:7-14. [PMID: 29665948 DOI: 10.5588/ijtld.17.0354] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Tuberculosis (TB) treatment regimens have been extrapolated from adults to children. However, pediatric disease merits different treatment strategies to avoid under- or over-treatment. While animal models have been pivotal in identifying effective regimens for adult disease, pediatric TB is heterogeneous and cannot be represented by a single preclinical model. Infants and young children most commonly have disseminated disease or tuberculous meningitis (TBM), school-aged children have paucibacillary disease, and adolescents have adult-like cavitary lung disease. Models simulating these forms of pediatric TB have been developed, but their utility in assessing treatment regimens is in the early stages. Disseminated, intracellular disease can be partly reproduced by an in vitro pharmacodynamic system, TBM by a pediatric rabbit model of TBM, paucibacillary TB by the balbC mouse model, and cavitary disease by a rabbit model and a C3HeB/FeJ mouse model of pulmonary TB. Although there is no one-size-fits-all preclinical 'pediatric TB model', these models can be employed to study drug distribution to the sites of disease and, coupled with translational modeling, used to help select and optimize regimens for testing in children. Use of these models may accelerate the development of regimens for rare or hard-to-treat TB, namely drug-resistant TB and TBM.
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Affiliation(s)
- E W Tucker
- Department of Anesthesiology and Critical Care Medicine, Division of Pediatric Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, Division of Pediatric Critical Care, Johns Hopkins All Children's Hospital, St Petersburg, Florida
| | - K E Dooley
- Department of Medicine, Division of Clinical Pharmacology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Matucci T, Galli L, de Martino M, Chiappini E. Treating children with tuberculosis: new weapons for an old enemy. J Chemother 2019; 31:227-245. [DOI: 10.1080/1120009x.2019.1598039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Tommaso Matucci
- Department of Health Sciences, Anna Meyer Children University Hospital, University of Florence, Florence, Italy
| | - Luisa Galli
- Department of Health Sciences, Anna Meyer Children University Hospital, University of Florence, Florence, Italy
| | - Maurizio de Martino
- Department of Health Sciences, Anna Meyer Children University Hospital, University of Florence, Florence, Italy
| | - Elena Chiappini
- Department of Health Sciences, Anna Meyer Children University Hospital, University of Florence, Florence, Italy
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Velizarova S, Gabrovska N, Spasova A, Marais B, Harausz EP, Tiberi S, Migliori GB, Manissero D. Management and outcomes of severe childhood tuberculosis in the pediatric intensive care setting: can we identify best practices? ACTA ACUST UNITED AC 2019; 45:e20190043. [PMID: 31038655 PMCID: PMC6733735 DOI: 10.1590/1806-3713/e20190043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Svetlana Velizarova
- . Medical University, Department of Pulmonary Diseases, Hospital for Lung Disease "St. Sofia" - Children's Clinic, Sofia, Bulgaria
| | - Natalia Gabrovska
- . Medical University, Department of Pulmonary Diseases, Hospital for Lung Disease "St. Sofia" - Children's Clinic, Sofia, Bulgaria
| | - Albena Spasova
- . Medical University, Department of Pulmonary Diseases, Hospital for Lung Disease "St. Sofia" - Children's Clinic, Sofia, Bulgaria
| | - Ben Marais
- . Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, Australia.,. Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, Australia
| | | | - Simon Tiberi
- . Barts Health NHS Trust, Royal London Hospital, Division of Infection, London, United Kingdom.,. Blizard Institute, Barts and the London School of Medicine and Dentistry, Centre for Primary Care and Public Health, London, United Kingdom
| | - Giovanni Battista Migliori
- . Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri - IRCCS - Tradate, Italia
| | - Davide Manissero
- . University College of London, Institute for Global Health, London, United Kingdom
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Abstract
Tuberculosis remains the leading cause of death from an infectious disease among adults worldwide, with more than 10 million people becoming newly sick from tuberculosis each year. Advances in diagnosis, including the use of rapid molecular testing and whole-genome sequencing in both sputum and non-sputum samples, could change this situation. Although little has changed in the treatment of drug-susceptible tuberculosis, data on increased efficacy with new and repurposed drugs have led WHO to recommend all-oral therapy for drug-resistant tuberculosis for the first time ever in 2018. Studies have shown that shorter latent tuberculosis prevention regimens containing rifampicin or rifapentine are as effective as longer, isoniazid-based regimens, and there is a promising vaccine candidate to prevent the progression of infection to the disease. But new tools alone are not sufficient. Advances must be made in providing high-quality, people-centred care for tuberculosis. Renewed political will, coupled with improved access to quality care, could relegate the morbidity, mortality, and stigma long associated with tuberculosis, to the past.
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Affiliation(s)
- Jennifer Furin
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
| | - Helen Cox
- Division of Medical Microbiology and the Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Madhukar Pai
- McGill International Tuberculosis Centre, McGill University, Montreal, QC, Canada; Manipal McGill Centre for Infectious Diseases, Manipal Academy of Higher Education, Manipal, India
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Khan PY, Yates TA, Osman M, Warren RM, van der Heijden Y, Padayatchi N, Nardell EA, Moore D, Mathema B, Gandhi N, Eldholm V, Dheda K, Hesseling AC, Mizrahi V, Rustomjee R, Pym A. Transmission of drug-resistant tuberculosis in HIV-endemic settings. THE LANCET. INFECTIOUS DISEASES 2019; 19:e77-e88. [PMID: 30554996 PMCID: PMC6474238 DOI: 10.1016/s1473-3099(18)30537-1] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 08/10/2018] [Accepted: 08/10/2018] [Indexed: 12/17/2022]
Abstract
The emergence and expansion of the multidrug-resistant tuberculosis epidemic is a threat to the global control of tuberculosis. Multidrug-resistant tuberculosis is the result of the selection of resistance-conferring mutations during inadequate antituberculosis treatment. However, HIV has a profound effect on the natural history of tuberculosis, manifesting in an increased rate of disease progression, leading to increased transmission and amplification of multidrug-resistant tuberculosis. Interventions specific to HIV-endemic areas are urgently needed to block tuberculosis transmission. These interventions should include a combination of rapid molecular diagnostics and improved chemotherapy to shorten the duration of infectiousness, implementation of infection control measures, and active screening of multidrug-resistant tuberculosis contacts, with prophylactic regimens for individuals without evidence of disease. Development and improvement of the efficacy of interventions will require a greater understanding of the factors affecting the transmission of multidrug-resistant tuberculosis in HIV-endemic settings, including population-based molecular epidemiology studies. In this Series article, we review what we know about the transmission of multidrug-resistant tuberculosis in settings with high burdens of HIV and define the research priorities required to develop more effective interventions, to diminish ongoing transmission and the amplification of drug resistance.
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Affiliation(s)
- Palwasha Y Khan
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK; TB Centre, London School of Hygiene & Tropical Medicine, London, UK; Interactive Research and Development, Karachi, Pakistan
| | - Tom A Yates
- Institute for Global Health, University College London, London, UK; Institute of Child Health, University College London, London, UK
| | - Muhammad Osman
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Robin M Warren
- Department of Science and Technology/National Research Foundation Centre of Excellence in Biomedical Tuberculosis Research, Division of Molecular Biology and Human Genetics, Department of Biomedical Sciences, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Yuri van der Heijden
- Vanderbilt Tuberculosis Center and Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Nesri Padayatchi
- South African Medical Research Council HIV-TB Pathogenesis and Treatment Research Unit, Centre for the AIDS Programme of Research in South Africa, Durban, South Africa
| | - Edward A Nardell
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
| | - David Moore
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK; TB Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Barun Mathema
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Neel Gandhi
- Rollins School of Public Health and Emory School of Medicine, Emory University, Atlanta, GA, USA
| | - Vegard Eldholm
- Division of Infectious Disease Control, Norwegian Institute of Public Health, Oslo, Norway
| | - Keertan Dheda
- Lung Infection and Immunity Unit, Division of Pulmonology and University of Cape Town Lung Institute, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Anneke C Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Valerie Mizrahi
- Department of Science and Technology/National Research Foundation Centre of Excellence in Biomedical Tuberculosis Research, Department of Pathology, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Roxana Rustomjee
- Division of AIDS, National Institutes of Health, Bethesda, MD, USA
| | - Alexander Pym
- Department of Infection and Immunity, University College London, London, UK; Africa Health Research Institute, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, KwaZulu-Natal, South Africa.
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Abstract
BACKGROUND In recent years, there is an increasing interest in the use of linezolid for the treatment of tuberculosis (TB). METHODS Patients less than 18 years of age who received linezolid within the Spanish Pediatric TB Network from 2001 to 2016 were retrospectively included. Treatment characteristics, adverse events (AEs) and outcomes were analyzed. RESULTS Fifteen children were included (53% male) with a median age of 3.6 years [interquartile range (IQR): 1.6-6.2]. Median follow-up was 54 months (IQR: 38-76). The reasons for linezolid use were drug-resistant TB in 8 (53%) patients, drug-induced liver injury in 5 (33%) patients and chronic liver disease in 2 (13%) patients. Four children (26%) were on immunosuppressive therapy when TB was diagnosed. Five children (33%) were diagnosed with extrapulmonary TB. The median duration of linezolid treatment was 13 months (IQR: 7.5-17). Nine patients had 13 linezolid-related AEs. Hematologic toxicity was observed in 8 patients (53%) and gastrointestinal intolerance in 3 patients (20%). In 2 patients, linezolid dose was reduced, and in 2 patients, linezolid was discontinued because of AEs. A 2-year-old girl went back to her country of birth and was lost to follow-up. No relapses were observed among the other 14 patients (93%). CONCLUSIONS Linezolid may be considered when treating children with drug-resistant TB but also in the cases of patients with chronic liver disease or drug-induced liver injury. However, AEs should be closely monitored. Further studies are needed to determine the optimum dosage and the optimal duration of linezolid treatment in children.
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Garg RK, Rizvi I, Malhotra HS, Uniyal R, Kumar N. Management of complex tuberculosis cases: a focus on drug-resistant tuberculous meningitis. Expert Rev Anti Infect Ther 2019; 16:813-831. [PMID: 30359140 DOI: 10.1080/14787210.2018.1540930] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Drug-resistant tuberculous meningitis has been reported worldwide. Isoniazid mono-resistance is the most frequent cause of drug-resistant tuberculous meningitis, a life-threatening disease. Extensive drug-resistant tuberculous meningitis has also been reported in some isolated case reports. Areas covered: We reviewed the current literature on drug-resistant tuberculous meningitis, as well as drug-resistant tuberculosis. Expert commentary: Drug-resistant tuberculous meningitis is a life-threatening disease and needs prompt diagnosis and treatment. Xpert MTB/RIF Ultra technology can detect Mycobacterium tuberculosis and rifampicin resistance in cerebrospinal fluid (CSF) even with low numbers of bacilli. The optimum antituberculosis drug regimen for multidrug-resistant tuberculous meningitis is largely unknown as no second-line antituberculosis drug-containing regimen has been tested in a randomized controlled fashion in drug-resistant tuberculous meningitis. A combination of levofloxacin, kanamycin, ethionamide, linezolid, and pyrazinamide would be an appropriate regimen because of excellent CSF profile of most of these drugs. End TB Strategy will help in checking the increasing challenge of drug-resistant tuberculous meningitis as it aims to eliminate all kinds of tuberculosis by the year 2035.
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Affiliation(s)
- Ravindra Kumar Garg
- a Department of Neurology , King George Medical University , Lucknow , India
| | - Imran Rizvi
- a Department of Neurology , King George Medical University , Lucknow , India
| | | | - Ravi Uniyal
- a Department of Neurology , King George Medical University , Lucknow , India
| | - Neeraj Kumar
- a Department of Neurology , King George Medical University , Lucknow , India
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Seddon JA, Schaaf HS, Marais BJ, McKenna L, Garcia-Prats AJ, Hesseling AC, Hughes J, Howell P, Detjen A, Amanullah F, Singh U, Master I, Perez-Velez CM, Misra N, Becerra MC, Furin JJ. Time to act on injectable-free regimens for children with multidrug-resistant tuberculosis. THE LANCET RESPIRATORY MEDICINE 2019; 6:662-664. [PMID: 30191832 DOI: 10.1016/s2213-2600(18)30329-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 07/24/2018] [Indexed: 01/26/2023]
Affiliation(s)
- James A Seddon
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7505, South Africa; Department of Paediatrics, Imperial College London, London, UK.
| | - H Simon Schaaf
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7505, South Africa
| | - Ben J Marais
- The Children's Hospital at Westmead and Discipline of Paediatrics and Adolescent Medicine, The University of Sydney, Sydney, NSW, Australia
| | | | - Anthony J Garcia-Prats
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7505, South Africa
| | - Anneke C Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7505, South Africa
| | - Jennifer Hughes
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7505, South Africa
| | - Pauline Howell
- Clinical HIV Research Unit, Department of Medicine, University of Witswatersrand, Johannesburg, South Africa
| | | | | | - Urvashi Singh
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Iqbal Master
- King Dinizulu Hospital Complex, Kwazulu Natal Department of Health, Durban, South Africa
| | - Carlos M Perez-Velez
- Tuberculosis Control and Prevention Program, Pima County Health Department, Pima County, AZ, USA; Division of Infectious Diseases, University of Arizona College of Medicine, Tucson, AX, USA
| | - Nirupa Misra
- King Dinizulu Hospital Complex, Kwazulu Natal Department of Health, Durban, South Africa
| | - Mercedes C Becerra
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Jennifer J Furin
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
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Multi and extensively drug-resistant pulmonary tuberculosis: advances in diagnosis and management. Curr Opin Pulm Med 2019; 24:244-252. [PMID: 29470252 DOI: 10.1097/mcp.0000000000000477] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW Multidrug-resistant (MDR) tuberculosis (TB) and extensively drug-resistant (XDR)-TB epidemics are key obstacles towards TB control and elimination. RECENT FINDINGS Diagnosis of MDR/XDR-TB is difficult and requires several weeks. New diagnostic tools are being tested and proposed allowing for shorter time to diagnosis and reduced delays in starting an adequate treatment regimen. MDR/XDR-TB treatment strategies are currently on an evolving stage. New shortened treatments based on the recommended 'Bangladesh regimen' or on the newer anti-TB drugs, delamanid and bedaquiline may represent part of the future scenario. In addition, more information on safety and efficacy of delamanid and bedaquiline has been published, allowing to better position these drugs. Recent information on treatment regimens for the paediatric age, with or without delamanid or bedaquiline, has become available. This is of great help in designing safer and more efficacious regimens for the treatment of MDR/XDR-TB in children and adolescents. SUMMARY The accessibility, sustainability and scale-up of new diagnostic technologies are lagging behind and more efforts are needed. In addition, we need high-quality information on safety and efficacy of various combinations of drugs to obtain the best possible regimens to treat the largest possible proportion of patients.
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Lu M, Saddi V, Britton PN, Selvadurai H, Robinson PD, Pandit C, Marais BJ, Fitzgerald DA. Disease caused by non-tuberculous mycobacteria in children with cystic fibrosis. Paediatr Respir Rev 2019; 29:42-52. [PMID: 30473423 DOI: 10.1016/j.prrv.2018.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 05/09/2018] [Indexed: 01/24/2023]
Abstract
Non-tuberculous mycobacterial (NTM) (especially M. abscessus complex) infections pose a considerable challenge in the management of lung disease in patients with cystic fibrosis (CF). The apparent increase in prevalence is likely multifactorial. Emergent evidence of patient-to-patient transmission and isolation of highly resistant strains is a concern for all CF centers around the world. Treatment is often long and burdensome with multiple agents. Treatment side effects are frequent and can cause significant morbidity. Although consensus guidelines provide some direction, many units are faced with the challenges of: finding drug combinations for highly resistant strains; dealing with interruptions of treatment; discussing additional facilitating procedures in the form of gastrostomy and long-term vascular access devices; as well as supporting families emotionally and psychologically through the process.
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Affiliation(s)
- Mimi Lu
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia.
| | - Vishal Saddi
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Philip N Britton
- Department of Infectious Diseases, The Children's Hospital at Westmead, Sydney, NSW, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Hiran Selvadurai
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Paul D Robinson
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Chetan Pandit
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Ben J Marais
- Department of Infectious Diseases, The Children's Hospital at Westmead, Sydney, NSW, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Dominic A Fitzgerald
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
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Verma M, Furin J, Langer R, Traverso G. Making the case: developing innovative adherence solutions for the treatment of tuberculosis. BMJ Glob Health 2019; 4:e001323. [PMID: 30815283 PMCID: PMC6361324 DOI: 10.1136/bmjgh-2018-001323] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 01/10/2019] [Accepted: 01/12/2019] [Indexed: 02/02/2023] Open
Affiliation(s)
- Malvika Verma
- Department of Biological Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Jennifer Furin
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert Langer
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Giovanni Traverso
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
- Division of Gastroenterology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
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Furin J. Advances in the diagnosis, treatment, and prevention of tuberculosis in children. Expert Rev Respir Med 2019; 13:301-311. [PMID: 30648437 DOI: 10.1080/17476348.2019.1569518] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Pediatric tuberculosis (TB) is a significant global health threat and is one of the top ten causes of death in children. There are a number of diagnostic, treatment, and preventive innovations that have been developed in the last decade for TB, however, these are out of reach for many children in the world. Areas covered: A comprehensive review of the literature on TB in children was done using PubMed and Ovid databases from 1 January 1996 up to 31 October 2018. Topic areas covered included diagnosis of TB, treatment of TB (including novel medications and regimens), prevention of DR-TB, and support to achieve the best possible outcomes. Each of these areas are explored in more detail in the paper. Expert commentary: There is great potential for radical changes in the way all forms of TB are diagnosed, treated and prevented in children. If there is continued advocacy and adequate funding and accountability, it could be possible to make great strides toward eliminating TB in children in the next ten years.
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Affiliation(s)
- Jennifer Furin
- a Harvard Medical School , Department of Global Health and Social Medicine , Boston , MA , USA
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39
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Huynh J, Marais BJ. Multidrug-resistant tuberculosis infection and disease in children: a review of new and repurposed drugs. Ther Adv Infect Dis 2019; 6:2049936119864737. [PMID: 31367376 PMCID: PMC6643170 DOI: 10.1177/2049936119864737] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 06/28/2019] [Indexed: 01/01/2023] Open
Abstract
The World Health Organization estimates that 10 million new cases of tuberculosis (TB) occurred worldwide in 2017, of which 600,000 were rifampicin or multidrug-resistant (RR/MDR) TB. Modelling estimates suggest that 32,000 new cases of MDR-TB occur in children annually, but only a fraction of these are correctly diagnosed and treated. Accurately diagnosing TB in children, who usually have paucibacillary disease, and implementing effective TB prevention and treatment programmes in resource-limited settings remain major challenges. In light of the underappreciated RR/MDR-TB burden in children, and the lack of paediatric data on newer drugs for TB prevention and treatment, we present an overview of new and repurposed TB drugs, describing the available evidence for safety and efficacy in children to assist clinical care and decision-making.
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Affiliation(s)
- Julie Huynh
- Department of Infectious Diseases and
Microbiology, The Children’s Hospital Westmead, New South Wales, 2145,
Australia
- Discipline of Child and Adolescent Health,
University of Sydney, The Children’s Hospital Westmead, Westmead, New South
Wales, 2145, Australia
| | - Ben J. Marais
- Department of Infectious Diseases and
Microbiology, The Children’s Hospital Westmead, New South Wales,
Australia
- Discipline of Child and Adolescent Health,
University of Sydney, The Children’s Hospital Westmead, New South Wales,
Australia
- Marie Bashir Institute for Infectious Diseases
and Biosecurity, University of Sydney, Sydney, Australia
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40
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Sharma S. Emerging treatment trends in pediatric TB. ACTA ACUST UNITED AC 2019; 66:214-217. [DOI: 10.1016/j.ijtb.2019.02.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 02/16/2019] [Indexed: 01/26/2023]
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Kay A, Garcia-Prats AJ, Mandalakas AM. HIV-associated pediatric tuberculosis: prevention, diagnosis and treatment. Curr Opin HIV AIDS 2018; 13:501-506. [PMID: 30286040 PMCID: PMC11849721 DOI: 10.1097/coh.0000000000000500] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PURPOSE OF REVIEW The detrimental synergy of colliding HIV and tuberculosis (TB) epidemics is most devastating among children and adolescents living with HIV (CALWH) who shoulder a disproportionate burden of all child TB mortality. RECENT FINDINGS CALWH benefit less from Bacille-Calmette Guerin vaccination than HIV-uninfected children and are not receiving TB preventive therapy despite global recommendations. Further, the predictive utility of most diagnostic tools is reduced in CALWH. Finally, antiretroviral and anti-TB drug interactions continue to complicate cotreatment for children. Despite these challenges, recent data fuel a new awareness of TB as a hidden cause of child mortality and a renewed commitment to TB prevention. New diagnostic approaches using existing tools with novel specimens, such as stool, may improve the diagnosis of TB in CALWH. Further, pharmacokinetic studies and the development of new drug formulations promise better treatment options for CALWH in the near future. SUMMARY With the awareness that TB is the leading cause of mortality among CALWH, comes a responsibility to accelerate research to prevent, diagnose and treat TB in this vulnerable population. In the present, we must adopt evidence-based preventive and treatment strategies to enhance outcomes of CALWH and combating TB.
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Affiliation(s)
- Alexander Kay
- The Global TB Program, Texas Children’s Hospital and the Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Baylor College of Medicine Childen’s Foundation Eswatini, Mbabane, Eswatini
| | - Anthony J. Garcia-Prats
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Anna Maria Mandalakas
- The Global TB Program, Texas Children’s Hospital and the Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
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Harausz EP, Garcia-Prats AJ, Law S, Schaaf HS, Kredo T, Seddon JA, Menzies D, Turkova A, Achar J, Amanullah F, Barry P, Becerra M, Chan ED, Chan PC, Ioana Chiotan D, Crossa A, Drobac PC, Fairlie L, Falzon D, Flood J, Gegia M, Hicks RM, Isaakidis P, Kadri SM, Kampmann B, Madhi SA, Marais E, Mariandyshev A, Méndez-Echevarría A, Moore BK, Nargiza P, Ozere I, Padayatchi N, Ur-Rehman S, Rybak N, Santiago-Garcia B, Shah NS, Sharma S, Shim TS, Skrahina A, Soriano-Arandes A, van den Boom M, van der Werf MJ, van der Werf TS, Williams B, Yablokova E, Yim JJ, Furin J, Hesseling AC. Treatment and outcomes in children with multidrug-resistant tuberculosis: A systematic review and individual patient data meta-analysis. PLoS Med 2018; 15:e1002591. [PMID: 29995958 PMCID: PMC6040687 DOI: 10.1371/journal.pmed.1002591] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Accepted: 05/18/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND An estimated 32,000 children develop multidrug-resistant tuberculosis (MDR-TB; Mycobacterium tuberculosis resistant to isoniazid and rifampin) each year. Little is known about the optimal treatment for these children. METHODS AND FINDINGS To inform the pediatric aspects of the revised World Health Organization (WHO) MDR-TB treatment guidelines, we performed a systematic review and individual patient data (IPD) meta-analysis, describing treatment outcomes in children treated for MDR-TB. To identify eligible reports we searched PubMed, LILACS, Embase, The Cochrane Library, PsychINFO, and BioMedCentral databases through 1 October 2014. To identify unpublished data, we reviewed conference abstracts, contacted experts in the field, and requested data through other routes, including at national and international conferences and through organizations working in pediatric MDR-TB. A cohort was eligible for inclusion if it included a minimum of three children (aged <15 years) who were treated for bacteriologically confirmed or clinically diagnosed MDR-TB, and if treatment outcomes were reported. The search yielded 2,772 reports; after review, 33 studies were eligible for inclusion, with IPD provided for 28 of these. All data were from published or unpublished observational cohorts. We analyzed demographic, clinical, and treatment factors as predictors of treatment outcome. In order to obtain adjusted estimates, we used a random-effects multivariable logistic regression (random intercept and random slope, unless specified otherwise) adjusted for the following covariates: age, sex, HIV infection, malnutrition, severe extrapulmonary disease, or the presence of severe disease on chest radiograph. We analyzed data from 975 children from 18 countries; 731 (75%) had bacteriologically confirmed and 244 (25%) had clinically diagnosed MDR-TB. The median age was 7.1 years. Of 910 (93%) children with documented HIV status, 359 (39%) were infected with HIV. When compared to clinically diagnosed patients, children with confirmed MDR-TB were more likely to be older, to be infected with HIV, to be malnourished, and to have severe tuberculosis (TB) on chest radiograph (p < 0.001 for all characteristics). Overall, 764 of 975 (78%) had a successful treatment outcome at the conclusion of therapy: 548/731 (75%) of confirmed and 216/244 (89%) of clinically diagnosed children (absolute difference 14%, 95% confidence interval [CI] 8%-19%, p < 0.001). Treatment was successful in only 56% of children with bacteriologically confirmed TB who were infected with HIV who did not receive any antiretroviral treatment (ART) during MDR-TB therapy, compared to 82% in children infected with HIV who received ART during MDR-TB therapy (absolute difference 26%, 95% CI 5%-48%, p = 0.006). In children with confirmed MDR-TB, the use of second-line injectable agents and high-dose isoniazid (15-20 mg/kg/day) were associated with treatment success (adjusted odds ratio [aOR] 2.9, 95% CI 1.0-8.3, p = 0.041 and aOR 5.9, 95% CI 1.7-20.5, p = 0.007, respectively). These findings for high-dose isoniazid may have been affected by site effect, as the majority of patients came from Cape Town. Limitations of this study include the difficulty of estimating the treatment effects of individual drugs within multidrug regimens, only observational cohort studies were available for inclusion, and treatment decisions were based on the clinician's perception of illness, with resulting potential for bias. CONCLUSIONS This study suggests that children respond favorably to MDR-TB treatment. The low success rate in children infected with HIV who did not receive ART during their MDR-TB treatment highlights the need for ART in these children. Our findings of individual drug effects on treatment outcome should be further evaluated.
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Affiliation(s)
- Elizabeth P Harausz
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa.,Military HIV Research Program, Bethesda, Maryland, United States of America
| | - Anthony J Garcia-Prats
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Stephanie Law
- Montreal Chest Institute, McGill University, Montreal, Quebec, Canada
| | - H Simon Schaaf
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Tamara Kredo
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - James A Seddon
- Centre for International Child Health, Imperial College, London, United Kingdom
| | - Dick Menzies
- Montreal Chest Institute, McGill University, Montreal, Quebec, Canada
| | - Anna Turkova
- Imperial College Healthcare NHS Trust, Institute of Clinical Trials and Methodology, London, United Kingdom
| | - Jay Achar
- Manson Unit, Médecins Sans Frontières (MSF), London, United Kingdom
| | | | - Pennan Barry
- California Department of Public Health, Sacramento, California, United States of America
| | - Mercedes Becerra
- Partners In Health, Harvard Medical School, and Brigham and Women's Hospital, Boston, Massachusetts, United States of America
| | - Edward D Chan
- Denver Veterans Affairs Medical Center, National Jewish Health, Denver, Colorado, United States of America
| | - Pei Chun Chan
- Division of Chronic Infectious Disease, Centers for Disease Control, Taipei, Taiwan
| | - Domnica Ioana Chiotan
- Epidemiological Surveillance Department, Romanian National TB Program, Bucharest, Romania
| | - Aldo Crossa
- New York City Department of Health and Mental Hygiene, New York, New York, United States of America
| | - Peter C Drobac
- Partners In Health, Harvard Medical School, and Brigham and Women's Hospital, Boston, Massachusetts, United States of America
| | - Lee Fairlie
- Wits Reproductive Health & HIV Institute (WRHI), University of the Witwatersrand, Johannesburg, South Africa
| | - Dennis Falzon
- Laboratories, Diagnostics and Drug Resistance Unit, Global TB Programme, World Health Organization, Geneva, Switzerland
| | - Jennifer Flood
- California Department of Public Health, Sacramento, California, United States of America
| | - Medea Gegia
- Technical Support Coordination, Global TB Programme, World Health Organization, Geneva, Switzerland
| | - Robert M Hicks
- Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Petros Isaakidis
- Médecins Sans Frontières (MSF)/Doctors Without Borders, Mumbai, India
| | - S M Kadri
- Disease Control, Directorate of Health Services, Kashmir, India
| | - Beate Kampmann
- Paediatric Infection & Immunity, Centre of International Child Health, Imperial College London, London, United Kingdom.,Vaccines & Immunity Theme, MRC Unit The Gambia, Banjul, The Gambia
| | - Shabir A Madhi
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa
| | - Else Marais
- Department of Clinical Microbiology and Infectious Diseases, University of the Witwatersrand and the National Health Laboratory Services, Johannesburg, South Africa
| | | | - Ana Méndez-Echevarría
- Pediatric, Infectious and Tropical Diseases Department, Hospital La Paz, Madrid, Spain
| | - Brittany Kathryn Moore
- Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Parpieva Nargiza
- Republican Scientific Medical Center of Phtiziology and Pulmonology, Ministry of Health, Tashkent, Uzbekistan
| | - Iveta Ozere
- Riga Eastern Clinical University Hospital, Centre for Tuberculosis and Lung Diseases, Riga, Latvia
| | | | | | - Natasha Rybak
- Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Begoña Santiago-Garcia
- Pediatric Infectious Diseases Unit, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - N Sarita Shah
- Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Sangeeta Sharma
- Department of Pediatrics, National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
| | - Tae Sun Shim
- Department of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Alena Skrahina
- The Republican Research and Practical Centre for Pulmonology and TB, Minsk, Belarus
| | - Antoni Soriano-Arandes
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Unit of International Health-Tuberculosis Drassanes-Vall Hebron, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Martin van den Boom
- Joint Tuberculosis, HIV & Viral Hepatitis Programme, WHO Regional Office for Europe, Copenhagen, Denmark
| | - Marieke J van der Werf
- Disease Programme Tuberculosis, European Centre for Disease Prevention and Control, Stockholm, Sweden
| | | | - Bhanu Williams
- Northwick Park Hospital, London Northwest Healthcare NHS Trust, London, United Kingdom
| | - Elena Yablokova
- Northern State Medical University, Arkhangelsk, Russian Federation
| | - Jae-Joon Yim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Jennifer Furin
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Anneke C Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
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Abstract
PURPOSE OF REVIEW Although tuberculosis (TB) causes much morbidity and mortality in children, diagnosis and treatment remain challenging. Recently, children have gained increasing attention in research and clinical trials driving improved contact management, case identification and treatment of both drug-susceptible and drug-resistant TB. This review highlights some recent advances. RECENT FINDINGS The tuberculin skin test is the most widely used test to distinguish Mycobacterium tuberculosis (M. tuberculosis) infection from active TB, however, using M. tuberculosis-specific, antigenic stimulation of CD4 and CD8 cells appear more effective. The use of Xpert MTB/RIF to identify M. tuberculosis in clinical samples, together with novel sampling methods have in part, overcome the difficulty of sampling and increased case identification capacity. Advances in treating both drug-susceptible and drug-resistant childhood TB show promise in being more paediatric friendly and improving adherence. Dosing strategies for drug-sensitive TB have improved with dispersible fixed drug combinations now available. In the treatment and prevention of drug-resistant TB, however, research involving the use of newer and more effective drugs currently recommended for adults, are still ongoing in children. SUMMARY The World Health Organization aims to end the TB epidemic by 2035 whereas the United Nations' Sustainable Developmental Goals sets this ambitious target for 2030. Therefore, adequate funding and implementing effective national TB programs must be prioritized, particularly in high-burden, low-income settings.
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Abstract
The DOTS strategy assisted global tuberculosis (TB) control, but was unable to prevent the emergence and spread of drug-resistant strains. Genomic evidence confirms the transmission of drug-resistant Mycobacterium tuberculosis strains in many different settings, indicative of epidemic spread. These findings emphasise the need for enhanced infection control measures in health care and congregate settings. Young children in TB endemic areas are particularly vulnerable. Although advances in TB drug and vaccine development are urgently needed, improved access to currently available preventive therapy and treatment for drug resistant TB could reduce the disease burden and adverse outcomes experienced by children. We review new insights into the transmission dynamics of drug resistant TB, the estimated disease burden in children and optimal management strategies to consider.
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Affiliation(s)
- Alexander C Outhred
- The Children's Hospital at Westmead and the Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, Australia
| | - Philip N Britton
- The Children's Hospital at Westmead and the Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, Australia
| | - Ben J Marais
- The Children's Hospital at Westmead and the Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, Australia.
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46
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Schaaf HS, Garcia-Prats AJ, McKenna L, Seddon JA. Challenges of using new and repurposed drugs for the treatment of multidrug-resistant tuberculosis in children. Expert Rev Clin Pharmacol 2017; 11:233-244. [DOI: 10.1080/17512433.2018.1421067] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- H. Simon Schaaf
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Anthony J. Garcia-Prats
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | | | - James A. Seddon
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Centre for International Child Health, Department of Paediatrics, Imperial College London, London, UK
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47
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Achar J, Hewison C, Cavalheiro AP, Skrahina A, Cajazeiro J, Nargiza P, Herboczek K, Rajabov AS, Hughes J, Ferlazzo G, Seddon JA, du Cros P. Off-Label Use of Bedaquiline in Children and Adolescents with Multidrug-Resistant Tuberculosis. Emerg Infect Dis 2017; 23. [PMID: 28758889 PMCID: PMC5621552 DOI: 10.3201/eid2310.170303] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We describe 27 children and adolescents <18 years of age who received bedaquiline during treatment for multidrug-resistant tuberculosis. We report good treatment responses and no cessation attributable to adverse effects. Bedaquiline could be considered for use with this age group for multidrug-resistant tuberculosis when treatment options are limited.
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48
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Mukherjee A, Lodha R, Kabra SK. Current therapies for the treatment of multidrug-resistant tuberculosis in children in India. Expert Opin Pharmacother 2017; 18:1595-1606. [PMID: 28847228 PMCID: PMC5942143 DOI: 10.1080/14656566.2017.1373090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 08/25/2017] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Multidrug-resistant tuberculosis (MDR-TB) is a serious life threatening condition affecting children as well as adults worldwide. Timely diagnosis and effective treatment, both of which are complex in children, are the prerogatives for a favorable outcome. Areas covered: This review covers epidemiology, treatment regimen and duration, newer drugs and adverse events in children with MDR-TB. Special note has been made of epidemiology and principles of treatment followed in Indian children. Expert opinion: High index of suspicion is essential for diagnosing childhood MDR-TB. If there is high probability, a child can be diagnosed as presumptive MDR-TB and started on empiric treatment in consultation with experts. However, every effort should be made to confirm the diagnosis. Backbone of an effective MDR-TB regimen consists of four 2nd line anti-TB drugs plus pyrazinamide; duration being 18-24 months. The newer drugs delamanid and bedaquiline can be used in younger children if no other alternatives are available after consultation with experts. Wider availability of these drugs should be ensured for benefit to all concerned. More research is required for development of new and repurposed drugs to combat MDR-TB. Children need to be included in clinical trials for such life-saving drugs, so that nobody is denied the benefits.
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Affiliation(s)
- Aparna Mukherjee
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Lodha
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Sushil Kumar Kabra
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
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49
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D'Ambrosio L, Centis R, Tiberi S, Tadolini M, Dalcolmo M, Rendon A, Esposito S, Migliori GB. Delamanid and bedaquiline to treat multidrug-resistant and extensively drug-resistant tuberculosis in children: a systematic review. J Thorac Dis 2017; 9:2093-2101. [PMID: 28840010 DOI: 10.21037/jtd.2017.06.16] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The new drugs delamanid and bedaquiline are increasingly used to treat multidrug-resistant (MDR-) and extensively drug-resistant tuberculosis (XDR-TB). As evidence is lacking, the World Health Organization recommends their use under specific conditions in adults, delamanid only being recommended in children ≥6 years of age. No systematic review has yet evaluated the efficacy, safety and tolerability of the new drugs in children. A search of peer-reviewed, scientific evidence was performed, to evaluate the efficacy/effectiveness, safety, and tolerability of delamanid or bedaquiline-containing regimens in children with confirmed M/XDR-TB. We used PubMed and Embase to identify any relevant manuscripts in English until 31 December 2016, excluding editorials and reviews. Three out of 96 manuscripts retrieved satisfied the inclusion criteria, while 93 were excluded because dealing exclusively with adults (12: 4 on delamanid and 8 on bedaquiline), being recommendations or guidelines (8 manuscripts), reviews (17 papers) or other studies (56 papers). One of the studies retrieved reported evidence on 19 M/XDR-TB children, 16 of them treated under compassionate use with delamanid (13 achieving consistent bacteriological conversion) and 3 candidates for the drug. Two studies reported details on the first paediatric case treated (and cured) with a delamanid-containing regimen. Eight trials including children were also retrieved (clinicaltrials.gov). Although the methodology used in the study was rigorous, the results are limited by the paucity of the studies available in the literature on the use of new anti-TB drugs in children. In conclusion, more evidence is needed on the use of delamanid and bedaquiline in paediatric patients.
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Affiliation(s)
- Lia D'Ambrosio
- World Health Organization Collaborating Centre for Tuberculosis and Lung Diseases, Maugeri Care and Research Institute, IRCCS, Tradate, Italy.,Public Health Consulting Group, Lugano, Switzerland
| | - Rosella Centis
- World Health Organization Collaborating Centre for Tuberculosis and Lung Diseases, Maugeri Care and Research Institute, IRCCS, Tradate, Italy
| | - Simon Tiberi
- Division of Infection, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Marina Tadolini
- Unit of Infectious Diseases, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | | | - Adrian Rendon
- Center for Research, Prevention and Treatment of Respiratory Infections, University Hospital of Monterrey, Monterrey, Mexico
| | - Susanna Esposito
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Perugia, Italy
| | - Giovanni Battista Migliori
- World Health Organization Collaborating Centre for Tuberculosis and Lung Diseases, Maugeri Care and Research Institute, IRCCS, Tradate, Italy
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50
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Pontali E, D'Ambrosio L, Centis R, Sotgiu G, Migliori GB. Multidrug-resistant tuberculosis and beyond: an updated analysis of the current evidence on bedaquiline. Eur Respir J 2017; 49:49/3/1700146. [DOI: 10.1183/13993003.00146-2017] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 01/20/2017] [Indexed: 11/05/2022]
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