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Hasan T, Medcalf E, Nyang'wa BT, Egizi E, Berry C, Dodd M, Foraida S, Gegia M, Li M, Mirzayev F, Morgan H, Motta I, Nguyen L, Schumacher S, Schlub T, Fox G. The Safety and Tolerability of Linezolid in Novel Short-Course Regimens Containing Bedaquiline, Pretomanid, and Linezolid to Treat Rifampicin-Resistant Tuberculosis: An Individual Patient Data Meta-analysis. Clin Infect Dis 2024; 78:730-741. [PMID: 37874021 PMCID: PMC10954324 DOI: 10.1093/cid/ciad653] [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: 08/19/2023] [Revised: 09/28/2023] [Accepted: 10/20/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Effectiveness, safety, tolerability, and adherence are critical considerations in shifting to shorter tuberculosis (TB) regimens. Novel 6-month oral regimens that include bedaquiline (B), pretomanid (Pa), and linezolid (L), with or without a fourth drug, have been shown to be as or more effective than the established longer regimens for the treatment of multidrug-resistant/rifampicin-resistant TB (MDR/RR-TB). We aimed to evaluate the safety and tolerability of linezolid in BPaL-containing regimens for the treatment of MDR/RR-TB among recently completed clinical trials. METHODS A review and meta-analysis was undertaken including published and unpublished data from clinical trials, conducted between 2010 and 2021, that evaluated regimens containing BPaL for the treatment of MDR/RR-TB. Individual patient data were obtained. For each BPaL-containing regimen, we evaluated the frequency and severity of treatment-related adverse events. The risk difference of adverse events for each regimen was calculated, in comparison to patients assigned to receiving the lowest cumulative exposure of linezolid. RESULTS Data from 3 clinical trials investigating 8 unique BPaL-containing regimens were included, comprising a total of 591 participants. Adverse events were more frequent in groups randomized to a higher cumulative linezolid dose. Among patients who were randomized to a daily dose of 1200 mg linezolid, 68 of 195 (35%) experienced a grade 3-4 adverse event versus 89 of 396 (22%) patients receiving BPaL-containing regimens containing 600 mg linezolid. CONCLUSIONS Regimens containing BPaL were relatively well tolerated when they included a daily linezolid dose of 600 mg. These novel regimens promise to improve the tolerability of treatment for MDR/RR-TB.
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Affiliation(s)
- Tasnim Hasan
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Ellie Medcalf
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Bern-Thomas Nyang'wa
- Public Health Department, Médecins sans Frontières, Amsterdam, The Netherlands
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Erica Egizi
- TB Alliance Research and Development, New York City, USA
| | - Catherine Berry
- Manson Unit, Médecins sans Frontières, London, United Kingdom
| | - Matthew Dodd
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Salah Foraida
- TB Alliance Research and Development, New York City, USA
| | - Medea Gegia
- Global Tuberculosis Program, World Health Organization, Geneva, Switzerland
| | - Mengchun Li
- TB Alliance Research and Development, New York City, USA
| | - Fuad Mirzayev
- Global Tuberculosis Program, World Health Organization, Geneva, Switzerland
| | - Hannah Morgan
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Ilaria Motta
- Manson Unit, Médecins sans Frontières, London, United Kingdom
| | - Linh Nguyen
- Global Tuberculosis Program, World Health Organization, Geneva, Switzerland
| | - Samuel Schumacher
- Global Tuberculosis Program, World Health Organization, Geneva, Switzerland
| | - Tim Schlub
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Greg Fox
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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Zou F, Cui Z, Lou S, Ou Y, Zhu C, Shu C, Chen J, Zhao R, Wu Z, Wang L, Chen Z, Chen H, Lan Y. Adverse drug events associated with linezolid administration: a real-world pharmacovigilance study from 2004 to 2023 using the FAERS database. Front Pharmacol 2024; 15:1338902. [PMID: 38434706 PMCID: PMC10904462 DOI: 10.3389/fphar.2024.1338902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/31/2024] [Indexed: 03/05/2024] Open
Abstract
Introduction: Linezolid is an oxazolidinone antibiotic that is active against drug-resistant Gram-positive bacteria and multidrug-resistant Mycobacterium tuberculosis. Real-world studies on the safety of linezolid in large populations are lacking. This study aimed to determine the adverse events associated with linezolid in real-world settings by analyzing data from the US Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS). Methods: We retrospectively extracted reports on adverse drug events (ADEs) from the FAERS database from the first quarter of 2004 to that of 2023. By using disproportionality analysis including reporting odds ratio (ROR), proportional reporting ratio (PRR), Bayesian Confidence Propagation Neural Network (BCPNN), along with the multi-item gamma Poisson shrinker (MGPS), we evaluated whether there was a significant association between linezolid and ADE. The time to onset of ADE was further analyzed in the general population and within each age, weight, reporting population, and weight subgroups. Results: A total of 11,176 reports of linezolid as the "primary suspected" drug and 263 significant adverse events of linezolid were identified, including some common adverse events such as thrombocytopenia (n = 1,139, ROR 21.98), anaemia (n = 704, ROR 7.39), and unexpected signals that were not listed on the drug label such as rhabdomyolysis (n = 90, ROR 4.33), and electrocardiogram QT prolonged (n = 73, ROR 4.07). Linezolid-induced adverse reactions involved 27 System Organ Class (SOC). Gender differences existed in ADE signals related to linezolid. The median onset time of all ADEs was 6 days, and most ADEs (n = 3,778) occurred within the first month of linezolid use but some may continue to occur even after a year of treatment (n = 46). Conclusion: This study reports the time to onset of adverse effects in detail at the levels of SOC and specific preferred term (PT). The results of our study provide valuable insights for optimizing the use of linezolid and reducing potential side effects, expected to facilitate the safe use of linezolid in clinical settings.
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Affiliation(s)
- Fan Zou
- Department of Tuberculosis, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Zhiwei Cui
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Siyu Lou
- Department of Tuberculosis, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Yingyong Ou
- Department of Tuberculosis, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Chengyu Zhu
- Department of Tuberculosis, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Chengjie Shu
- Department of Tuberculosis, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Junyou Chen
- Department of Tuberculosis, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Ruizhen Zhao
- Department of Tuberculosis, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Zhu Wu
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Li Wang
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Zhenyong Chen
- Department of Tuberculosis, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Huayu Chen
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Yuanbo Lan
- Department of Tuberculosis, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
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Chen J, Zhu C, He Y, Cao H. Comparison of Plasma Concentration of Linezolid's Detection by FICA and LC-MS/MS. J Chromatogr Sci 2024:bmae003. [PMID: 38364367 DOI: 10.1093/chromsci/bmae003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 12/12/2023] [Indexed: 02/18/2024]
Abstract
Linezolid was the first totally synthetic oxazolidinone antibiotic that was approved for clinical use against Mycobacterium tuberculosis. Our study investigated the correlation and consistency of fluorescence immunochromatography assay (FICA) and high-performance liquid chromatography-tandem mass spectrometry (LC-MS/MS) in measuring linezolid levels in the plasma. Plasma samples were collected from 80 to 100 tuberculosis patients. The samples were analyzed by FICA and LC-MS/MS, and linezolid levels measured by the two methods were compared by outlier test, correlation coefficient, Bland-Altman scatter plot, Deming regression analysis and bias evaluation. A total of 83 plasma samples were collected, all of which were non-outlier. The correlation coefficient of FICA and LC-MS/MS results was 0.9845. Deming regression analysis showed that the regression equation of FICA and LC-MS/MS was y = 0.2229 + 1.0076x. The medical decision levels of 2 and 7 μg/mL were taken into the regression equation, and the 95% CI of 2- and 7-μg/mL bias were both within the allowed error range. The findings indicated a strong correlation between the results obtained from FICA and LC-MS/MS were consistent showed good correlation, demonstrating their equivalence in measurement.
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Affiliation(s)
- Jing Chen
- Pharmacy Department, Huzhou Central Hospital (The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University), Huzhou 313000, Zhejiang, China
| | - Chenxia Zhu
- Pharmacy Department, Huzhou Central Hospital (The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University), Huzhou 313000, Zhejiang China
| | - Yangjin He
- Research and development department, Zhejiang Zhunce Biotechnology Co., Ltd, Huzhou 313000, Zhejiang, China
| | - Hengbin Cao
- Pharmacy Department, Huzhou Central Hospital (The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University), Huzhou 313000, Zhejiang, China
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Cui D, Hu X, Shi L, Wang D, Chen G. Linezolid-related adverse effects in the treatment of rifampicin resistant tuberculosis: a retrospective study. J Chemother 2022:1-7. [PMID: 36322121 DOI: 10.1080/1120009x.2022.2136447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Linezolid (LZD) is an effective drug in treating multidrug-resistant tuberculosis and extensively drug-resistant tuberculosis. This study aimed to evaluate the safety of LZD in the treatment of patients with rifampicin resistant tuberculosis. This was a multicenter retrospective study. A total of 184 patients of the rifampicin resistant tuberculosis patients treated with LZD from Jan 2018 to Apr 2020 in three hospitals were involved, and their clinical symptoms were recorded and analyzed. Meanwhile, the types and incidence of adverse effects associated with LZD were evaluated. It showed that peripheral neuritis (51, 27.7%) and hemochromatosis (42, 22.8%) were the most common adverse effects observed among these patients. The median time of symptoms after LZD treatment was 45.5 and 120.0 days, respectively. Furthermore, female patients had a significantly higher risk for leukopenia (P = 0.002) and hemochromatosis (P = 0.033) when compared with male patients. History of underlying disease was the risk factor for thrombocytopenia (P = 0.022). Patients with long duration of medication (RR = 1.004, 95%CI: 1.002-1.006, P < 0.001) and daily dosage ≥600mg (RR = 3.059, 95%CI: 1.238-7.558, P = 0.015) were at higher risk of hemochromatosis. Age was the risk factor for rash (P = 0.008) and nausea and vomiting (P = 0.018). In addition, LZD administration time was the risk factor for optic neuritis (P < 0.001) and peripheral neuritis (P < 0.001). LZD can cause adverse symptoms in patients with rifampicin resistant tuberculosis. Gender, history of underlying disease, LZD use time, LZD dosage, and age are the risk factors in the LZD treatment of these patients. During medication, bone marrow suppression and neuropathy should be closely monitored. This study could potentially provide useful information for the clinical practice.
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Affiliation(s)
- Dan Cui
- Department of Tuberculosis, Hebei Chest Hospital, Shijiazhuang, China
| | - Xiaomeng Hu
- Tuberculosis IV Ward, Wuhan Pulmonary Hospital, Wuhan, China
| | - Li Shi
- Department of Tuberculosis, Changsha Central Hospital, University of South China, Changsha, China
| | - Dongchang Wang
- Department of Respiratory Medicine, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Gang Chen
- Department of Respiratory Medicine, The Third Hospital of Hebei Medical University, Shijiazhuang, China
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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: 6] [Impact Index Per Article: 3.0] [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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Antitubercular, Cytotoxicity, and Computational Target Validation of Dihydroquinazolinone Derivatives. Antibiotics (Basel) 2022; 11:antibiotics11070831. [PMID: 35884084 PMCID: PMC9311641 DOI: 10.3390/antibiotics11070831] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/16/2022] [Accepted: 06/17/2022] [Indexed: 02/04/2023] Open
Abstract
A series of 2,3-dihydroquinazolin-4(1H)-one derivatives (3a–3m) was screened for in vitro whole-cell antitubercular activity against the tubercular strain H37Rv and multidrug-resistant (MDR) Mycobacterium tuberculosis (MTB) strains. Compounds 3l and 3m with di-substituted aryl moiety (halogens) attached to the 2-position of the scaffold showed a minimum inhibitory concentration (MIC) of 2 µg/mL against the MTB strain H37Rv. Compound 3k with an imidazole ring at the 2-position of the dihydroquinazolin-4(1H)-one also showed significant inhibitory action against both the susceptible strain H37Rv and MDR strains with MIC values of 4 and 16 µg/mL, respectively. The computational results revealed the mycobacterial pyridoxal-5′-phosphate (PLP)-dependent aminotransferase (BioA) enzyme as the potential target for the tested compounds. In vitro, ADMET calculations and cytotoxicity studies against the normal human dermal fibroblast cells indicated the safety and tolerability of the test compounds 3k–3m. Thus, compounds 3k–3m warrant further optimization to develop novel BioA inhibitors for the treatment of drug-sensitive H37Rv and drug-resistant MTB.
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Kotrbová L, Lara AC, Corretto E, Scharfen J, Ulmann V, Petříčková K, Chroňáková A. Evaluation and comparison of antibiotic susceptibility profiles of Streptomyces spp. from clinical specimens revealed common and region-dependent resistance patterns. Sci Rep 2022; 12:9353. [PMID: 35672429 PMCID: PMC9174267 DOI: 10.1038/s41598-022-13094-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/20/2022] [Indexed: 12/02/2022] Open
Abstract
Notwithstanding the fact that streptomycetes are overlooked in clinical laboratories, studies describing their occurrence in disease and potential pathogenicity are emerging. Information on their species diversity in clinical specimens, aetiology and appropriate therapeutic treatment is scarce. We identified and evaluated the antibiotic susceptibility profile of 84 Streptomyces clinical isolates from the Czech Republic. In the absence of appropriate disk diffusion (DD) breakpoints for antibiotic susceptibility testing (AST) of Streptomyces spp., we determined DD breakpoints by correlation with the broth microdilution method and by the distribution of zone diameters among isolates. Correlation accuracy was high for 9 antibiotics, leading to the establishment of the most valid DD breakpoints for Streptomyces antibiotic susceptibility evaluation so far. Clinical strains belonged to 17 different phylotypes dominated by a cluster of strains sharing the same percentage of 16S rRNA gene sequence identity with more than one species (S. albidoflavus group, S. hydrogenans, S. resistomycificus, S. griseochromogenes; 70% of isolates). AST results showed that Streptomyces exhibited intrinsic resistance to penicillin, general susceptibility to amikacin, gentamycin, vancomycin and linezolid, and high percentage of susceptibility to tetracyclines and clarithromycin. For the remaining antibiotics, AST showed inter- and intra-species variations when compared to available literature (erythromycin, trimethoprim-sulfamethoxazole), indicating a region-dependent rather than species-specific patterns.
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Alene KA, Murray MB, van de Water BJ, Becerra MC, Atalell KA, Nicol MP, Clements ACA. Treatment Outcomes Among Pregnant Patients With Multidrug-Resistant Tuberculosis: A Systematic Review and Meta-analysis. JAMA Netw Open 2022; 5:e2216527. [PMID: 35687333 PMCID: PMC9187956 DOI: 10.1001/jamanetworkopen.2022.16527] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
IMPORTANCE The management of multidrug-resistant tuberculosis (MDR-TB) during pregnancy is challenging, yet no systematic synthesis of evidence has accurately measured treatment outcomes. OBJECTIVE To systematically synthesize treatment outcomes and adverse events among pregnant patients with MDR-TB. DATA SOURCES PubMed, Scopus, Web of Science, and ProQuest were searched from the inception of each database through August 31, 2021. STUDY SELECTION Studies containing cohorts of pregnant patients with a defined treatment outcome were eligible. DATA EXTRACTION AND SYNTHESIS Independent reviewers screened studies and assessed the risk of bias. The study followed the Preferring Reporting Items for Systematic Review and Meta-analyses reporting guideline. Meta-analysis was performed using random-effects models. The sources of heterogeneity were explored through metaregression. MAIN OUTCOMES AND MEASURES The primary outcome was the proportion of patients with each treatment outcome (including treatment success, death, loss to follow-up, and treatment failure), and the secondary outcomes included the proportion of patients experiencing adverse events during pregnancy. RESULTS In this systematic review and meta-analysis, 10 studies containing 275 pregnant patients with available data on treatment outcomes were included. The pooled estimate was 72.5% (95% CI, 63.3%-81.0%) for treatment success, 6.8% (95% CI, 2.6%-12.4%) for death, 18.4% (95% CI, 13.1%-24.2%) for loss to follow-up, and 0.6% (95% CI, 0.0%-2.9%) for treatment failure. Treatment success was significantly higher in studies in which the proportion of patients taking linezolid was greater than the median (20.1%) compared with studies in which this proportion was lower than the median (odds ratio, 1.22; 95% CI, 1.05-1.42). More than half of the pregnant patients (54.7%; 95% CI, 43.5%-65.4%) experienced at least 1 type of adverse event, most commonly liver function impairment (30.4%; 95% CI, 17.7%-45.7%), kidney function impairment (14.9%; 95% CI, 6.2%-28.3%), hypokalemia (11.9%; 95% CI, 3.9%-25.6%), hearing loss (11.8%; 95% CI, 5.5%-21.3%), gastrointestinal disorders (11.8%; 95% CI, 5.2%-21.8%), psychiatric disorders (9.1%; 95% CI, 2.5%-21.6%), or anemia (8.9%; 95% CI, 3.6%-17.4%). The pooled proportion of favorable pregnancy outcomes was 73.2% (95% CI, 49.4%-92.1%). The most common types of adverse pregnancy outcomes were preterm birth (9.5%; 95% CI, 0.0%-29.0%), pregnancy loss (6.0%; 95% CI, 1.3%-12.9%), low birth weight (3.9%; 95% CI, 0.0%-18.7%), and stillbirth (1.9%; 95% CI, 0.1%-5.1%). Most of the studies had low-quality (3 studies) or medium-quality (4 studies) scores. CONCLUSIONS AND RELEVANCE In this systematic review and meta-analysis, high treatment success and favorable pregnancy outcomes were reported among pregnant patients with MDR-TB. Further research is needed to design shorter, more effective, and safer treatment regimens for pregnant patients with MDR-TB.
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Affiliation(s)
- Kefyalew Addis Alene
- Telethon Kids Institute, Nedlands, Western Australia, Australia
- Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
| | - Megan B. Murray
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | | | - Mercedes C. Becerra
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | | | - Mark P. Nicol
- Institute for Infectious Diseases and Molecular Medicine, Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa
- School of Biomedical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Archie C. A. Clements
- Telethon Kids Institute, Nedlands, Western Australia, Australia
- Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
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MDR Tuberculosis Treatment. Medicina (B Aires) 2022; 58:medicina58020188. [PMID: 35208510 PMCID: PMC8878254 DOI: 10.3390/medicina58020188] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/13/2022] [Accepted: 01/15/2022] [Indexed: 11/17/2022] Open
Abstract
Multidrug-resistant (MDR) tuberculosis (TB), resistant to isoniazid and rifampicin, continues to be one of the most important threats to controlling the TB epidemic. Over the last few years, there have been promising pharmacological advances in the paradigm of MDR TB treatment: new and repurposed drugs have shown excellent bactericidal and sterilizing activity against Mycobacterium tuberculosis and several all-oral short regimens to treat MDR TB have shown promising results. The purpose of this comprehensive review is to summarize the most important drugs currently used to treat MDR TB, the recommended regimens to treat MDR TB, and we also summarize new insights into the treatment of patients with MDR TB.
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Oehadian A, Santoso P, Menzies D, Ruslami R. Hematologic Toxicity of Linezolid in Multidrug Resistant and Extensively Drug Resistant Tuberculosis (MDR/XDR-TB): the role of mitochondria. Tuberc Respir Dis (Seoul) 2022; 85:111-121. [PMID: 35045688 PMCID: PMC8987663 DOI: 10.4046/trd.2021.0122] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 01/16/2022] [Indexed: 12/02/2022] Open
Abstract
Multidrug-resistant tuberculosis (MDR-TB) is caused by an organism that is resistant to both rifampicin and isoniazid. Extensively drug-resistant TB, a rare type of MDR-TB, is caused by an organism that is resistant to quinolone and one of group A TB drugs (i.e., linezolid and bedaquiline). In 2018, the World Health Organization revised the groupings of TB medicines and reclassified linezolid as a group A drug for the treatment of MDR-TB. Linezolid is a synthetic antimicrobial agent in the oxazolidinone class. Although linezolid has a good efficacy, it can cause substantial adverse events, especially hematologic toxicity. In both TB infection and linezolid mechanism of action, mitochondrial dysfunction plays an important role. In this concise review, characteristics of linezolid as an anti-TB drug are summarized, including its efficacy, pathogenesis of hematologic toxicity highlighting mitochondrial dysfunction, and the monitoring and management of hematologic toxicity.
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Affiliation(s)
- Amaylia Oehadian
- Department of Internal Medicine, Hasan Sadikin Hospital, Faculty of Medicine Universitas Padjadjaran, Bandung, Indonesia
| | - Prayudi Santoso
- Department of Internal Medicine, Hasan Sadikin Hospital, Faculty of Medicine Universitas Padjadjaran, Bandung, Indonesia
| | - Dick Menzies
- McGill International TB Centre Respiratory Epidemiology and Clinical Research Unit, Montreal Canada, Director of the WHO McGill Collaborative Centre for TB Research
| | - Rovina Ruslami
- Department of Biomedical Science, Division of Pharmacology, Faculty of Medicine Universitas Padjadjaran, Bandung, Indonesia
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Hewison C, Khan U, Bastard M, Lachenal N, Coutisson S, Osso E, Ahmed S, Khan P, Franke MF, Rich ML, Varaine F, Melikyan N, Seung KJ, Adenov M, Adnan S, Danielyan N, Islam S, Janmohamed A, Karakozian H, Kamene Kimenye M, Kirakosyan O, Kholikulov B, Krisnanda A, Kumsa A, Leblanc G, Lecca L, Nkuebe M, Mamsa S, Padayachee S, Thit P, Mitnick CD, Huerga H. Safety of Treatment Regimens Containing Bedaquiline and Delamanid in the endTB Cohort. Clin Infect Dis 2022; 75:1006-1013. [PMID: 35028659 PMCID: PMC9522425 DOI: 10.1093/cid/ciac019] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Safety of treatment for multidrug-resistant tuberculosis (MDR/RR-TB) can be an obstacle to treatment completion. Evaluate safety of longer MDR/RR-TB regimens containing bedaquiline and/or delamanid. METHODS Multicentre (16 countries), prospective, observational study reporting incidence and frequency of clinically relevant adverse events of special interest (AESIs) among patients who received MDR/RR-TB treatment containing bedaquiline and/or delamanid. The AESIs were defined a priori as important events caused by bedaquiline, delamanid, linezolid, injectables, and other commonly used drugs. Occurrence of these events was also reported by exposure to the likely causative agent. RESULTS Among 2296 patients, the most common clinically relevant AESIs were peripheral neuropathy (26.4%), electrolyte depletion (26.0%), and hearing loss (13.2%) with an incidence per 1000 person months of treatment, 1000 person-months of treatment 21.5 (95% confidence interval [CI]: 19.8-23.2), 20.7 (95% CI: 19.1-22.4), and 9.7 (95% CI: 8.6-10.8), respectively. QT interval was prolonged in 2.7% or 1.8 (95% CI: 1.4-2.3)/1000 person-months of treatment. Patients receiving injectables (N = 925) and linezolid (N = 1826) were most likely to experience events during exposure. Hearing loss, acute renal failure, or electrolyte depletion occurred in 36.8% or 72.8 (95% CI: 66.0-80.0) times/1000 person-months of injectable drug exposure. Peripheral neuropathy, optic neuritis, and/or myelosuppression occurred in 27.8% or 22.8 (95% CI: 20.9-24.8) times/1000 patient-months of linezolid exposure. CONCLUSIONS AEs often related to linezolid and injectable drugs were more common than those frequently attributed to bedaquiline and delamanid. MDR-TB treatment monitoring and drug durations should reflect expected safety profiles of drug combinations. CLINICAL TRIALS REGISTRATION NCT02754765.
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Affiliation(s)
- Catherine Hewison
- Correspondence: Catherine Hewison, Medical Department, Médecins Sans Frontières, 14-34 avenue Jean Jaurès, 75019, Paris, France () and ()
| | | | | | - Nathalie Lachenal
- Pharmacovigilance Unit, Médecins Sans Frontières, Geneva, Switzerland
| | - Sylvine Coutisson
- Pharmacovigilance Unit, Médecins Sans Frontières, Geneva, Switzerland
| | - Elna Osso
- Partners In Health, Boston, Massachusetts, USA, and Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Saman Ahmed
- Interactive Research and Development, Karachi, Pakistan
| | - Palwasha Khan
- Interactive Research and Development Global, Singapore, Singapore
| | - Molly F Franke
- Partners In Health, Boston, Massachusetts, USA, and Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Michael L Rich
- Partners In Health, Boston, Massachusetts, USA, and Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA,Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | | | - Nara Melikyan
- Field Epidemiology Department, Epicentre, Paris, France
| | - Kwonjune J Seung
- Partners In Health, Boston, Massachusetts, USA, and Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA,Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Malik Adenov
- National Scientific Center of Phthisiopulmonology, MOH RK (NSCP MOH RK), Almaty, Kazakhstan
| | | | | | | | | | - Hayk Karakozian
- Medical Department, Médecins Sans Frontières, Bishkek, Krygystan
| | | | | | | | - Aga Krisnanda
- Aga Krisnanda, Interactive Research and Development, Jakarta, Indonesia
| | | | | | | | | | | | | | - Phone Thit
- Medical Department, Médecins Sans Frontières, Yangon, Myanmar
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12
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Guglielmetti L, Ardizzoni E, Atger M, Baudin E, Berikova E, Bonnet M, Chang E, Cloez S, Coit JM, Cox V, de Jong BC, Delifer C, Do JM, Tozzi DDS, Ducher V, Ferlazzo G, Gouillou M, Khan A, Khan U, Lachenal N, LaHood AN, Lecca L, Mazmanian M, McIlleron H, Moschioni M, O’Brien K, Okunbor O, Oyewusi L, Panda S, Patil SB, Phillips PPJ, Pichon L, Rupasinghe P, Rich ML, Saluhuddin N, Seung KJ, Tamirat M, Trippa L, Cellamare M, Velásquez GE, Wasserman S, Zimetbaum PJ, Varaine F, Mitnick CD. Evaluating newly approved drugs for multidrug-resistant tuberculosis (endTB): study protocol for an adaptive, multi-country randomized controlled trial. Trials 2021; 22:651. [PMID: 34563240 PMCID: PMC8465691 DOI: 10.1186/s13063-021-05491-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 07/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Treatment of multidrug- and rifampin-resistant tuberculosis (MDR/RR-TB) is expensive, labour-intensive, and associated with substantial adverse events and poor outcomes. While most MDR/RR-TB patients do not receive treatment, many who do are treated for 18 months or more. A shorter all-oral regimen is currently recommended for only a sub-set of MDR/RR-TB. Its use is only conditionally recommended because of very low-quality evidence underpinning the recommendation. Novel combinations of newer and repurposed drugs bring hope in the fight against MDR/RR-TB, but their use has not been optimized in all-oral, shorter regimens. This has greatly limited their impact on the burden of disease. There is, therefore, dire need for high-quality evidence on the performance of new, shortened, injectable-sparing regimens for MDR-TB which can be adapted to individual patients and different settings. METHODS endTB is a phase III, pragmatic, multi-country, adaptive, randomized, controlled, parallel, open-label clinical trial evaluating the efficacy and safety of shorter treatment regimens containing new drugs for patients with fluoroquinolone-susceptible, rifampin-resistant tuberculosis. Study participants are randomized to either the control arm, based on the current standard of care for MDR/RR-TB, or to one of five 39-week multi-drug regimens containing newly approved and repurposed drugs. Study participation in all arms lasts at least 73 and up to 104 weeks post-randomization. Randomization is response-adapted using interim Bayesian analysis of efficacy endpoints. The primary objective is to assess whether the efficacy of experimental regimens at 73 weeks is non-inferior to that of the control. A sample size of 750 patients across 6 arms affords at least 80% power to detect the non-inferiority of at least 1 (and up to 3) experimental regimens, with a one-sided alpha of 0.025 and a non-inferiority margin of 12%, against the control in both modified intention-to-treat and per protocol populations. DISCUSSION The lack of a safe and effective regimen that can be used in all patients is a major obstacle to delivering appropriate treatment to all patients with active MDR/RR-TB. Identifying multiple shorter, safe, and effective regimens has the potential to greatly reduce the burden of this deadly disease worldwide. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT02754765. Registered on 28 April 2016; the record was last updated for study protocol version 3.3, on 27 August 2019.
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Affiliation(s)
- L. Guglielmetti
- Médecins Sans Frontières, Paris, France
- Sorbonne Université, INSERM, U1135, Centre d’Immunologie Et Des Maladies Infectieuses, Paris, France
- Assistance Publique Hôpitaux de Paris, Groupe Hospitalier Universitaire Sorbonne Université, Hôpital Pitié-Salpêtrière, Centre National De Référence Des Mycobactéries Et De La Résistance Des Mycobactéries Aux Antituberculeux, Paris, France
| | - E. Ardizzoni
- Institute of Tropical Medicine, Antwerp, Belgium
| | - M. Atger
- Médecins Sans Frontières, Paris, France
| | | | - E. Berikova
- Partners In Health, Astana, Kazakhstan
- National Scientific Center of Phthisiopulmonology, Almaty, Kazakhstan
| | - M. Bonnet
- Médecins Sans Frontières, Paris, France
- Institut de Recherche pour le Développement/INSERM U1175/UMI233/ Université de Montpellier, Montpellier, France
| | - E. Chang
- Médecins Sans Frontières, Toronto, Ontario Canada
| | - S. Cloez
- Médecins Sans Frontières, Paris, France
| | - J. M. Coit
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA USA
| | - V. Cox
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | | | | | - J. M. Do
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA USA
| | | | - V. Ducher
- Médecins Sans Frontières, Paris, France
| | - G. Ferlazzo
- Southern Africa Medical Unit, Médecins Sans Frontières, Cape Town, South Africa
| | | | - A. Khan
- Interactive Research and Development, Karachi, Pakistan
| | - U. Khan
- Interactive Research and Development, Karachi, Pakistan
| | | | - A. N. LaHood
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA USA
| | - L. Lecca
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA USA
- Socios En Salud-Sucursal Peru, Lima, Peru
| | - M. Mazmanian
- Médecins Sans Frontières, Paris, France
- Assistance Publique Hôpitaux de Paris, Unité de Recherche Clinique, Hôpital Pitié-Salpêtrière, Paris, France
| | - H. McIlleron
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | | | | | - O. Okunbor
- Social & Scientific Systems-DLH, Silver Spring, MD USA
| | | | - S. Panda
- Epidemiology and Communicable Diseases Division, Indian Council of Medical Research, Pune, India
- Indian Council of Medical Research – National AIDS Research Institute, Pune, India
| | - S. B. Patil
- Indian Council of Medical Research – National AIDS Research Institute, Pune, India
| | - P. P. J. Phillips
- University of San Francisco Center for Tuberculosis, San Francisco, CA USA
| | - L. Pichon
- Médecins Sans Frontières, Paris, France
| | | | - M. L. Rich
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA USA
- Partners In Health, Boston, MA USA
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA USA
| | - N. Saluhuddin
- Department of Infectious Diseases, Indus Hospital, Karachi, Pakistan
| | - K. J. Seung
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA USA
- Partners In Health, Boston, MA USA
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA USA
| | | | - L. Trippa
- Dana-Farber Cancer Institute, Boston, MA USA
- Harvard T.H. Chan School of Public Health, Boston, MA USA
| | | | - G. E. Velásquez
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA USA
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA USA
- Division of Infectious Diseases, Brigham and Women’s Hospital, Boston, MA USA
| | - S. Wasserman
- Wellcome Centre for Infectious Diseases Research in Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - P. J. Zimetbaum
- Harvard Medical School, Boston, MA USA
- Beth Israel Deaconess Medical Center, Boston, MA USA
| | | | - C. D. Mitnick
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA USA
- Partners In Health, Boston, MA USA
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA USA
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Pratama NYI, Zulkarnain BS, Fatmawati U. Hematological side effect analysis of linezolid in MDR-TB patients with individual therapy. J Basic Clin Physiol Pharmacol 2021; 32:777-781. [PMID: 34214355 DOI: 10.1515/jbcpp-2020-0468] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 04/07/2021] [Indexed: 01/07/2023]
Abstract
OBJECTIVES This study aimed to estimate the prevalence and analyze the risk factors for linezolid-induced hematological side effects in multidrug-resistant tuberculosis (MDR-TB) patients. METHODS Data were collected from medical records of MDR-TB patients who received linezolid between January 2018 and May 2020. Statistical significance analysis and multivariate analysis were performed with SPSS version 24 software. RESULTS Hematological side effects were identified in 27 out of 93 patients (29.0%). The most prevalent effect was anemia (29.0%), while the less prevalent effects were thrombocytopenia (3.2%) and leukopenia (2.2%). These side effects were reported after 2 weeks of linezolid treatment. The drug dose was more than 11 mg/kgBW/day or patient weighing less than 54 kg was identified as an independent risk factor for anemia in multivariate analysis. CONCLUSIONS Anemia was the most prevalent of linezolid-induced hematological side effects in MDR-TB patients. Therefore, hemoglobin monitoring might be recommended in patients weighing less than 54 kg and after receiving linezolid therapy for at least 2 weeks.
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Affiliation(s)
| | | | - Umi Fatmawati
- Department of Pharmacy, Dr Soetomo General Hospital, Surabaya, Indonesia
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14
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Zhang SH, Wei SS, Zhu ZY, Chen Y, Cai HL, Zhang BK. Physicochemical Assessment of Branded and Generic Linezolid Injection from Different Pharmaceutical Manufacturers. CURR PHARM ANAL 2021. [DOI: 10.2174/1573412916666200224104617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Up to date, generic linezolid injections produced by Chinese manufacturers
were not widely used in clinics in China. Quality evaluation of linezolid injections produced in China
is a prerequisite, which has rarely been performed.
Objective:
This study aimed to evaluate the quality of branded and generic injections from different
manufacturers and to provide a basis for quality control.
Methods:
In this study, the content of linezolid, related impurities and enantiomer of linezolid were
determined by high-performance liquid chromatography. The content of glucose was determined by the
iodine method. The insoluble particles and visible and sub-visible particles were determined by light
blockage and lamp test, respectively. Osmotic pressure was determined by the freezing point depression
method. The standard solution control method was used to check the color of the injection. Linezolid
injections from different manufacturers were evaluated uniformly.
Results:
No significant difference was found in the content of linezolid, glucose, related impurities,
visible particles, insoluble particles, pH value, and solution color between branded and generic drugs
from different manufacturers in China.
Conclusion:
The quality of samples from different manufacturers is consistent. Although the physicochemical
similarity does not guarantee the bioequivalence of studied branded and generic linezolid injections,
the results provide references for further bioequivalence study. Generic injections offer more
affordable treatment options for patients with infections than expensive branded drugs.
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Affiliation(s)
- Su-hua Zhang
- Department of Pharmacy, Second Xiangya Hospital, Central South University, Changsha 410011,China
| | - Shan-shan Wei
- Department of Pharmacy, Second Xiangya Hospital, Central South University, Changsha 410011,China
| | - Zhen-yu Zhu
- Department of Pharmacy, Second Xiangya Hospital, Central South University, Changsha 410011,China
| | - Ying Chen
- Department of Pharmacy, Second Xiangya Hospital, Central South University, Changsha 410011,China
| | - Hua-lin Cai
- Department of Pharmacy, Second Xiangya Hospital, Central South University, Changsha 410011,China
| | - Bi-kui Zhang
- Department of Pharmacy, Second Xiangya Hospital, Central South University, Changsha 410011,China
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Kwak N, Winters N, Campbell JR, Chan ED, Gegia M, Lange C, Lee M, Milanov V, Menzies D, Yim JJ. Changes in treatment for multidrug-resistant tuberculosis according to national income. Eur Respir J 2020; 56:13993003.01394-2020. [PMID: 32586878 DOI: 10.1183/13993003.01394-2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 06/02/2020] [Indexed: 11/05/2022]
Abstract
The aim of this study was to analyse temporal changes in treatments for and outcomes of multidrug-resistant (MDR)/rifampin-resistant (RR)-tuberculosis (TB) in the context of national economic status.We analysed data collected by the Collaborative Group for the Meta-Analysis of Individual Patient Data in MDR-TB Treatment on MDR/RR-TB patients from 37 countries. The data were stratified by three national income levels (low-/lower-middle, upper-middle and high) and grouped by time of treatment initiation (2001-2003, 2004-2006, 2007-2009, 2010-2012 and 2013-2015). Temporal trends over the study period were analysed. The probability of treatment success in different income groups over time was calculated using generalised linear mixed models with random effects.In total, 9036 patients were included in the analysis. Over the study period, use of group A drugs (levofloxacin/moxifloxacin, bedaquiline and linezolid) recommended by the World Health Organization increased and treatment outcomes improved in all income groups. Between 2001-2003 and 2013-2015, treatment success rates increased from 60% to 78% in low-/lower-middle-income countries, from 40% to 67% in upper-middle-income countries, and from 73% to 81% in high-income countries. In earlier years, the probability of treatment success in upper-middle-income countries was lower than that in low-/lower-middle-income countries, but no difference was observed after 2010. However, high-income countries had persistently higher probability of treatment success compared to upper-middle income countries.Improved treatment outcomes and greater uptake of group A drugs were observed over time for patients with MDR/RR-TB at all income levels. However, treatment outcomes are still unsatisfactory, especially in upper-middle-income countries.
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Affiliation(s)
- Nakwon Kwak
- Dept of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Nicholas Winters
- Respiratory Epidemiology and Clinical Research Unit (RECRU), Montreal Chest Institute, McGill University Health Centre Research Institute, McGill University, Montreal, QC, Canada
| | - Jonathon R Campbell
- Respiratory Epidemiology and Clinical Research Unit (RECRU), Montreal Chest Institute, McGill University Health Centre Research Institute, McGill University, Montreal, QC, Canada
| | - Edward D Chan
- Dept of Academic Affairs, National Jewish Health, Denver, CO, USA.,Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, USA
| | - Medea Gegia
- Global Tuberculosis Program, World Health Organization, Geneva, Switzerland
| | - Christoph Lange
- Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany.,German Center for Infection Research, Clinical Tuberculosis Unit, Borstel, Germany.,Respiratory Medicine and International Health, University of Luebeck, Luebeck, Germany.,Dept of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Myungsun Lee
- International Tuberculosis Research Center, Seoul, South Korea
| | - Vladimir Milanov
- Dept of Pulmonary Diseases, Medical University - Sofia, Hospital of Respiratory Diseases "St. Sofia", Sofia, Bulgaria
| | - Dick Menzies
- Respiratory Epidemiology and Clinical Research Unit (RECRU), Montreal Chest Institute, McGill University Health Centre Research Institute, McGill University, Montreal, QC, Canada
| | - Jae-Joon Yim
- Dept of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Seoul National University College of Medicine, Seoul, South Korea
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Guevara Salazar JA, Morán Díaz JR, Ramírez Segura E, Trujillo Ferrara JG. What are the origins of growing microbial resistance? Both Lamarck and Darwin were right. Expert Rev Anti Infect Ther 2020; 19:563-569. [PMID: 33073640 DOI: 10.1080/14787210.2021.1839418] [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] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Microorganisms of clinical importance frequently develop resistance to drug therapy, now a growing problem. The experience with Mycobacterium tuberculosis is a representative example of increasing multi-drug resistance. To avoid reaching a crisis in which patients could be left without adequate treatment, a new strategy is needed. Anti-microbial therapy has historically targeted the mechanisms rather than origin of drug resistance, thus allowing microorganisms to adapt and survive. AREAS COVERED This contribution analyses the historical development (1943-2020) of the evolution of multi-drug resistance by M. tuberculosis strains in light of Darwin's and Lamarck's theories of evolution. EXPERT OPINION Regarding the molecular origin of microbial drug resistance, genetic mutations and epigenetic modifications are known to participate. The analysis of the history of drug resistance by M. tuberculosis evidences a gradual development of resistance to some antibiotics, undoubtedly due to random mutations together with natural selection based on environmental pressures (e.g., antibiotics), representing Darwin's idea. More rapid adaptation of M. tuberculosis to new antibiotic treatments has also occurred, probably because of heritable acquired characteristics, evidencing Lamarck's proposal. Therefore, microbial infections should be treated with an antibiotic producing null or low mutagenic activity along with a resistance inhibitor, preferably in a single medication.
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Affiliation(s)
- Juan Alberto Guevara Salazar
- Departamento De Farmacología, Escuela Superior De Medicina, Instituto Politécnico Nacional, Ciudad De México, CDMX, Mexico
| | - Jessica Rubí Morán Díaz
- Departamento De Farmacología, Escuela Superior De Medicina, Instituto Politécnico Nacional, Ciudad De México, CDMX, Mexico
| | - Enrique Ramírez Segura
- Laboratorio De Bioquímica Médica, Escuela Superior De Medicina, Instituto Politécnico Nacional, Ciudad De México, CDMX, Mexico
| | - José Guadalupe Trujillo Ferrara
- Laboratorio De Bioquímica Médica, Escuela Superior De Medicina, Instituto Politécnico Nacional, Ciudad De México, CDMX, Mexico
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Mohr-Holland E, Reuter A, Furin J, Garcia-Prats A, De Azevedo V, Mudaly V, Kock Y, Trivino-Duran L, Isaakidis P, Hughes J. Injectable-free regimens containing bedaquiline, delamanid, or both for adolescents with rifampicin-resistant tuberculosis in Khayelitsha, South Africa. EClinicalMedicine 2020; 20:100290. [PMID: 32154506 PMCID: PMC7057194 DOI: 10.1016/j.eclinm.2020.100290] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 01/31/2020] [Accepted: 02/07/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Limited data exist on the use of bedaquiline and delamanid in adolescents with rifampicin-resistant tuberculosis (RR-TB). We describe RR-TB treatment of adolescents (10-19 years) with injectable-free regimens containing these drugs in Khayelitsha, South Africa. METHODS This retrospective study included adolescents initiating injectable-free RR-TB treatment regimens containing bedaquiline and/or delamanid from February 2015 to June 2018. We report adverse events (AEs) of interest, sputum culture conversion (SCC), and final end-of-treatment outcomes. FINDINGS Twenty-two patients were included; median age at treatment initiation was 17 years (interquartile range [IQR] 15-18), and six (27%) were HIV-positive (median CD4 count 191 cells/mm3 [IQR 157-204]). Eight (36%) patients had RR-TB with fluoroquinolone resistance; ten (45%), eight (36%), and four (18%) patients received regimens containing bedaquiline, delamanid, or the combination of bedaquiline and delamanid, respectively. The median durations of exposure to bedaquiline and delamanid were 5·6 (IQR 5·5-8·4) and 9·4 (IQR 5·9-14·4) months, respectively. There were 49 AEs of interest which occurred in 17 (77%) patients. Fourteen (64%) patients had pulmonary TB with positive sputum cultures at bedaquiline and/or delamanid initiation; among these SCC at month 6 was 79%. Final end-of-treatment outcomes for the 22 adolescent were: 17 (77%) successfully treated, two (9%) lost-to-follow-up, two (9%) treatment failed, and one (5%) died. INTERPRETATION This study found that injectable-free regimens containing bedaquiline and/or delamanid in a programmatic setting were effective and well tolerated in adolescents and should be routinely provided for RR-TB treatment in this age group as recommended by the World Health Organisation.
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Affiliation(s)
- Erika Mohr-Holland
- Médecins Sans Frontières, Khayelitsha Project and Cape Town Mission, 2nd Floor Isivivana Centre, 1 Julius Tsolo Street, Khayelitsha, Cape Town 7784, South Africa
- Médecins Sans Frontières, Southern Africa Medical Unit, 4th Floor Deneb House, 368 Main Rd, Observatory, Cape Town 7925, South Africa
| | - Anja Reuter
- Médecins Sans Frontières, Khayelitsha Project and Cape Town Mission, 2nd Floor Isivivana Centre, 1 Julius Tsolo Street, Khayelitsha, Cape Town 7784, South Africa
| | - Jennifer Furin
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Ave., Boston 02115, MA, United States
| | - Anthony Garcia-Prats
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Desmond Tutu TB Centre, Stellenbosch University, P.O. Box 241, Cape Town 8000, South Africa
| | - Virginia De Azevedo
- City Health Department, Ntlazane Rd, Khayelitsha, Cape Town 7784, South Africa
| | - Vanessa Mudaly
- Provincial Department of Health- Western Cape, 1st floor Norton Rose House, 8 Riebeek Street Cape Town 8001, South Africa
| | - Yulene Kock
- National Department of Health, Civitas Building, 222 Thabo Sehume St, CBD, Pretoria 0001, South Africa
| | - Laura Trivino-Duran
- Médecins Sans Frontières, Khayelitsha Project and Cape Town Mission, 2nd Floor Isivivana Centre, 1 Julius Tsolo Street, Khayelitsha, Cape Town 7784, South Africa
| | - Petros Isaakidis
- Médecins Sans Frontières, Southern Africa Medical Unit, 4th Floor Deneb House, 368 Main Rd, Observatory, Cape Town 7925, South Africa
| | - Jennifer Hughes
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Desmond Tutu TB Centre, Stellenbosch University, P.O. Box 241, Cape Town 8000, South Africa
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18
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Minakshi P, Ghosh M, Brar B, Kumar R, Lambe UP, Ranjan K, Manoj J, Prasad G. Nano-antimicrobials: A New Paradigm for Combating Mycobacterial Resistance. Curr Pharm Des 2020; 25:1554-1579. [PMID: 31218956 DOI: 10.2174/1381612825666190620094041] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 06/11/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Mycobacterium group contains several pathogenic bacteria including M. tuberculosis where the emergence of multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) is alarming for human and animal health around the world. The condition has further aggravated due to the speed of discovery of the newer drugs has been outpaced by the rate of resistance developed in microorganisms, thus requiring alternative combat strategies. For this purpose, nano-antimicrobials have emerged as a potential option. OBJECTIVE The current review is focused on providing a detailed account of nanocarriers like liposome, micelles, dendrimers, solid lipid NPs, niosomes, polymeric nanoparticles, nano-suspensions, nano-emulsion, mesoporous silica and alginate-based drug delivery systems along with the recent updates on developments regarding nanoparticle-based therapeutics, vaccines and diagnostic methods developed or under pipeline with their potential benefits and limitations to combat mycobacterial diseases for their successful eradication from the world in future. RESULTS Distinct morphology and the underlying mechanism of pathogenesis and resistance development in this group of organisms urge improved and novel methods for the early and efficient diagnosis, treatment and vaccination to eradicate the disease. Recent developments in nanotechnology have the potential to meet both the aspects: nano-materials are proven components of several efficient targeted drug delivery systems and the typical physicochemical properties of several nano-formulations have shown to possess distinct bacteriocidal properties. Along with the therapeutic aspects, nano-vaccines and theranostic applications of nano-formulations have grown in popularity in recent times as an effective alternative means to combat different microbial superbugs. CONCLUSION Nanomedicine holds a bright prospect to perform a key role in global tuberculosis elimination program.
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Affiliation(s)
- Prasad Minakshi
- Department of Animal Biotechnology, LLR University of Veterinary and Animal Sciences, Hisar-125 004, Haryana, India
| | - Mayukh Ghosh
- Department of Veterinary Biochemistry, Ranchi Veterinary College, Birsa Agricultural University, Ranchi-834 006, Jharkhand, India
| | - Basanti Brar
- Department of Animal Biotechnology, LLR University of Veterinary and Animal Sciences, Hisar-125 004, Haryana, India
| | - Rajesh Kumar
- Department of Veterinary Physiology, COVAS, KVASU, Pookode, Wayanad- 673576, Kerala, India
| | - Upendra P Lambe
- Department of Animal Biotechnology, LLR University of Veterinary and Animal Sciences, Hisar-125 004, Haryana, India
| | | | - Jinu Manoj
- RVDEC Mahendergarh, LUVAS, Haryana, India
| | - Gaya Prasad
- SVP University of Agriculture and Technology, Meerut, India
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19
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Salhotra VS, Sachdeva KS, Kshirsagar N, Parmar M, Ramachandran R, Padmapriyadarsini C, Patel Y, Mehandru L, Jaju J, Ponnuraja C, Gupta M, Kalaiselvan V, Shamim A, Khaparde S, Swaminathan S. Effectiveness and safety of bedaquiline under conditional access program for treatment of drug-resistant tuberculosis in India: An interim analysis. Indian J Tuberc 2019; 67:29-37. [PMID: 32192613 DOI: 10.1016/j.ijtb.2019.10.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 10/10/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND India accounts for a quarter of the world's multidrug-resistant tuberculosis (MDR-TB); with less than 50% having successful treatment outcomes. Bedaquiline (BDQ) was approved for use under conditional access program in India in 2015. OBJECTIVE We evaluate the effectiveness, safety, and tolerability of a BDQ containing regimen used under field settings in India. METHOD Interim analysis of a prospective cohort of MDR-TB patients on a BDQ containing regimen at six sites in the country. RESULTS Six hundred and twenty MDR-TB patients [349 (56%) males; 554 (89%) between 18 and 50 years and 240 (39%) severely malnourished] were started on BDQ containing regimen between June 2016 and August 2017. There 354 (57%) patients had MDR-TB with additional drug resistance to fluoroquinolone (MDRFQ); 31 (5%) with additional resistance to second-line injectable (MDRSLI) and 101 (16%) extensively drug-resistant TB. After 6 months of treatment, culture conversion was achieved in 513 of 620 (83%) patients. The median time to culture conversion was 60 days. Higher body mass index was the only factor associated with faster culture conversion (HR 1.97; 95% CI 1.24-2.9). Around 100 patients (16.3%) experienced a ≥60-ms increase in QTc interval during the treatment. Seventy-three (12%) deaths were reported, the majority of them (56%) occurring within the first 6 months of treatment. CONCLUSIONS BDQ with a background regimen has the potential to achieve higher and faster culture conversion rates with a lower toxicity profile among DR-TB patients. Use of BDQ with additional monitoring may be safe and effective even in the field settings.
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Affiliation(s)
- V S Salhotra
- Central TB Division, Ministry of Health and Family Welfare, India.
| | - K S Sachdeva
- Central TB Division, Ministry of Health and Family Welfare, India.
| | - Neelima Kshirsagar
- Clinical Pharmacology, Indian Council of Medical Research, New Delhi, India.
| | | | | | | | - Yogesh Patel
- Central TB Division, Ministry of Health and Family Welfare, India.
| | - Lalit Mehandru
- Central TB Division, Ministry of Health and Family Welfare, India.
| | - Jyoti Jaju
- Central TB Division, Ministry of Health and Family Welfare, India.
| | - C Ponnuraja
- ICMR, National Institute for Research in Tuberculosis, Chennai, India.
| | | | - V Kalaiselvan
- Indian Pharmacopoeia Commission, Ministry of Health & Family Welfare, India.
| | - Almas Shamim
- Central TB Division, Ministry of Health and Family Welfare, India.
| | - S Khaparde
- Central TB Division, Ministry of Health and Family Welfare, India.
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20
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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: 0.4] [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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21
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Millard J, Pertinez H, Bonnett L, Hodel EM, Dartois V, Johnson JL, Caws M, Tiberi S, Bolhuis M, Alffenaar JWC, Davies G, Sloan DJ. Linezolid pharmacokinetics in MDR-TB: a systematic review, meta-analysis and Monte Carlo simulation. J Antimicrob Chemother 2019; 73:1755-1762. [PMID: 29584861 PMCID: PMC6005026 DOI: 10.1093/jac/dky096] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 02/26/2018] [Indexed: 01/16/2023] Open
Abstract
Objectives The oxazolidinone linezolid is an effective component of drug-resistant TB treatment, but its use is limited by toxicity and the optimum dose is uncertain. Current strategies are not informed by clinical pharmacokinetic (PK)/pharmacodynamic (PD) data; we aimed to address this gap. Methods We defined linezolid PK/PD targets for efficacy (fAUC0–24:MIC >119 mg/L/h) and safety (fCmin <1.38 mg/L). We extracted individual-level linezolid PK data from existing studies on TB patients and performed meta-analysis, producing summary estimates of fAUC0–24 and fCmin for published doses. Combining these with a published MIC distribution, we performed Monte Carlo simulations of target attainment. Results The efficacy target was attained in all simulated individuals at 300 mg q12h and 600 mg q12h, but only 20.7% missed the safety target at 300 mg q12h versus 98.5% at 600 mg q12h. Although suggesting 300 mg q12h should be used preferentially, these data were reliant on a single centre. Efficacy and safety targets were missed by 41.0% and 24.2%, respectively, at 300 mg q24h and by 44.6% and 27.5%, respectively, at 600 mg q24h. However, the confounding effect of between-study heterogeneity on target attainment for q24h regimens was considerable. Conclusions Linezolid dosing at 300 mg q12h may retain the efficacy of the 600 mg q12h licensed dosing with improved safety. Data to evaluate commonly used 300 mg q24h and 600 mg q24h doses are limited. Comprehensive, prospectively obtained PK/PD data for linezolid doses in drug-resistant TB treatment are required.
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Affiliation(s)
- James Millard
- Wellcome Trust Liverpool Glasgow Centre for Global Health Research, Liverpool, UK.,Institute of Infection and Global Health, University of Liverpool, Liverpool, UK.,Africa Health Research Institute, Durban, South Africa
| | - Henry Pertinez
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - Laura Bonnett
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK.,Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Eva Maria Hodel
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK.,Liverpool School of Tropical Medicine, Liverpool, UK
| | - Véronique Dartois
- Public Health Research Institute, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - John L Johnson
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Maxine Caws
- Liverpool School of Tropical Medicine, Liverpool, UK.,Birat-Nepal Medical Trust, Lazimpat, Kathmandu, Nepal
| | - Simon Tiberi
- Department of Infection, Barts Health National Health Service Trust, London, UK
| | - Mathieu Bolhuis
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, Groningen, The Netherlands
| | - Jan-Willem C Alffenaar
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, Groningen, The Netherlands
| | - Geraint Davies
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - Derek J Sloan
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK.,Liverpool School of Tropical Medicine, Liverpool, UK.,School of Medicine, University of St Andrews, St Andrews, UK
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22
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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: 2.4] [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
| | - Ben J Marais
- Department of Infectious Diseases and Microbiology, The Children's Hospital Westmead, New South Wales, Australia
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23
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Olayanju O, Esmail A, Limberis J, Gina P, Dheda K. Linezolid interruption in patients with fluoroquinolone-resistant tuberculosis receiving a bedaquiline-based treatment regimen. Int J Infect Dis 2019; 85:74-79. [PMID: 31100421 DOI: 10.1016/j.ijid.2019.04.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 04/25/2019] [Accepted: 04/26/2019] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Treatment outcomes of patients with extensively drug-resistant tuberculosis (XDR-TB) are suboptimal and treatment options remain limited. Linezolid is associated with improved outcomes but also substantial toxicity, and details about the relationship between these are lacking from resource-poor HIV-endemic settings. METHODS This was a prospective follow-up study of 63 South African XDR-TB patients (58.7% HIV-infected; median CD4 131 cells/μl) between 2014 and 2018. The frequency and severity of linezolid-associated adverse events and the impact on treatment outcomes were compared between linezolid interrupters and non-interrupters. RESULTS Twenty-two patients (34.9%) discontinued or underwent dose reduction due to presumed linezolid-associated toxicity. Anaemia (77.3% vs. 7.3%; p< 0.001), peripheral neuropathy (63.6% vs. 14.6%; p= 0.003), and optic neuritis (18.2% vs. 9.8%; p= 0.34) occurred more frequently in linezolid interrupters than in non-interrupters. Anaemia, peripheral neuropathy, and optic neuritis occurred at a median of 5, 18, and 23 weeks, respectively, after treatment initiation. Linezolid interruption was not associated with unfavourable outcomes but was strongly associated with HIV co-infection (adjusted hazard ratio 4.831, 95% confidence interval 1.526-15.297; p= 0.007) and bacterial load (culture days to positivity; adjusted hazard ratio 0.824, 95% confidence interval 0.732- 0.927; p= 0.001). CONCLUSIONS Linezolid-related treatment interruption is common, is strongly associated with HIV co-infection, and system-specific toxicity occurs within predictable time frames. These data inform the clinical management of patients with drug-resistant TB.
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Affiliation(s)
- Olatunde Olayanju
- Centre for Lung Infection and Immunity Unit, Division of Pulmonology, Department of Medicine, University of Cape Town, South Africa
| | - Aliasgar Esmail
- Centre for Lung Infection and Immunity Unit, Division of Pulmonology, Department of Medicine, University of Cape Town, South Africa
| | - Jason Limberis
- Centre for Lung Infection and Immunity Unit, Division of Pulmonology, Department of Medicine, University of Cape Town, South Africa
| | - Phindile Gina
- Centre for Lung Infection and Immunity Unit, Division of Pulmonology, Department of Medicine, University of Cape Town, South Africa
| | - Keertan Dheda
- Centre for Lung Infection and Immunity Unit, Division of Pulmonology, Department of Medicine, University of Cape Town, South Africa; Faculty of Infectious and Tropical Diseases, Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, UK.
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24
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Fernandes GFDS, Salgado HRN, Santos JLD. A critical review of HPLC-based analytical methods for quantification of Linezolid. Crit Rev Anal Chem 2019; 50:196-211. [PMID: 31017000 DOI: 10.1080/10408347.2019.1605876] [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: 12/29/2022]
Abstract
Linezolid is a synthetic antimicrobial agent belonging to the oxazolidinone class. Since its approval in the year 2000 until now, linezolid remains the main representative drug for the oxazolidinone class of drugs, which is used in therapy due to its unique mode of action, which involves inhibition of protein synthesis. As linezolid holds great importance in antimicrobial therapy, it is necessary to compile the various analytical methods that have been reported in the literature for its analysis. Analytical techniques used for pharmaceutical analyses and therapeutic drug monitoring play an important role in comprehending the aspects regarding bioavailability, bioequivalence, and therapeutic monitoring during patient follow-ups. Even though linezolid has had the approval for clinical use for more than 18 years now, most of the analytical methods for its determination reported in the scientific literature are the ones which utilize HPLC. Therefore, the present review provides a summary of the HPLC-based methods used in the determination and quantification of linezolid in different matrices since the time of its discovery.
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Affiliation(s)
- Guilherme Felipe Dos Santos Fernandes
- Institute of Chemistry, São Paulo State University, Araraquara, Brazil.,School of Pharmaceutical Sciences, São Paulo State University, Araraquara, Brazil
| | | | - Jean Leandro Dos Santos
- Institute of Chemistry, São Paulo State University, Araraquara, Brazil.,School of Pharmaceutical Sciences, São Paulo State University, Araraquara, Brazil
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25
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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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26
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Abstract
BACKGROUND Linezolid was recently re-classified as a Group A drug by the World Health Organization (WHO) for treatment of multi-drug resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB), suggesting that it should be included in the regimen for all patients unless contraindicated. Linezolid use carries a considerable risk of toxicity, with the optimal dose and duration remaining unclear. Current guidelines are mainly based on evidence from observational non-comparative studies. OBJECTIVES To assess the efficacy of linezolid when used as part of a second-line regimen for treating people with MDR and XDR pulmonary tuberculosis, and to assess the prevalence and severity of adverse events associated with linezolid use in this patient group. SEARCH METHODS We searched the following databases: the Cochrane Infectious Diseases Specialized Register; CENTRAL; MEDLINE; Embase; and LILACS up to 13 July 2018. We also checked article reference lists and contacted researchers in the field. SELECTION CRITERIA We included studies in which some participants received linezolid, and others did not. We included randomized controlled trials (RCTs) of linezolid for MDR and XDR pulmonary tuberculosis to evaluate efficacy outcomes. We added non-randomized cohort studies to evaluate adverse events.Primary outcomes were all-cause and tuberculosis-associated death, treatment failure, and cure. Secondary outcomes were treatment interrupted, treatment completed, and time to sputum culture conversion. We recorded frequency of all and serious adverse events, adverse events leading to drug discontinuation or dose reduction, and adverse events attributed to linezolid, particularly neuropathy, anaemia, and thrombocytopenia. DATA COLLECTION AND ANALYSIS Two review authors (BS and DC) independently assessed the search results for eligibility and extracted data from included studies. All review authors assessed risk of bias using the Cochrane 'Risk of bias' tool for RCTs and the ROBINS-I tool for non-randomized studies. We contacted study authors for clarification and additional data when necessary.We were unable to perform a meta-analysis as one of the RCTs adopted a study design where participants in the study group received linezolid immediately and participants in the control group received linezolid after two months, and therefore there were no comparable data from this trial. We deemed meta-analysis of non-randomized study data inappropriate. MAIN RESULTS We identified three RCTs for inclusion. One of these studies had serious problems with allocation of the study drug and placebo, so we could not analyse data for intervention effect from it. The remaining two RCTs recruited 104 participants. One randomized 65 participants to receive linezolid or not, in addition to a background regimen; the other randomized 39 participants to addition of linezolid to a background regimen immediately, or after a delay of two months. We included 14 non-randomized cohort studies (two prospective, 12 retrospective), with a total of 1678 participants.Settings varied in terms of income and tuberculosis burden. One RCT and 7 out of 14 non-randomized studies commenced recruitment in or after 2009. All RCT participants and 38.7% of non-randomized participants were reported to have XDR-TB.Dosing and duration of linezolid in studies were variable and reported inconsistently. Daily doses ranged from 300 mg to 1200 mg; some studies had planned dose reduction for all participants after a set time, others had incompletely reported dose reductions for some participants, and most did not report numbers of participants receiving each dose. Mean or median duration of linezolid therapy was longer than 90 days in eight of the 14 non-randomized cohorts that reported this information.Duration of participant follow-up varied between RCTs. Only five out of 14 non-randomized studies reported follow-up duration.Both RCTs were at low risk of reporting bias and unclear risk of selection bias. One RCT was at high risk of performance and detection bias, and low risk for attrition bias, for all outcomes. The other RCT was at low risk of detection and attrition bias for the primary outcome, with unclear risk of detection and attrition bias for non-primary outcomes, and unclear risk of performance bias for all outcomes. Overall risk of bias for the non-randomized studies was critical for three studies, and serious for the remaining 11.One RCT reported higher cure (risk ratio (RR) 2.36, 95% confidence interval (CI) 1.13 to 4.90, very low-certainty evidence), lower failure (RR 0.26, 95% CI 0.10 to 0.70, very low-certainty evidence), and higher sputum culture conversion at 24 months (RR 2.10, 95% CI 1.30 to 3.40, very low-certainty evidence), amongst the linezolid-treated group than controls, with no differences in other primary and secondary outcomes. This study also found more anaemia (17/33 versus 2/32), nausea and vomiting, and neuropathy (14/33 versus 1/32) events amongst linezolid-receiving participants. Linezolid was discontinued early and permanently in two of 33 (6.1%) participants who received it.The other RCT reported higher sputum culture conversion four months after randomization (RR 2.26, 95% CI 1.19 to 4.28), amongst the group who received linezolid immediately compared to the group who had linezolid initiation delayed by two months. Linezolid was discontinued early and permanently in seven of 39 (17.9%) participants who received it.Linezolid discontinuation occurred in 22.6% (141/624; 11 studies), of participants in the non-randomized studies. Total, serious, and linezolid-attributed adverse events could not be summarized quantitatively or comparatively, due to incompleteness of data on duration of follow-up and numbers of participants experiencing events. AUTHORS' CONCLUSIONS We found some evidence of efficacy of linezolid for drug-resistant pulmonary tuberculosis from RCTs in participants with XDR-TB but adverse events and discontinuation of linezolid were common. Overall, there is a lack of comparative data on efficacy and safety. Serious risk of bias and heterogeneity in conducting and reporting non-randomized studies makes the existing, mostly retrospective, data difficult to interpret. Further prospective cohort studies or RCTs in high tuberculosis burden low-income and lower-middle-income countries would be useful to inform policymakers and clinicians of the efficacy and safety of linezolid as a component of drug-resistant TB treatment regimens.
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Affiliation(s)
- Bhagteshwar Singh
- Royal Liverpool University HospitalTropical and Infectious Diseases UnitLiverpoolUK
- University of LiverpoolInstitute of Infection & Global HealthLiverpoolUK
- Liverpool School of Tropical MedicineDepartment of Clinical SciencesLiverpoolUK
| | - Derek Cocker
- Liverpool School of Tropical MedicineDepartment of Clinical SciencesLiverpoolUK
- Northwick Park HospitalWatford RoadHarrowMiddlesexUKHA1 3UJ
| | - Hannah Ryan
- Royal Liverpool University HospitalTropical and Infectious Diseases UnitLiverpoolUK
- Liverpool School of Tropical MedicineDepartment of Clinical SciencesLiverpoolUK
| | - Derek J Sloan
- Liverpool School of Tropical MedicineDepartment of Clinical SciencesLiverpoolUK
- University of St AndrewsSchool of MedicineNorth HaughSt AndrewsUK
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27
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Lee M, Mok J, Kim DK, Shim TS, Koh WJ, Jeon D, Lee T, Lee SH, Kim JS, Park JS, Lee JY, Kim SY, Lee JH, Jo KW, Jhun BW, Kang YA, Ahn JH, Kim CK, Shin S, Song T, Shin SJ, Kim YR, Ahn H, Hahn S, Won HJ, Jang JY, Cho SN, Yim JJ. Delamanid, linezolid, levofloxacin, and pyrazinamide for the treatment of patients with fluoroquinolone-sensitive multidrug-resistant tuberculosis (Treatment Shortening of MDR-TB Using Existing and New Drugs, MDR-END): study protocol for a phase II/III, multicenter, randomized, open-label clinical trial. Trials 2019; 20:57. [PMID: 30651149 PMCID: PMC6335682 DOI: 10.1186/s13063-018-3053-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 11/14/2018] [Indexed: 01/15/2023] Open
Abstract
Background Treatment success rates of multidrug-resistant tuberculosis (MDR-TB) remain unsatisfactory, and long-term use of second-line anti-TB drugs is accompanied by the frequent occurrence of adverse events, low treatment compliance, and high costs. The development of new efficient regimens with shorter treatment durations for MDR-TB will solve these issues and improve treatment outcomes. Methods This study is a phase II/III, multicenter, randomized, open-label clinical trial of non-inferiority design comparing a new regimen to the World Health Organization-endorsed conventional regimen for fluoroquinolone-sensitive MDR-TB. The control arm uses a conventional treatment regimen with second-line drugs including injectables for 20–24 months. The investigational arm uses a new shorter regimen including delamanid, linezolid, levofloxacin, and pyrazinamide for 9 or 12 months depending on time to sputum culture conversion. The primary outcome is the treatment success rate at 24 months after treatment initiation. Secondary outcomes include time to sputum culture conversion on liquid and solid media, proportions of sputum culture conversion on liquid media after 2 and 6 months of treatment, treatment success rate according to pyrazinamide resistance, and occurrence of adverse events grade 3 and above as evaluated by the Common Terminology Criteria for Adverse Events. Based on an α = 0.025 level of significance (one-sided test), a power of 80%, and a < 10% difference in treatment success rate between the control and investigational arms (80% vs. 70%) when the anticipated actual success rate in the treatment group is assumed to be 90%, the number of participants needed per arm to show non-inferiority of the investigational regimen was calculated as 48. Additionally, assuming the proportion of fluoroquinolone-susceptible MDR-TB among participants as 50%, and 5% loss to follow-up, the number of participants is calculated as N/( 0.50 × 0.95), resulting in 102 persons per group (204 in total). Discussion This trial will reveal the effectiveness and safety of a new shorter regimen comprising four oral drugs, including delamanid, linezolid, levofloxacin, and pyrazinamide, for the treatment of fluoroquinolone-sensitive MDR-TB. Results from this trial will provide evidence for adopting a shorter and more convenient treatment regimen for MDR-TB. Trial registration ClincalTrials.gov, NCT02619994. Registered on 2 December 2015. Electronic supplementary material The online version of this article (10.1186/s13063-018-3053-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Myungsun Lee
- Clinical Research Section, International Tuberculosis Research Center, 247, Jangchungdan-ro, Jung-gu, Seoul, 04564, Republic of Korea
| | - Jeongha Mok
- Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, Pusan National University Hospital, 179, Gudeok-ro, Seo-gu, Busan, 49241, Republic of Korea
| | - Deog Kyeom Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Boramae Medical Center, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, Republic of Korea
| | - Tae Sun Shim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Won-Jung Koh
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Doosoo Jeon
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Pusan National University Yangsan Hospital, 20, Geumo-ro, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, 50612, Republic of Korea
| | - Taehoon Lee
- Department of Pulmonology, Ulsan University Hospital, University of Ulsan College of Medicine, 877, Bangeojinsunhwando-ro, Dong-gu, Ulsan, 44033, Republic of Korea
| | - Seung Heon Lee
- Department of Pulmonology, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-gu, Ansan, Gyeonggi-do, 15355, Republic of Korea
| | - Ju Sang Kim
- Department of Pulmonary and Critical Care Medicine, Department of Internal Medicine, The Catholic University of Korea, Incheon St. Mary's Hospital, 56, Dongsu-ro, Bupyeong-gu, Incheon, 21431, Republic of Korea
| | - Jae Seuk Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Dankook University Hospital, 201, Manghyang-ro, Dongnam-gu, Cheonan-si, Chungcheongnam-do, 31116, Republic of Korea
| | - Ji Yeon Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Medical Center, 245, Eulji-ro, Jung-gu, Seoul, 04564, Republic of Korea
| | - Song Yee Kim
- Division of Pulmonology, Department of Internal Medicine, Institute of Chest Diseases, Severance Hospital, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Jae Ho Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Kyung-Wook Jo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Byung Woo Jhun
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Young Ae Kang
- Division of Pulmonology, Department of Internal Medicine, Institute of Chest Diseases, Severance Hospital, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Joong Hyun Ahn
- Department of Pulmonary and Critical Care Medicine, Department of Internal Medicine, The Catholic University of Korea, Incheon St. Mary's Hospital, 56, Dongsu-ro, Bupyeong-gu, Incheon, 21431, Republic of Korea
| | - Chang-Ki Kim
- Seoul Clinical Laboratories, 13, Heungdeok 1-ro, Giheung-gu, Yongin, Gyeonggi-do, 16954, Republic of Korea
| | - Soyoun Shin
- Laboratory Medicine Center, The Korean Institute of Tuberculosis, 168-5, Osongsaengmyeong 4-ro, Osong-eup, Heungdeok-gu, Cheongju-si, Chungcheongbuk-do, 28158, Republic of Korea
| | - Taeksun Song
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Rondebosch 7701, Cape Town, South Africa
| | - Sung Jae Shin
- Department of Microbiology, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Young Ran Kim
- Clinical Research Section, International Tuberculosis Research Center, 247, Jangchungdan-ro, Jung-gu, Seoul, 04564, Republic of Korea
| | - Heejung Ahn
- Medical Research Collaborating Center, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Seokyung Hahn
- Medical Research Collaborating Center, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Ho Jeong Won
- Medical Research Collaborating Center, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Ji Yeon Jang
- Medical Research Collaborating Center, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Sang Nae Cho
- Clinical Research Section, International Tuberculosis Research Center, 247, Jangchungdan-ro, Jung-gu, Seoul, 04564, Republic of Korea
| | - Jae-Joon Yim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, 103, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
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Affiliation(s)
- Sang-Won Yoon
- Division of Pulmonary Medicine, Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jae Chol Choi
- Division of Pulmonary Medicine, Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
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Rode HB, Lade DM, Grée R, Mainkar PS, Chandrasekhar S. Strategies towards the synthesis of anti-tuberculosis drugs. Org Biomol Chem 2019; 17:5428-5459. [DOI: 10.1039/c9ob00817a] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
In this report, we reviewed the strategies towards the synthesis of anti-tuberculosis drugs. They include semisynthetic approaches, resolution based strategies, microbial transformations, solid phase synthesis, and asymmetric synthesis.
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Affiliation(s)
- Haridas B. Rode
- Department of Organic Synthesis and Process Chemistry
- CSIR-Indian Institute of Chemical Technology
- Hyderabad-500007
- India
- Academy of Scientific and Innovative Research (AcSIR)
| | - Dhanaji M. Lade
- Department of Organic Synthesis and Process Chemistry
- CSIR-Indian Institute of Chemical Technology
- Hyderabad-500007
- India
- Academy of Scientific and Innovative Research (AcSIR)
| | - René Grée
- University of Rennes
- CNRS
- ISCR (Institut des Sciences Chimiques de Rennes)
- UMR 6226
- F-35000 Rennes
| | - Prathama S. Mainkar
- Department of Organic Synthesis and Process Chemistry
- CSIR-Indian Institute of Chemical Technology
- Hyderabad-500007
- India
- Academy of Scientific and Innovative Research (AcSIR)
| | - Srivari Chandrasekhar
- Department of Organic Synthesis and Process Chemistry
- CSIR-Indian Institute of Chemical Technology
- Hyderabad-500007
- India
- Academy of Scientific and Innovative Research (AcSIR)
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Comparison of In Vitro Activity and MIC Distributions between the Novel Oxazolidinone Delpazolid and Linezolid against Multidrug-Resistant and Extensively Drug-Resistant Mycobacterium tuberculosis in China. Antimicrob Agents Chemother 2018; 62:AAC.00165-18. [PMID: 29844043 DOI: 10.1128/aac.00165-18] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 05/21/2018] [Indexed: 01/08/2023] Open
Abstract
Oxazolidinones are efficacious in treating mycobacterial infections, including tuberculosis (TB) caused by drug-resistant Mycobacterium tuberculosis In this study, we compared the in vitro activities and MIC distributions of delpazolid, a novel oxazolidinone, and linezolid against multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB) in China. Additionally, genetic mutations in 23S rRNA, rplC, and rplD genes were analyzed to reveal potential mechanisms underlying the observed oxazolidinone resistance. A total of 240 M. tuberculosis isolates were included in this study, including 120 MDR-TB isolates and 120 XDR-TB isolates. Overall, linezolid and delpazolid MIC90 values for M. tuberculosis isolates were 0.25 mg/liter and 0.5 mg/liter, respectively. Based on visual inspection, we tentatively set epidemiological cutoff (ECOFF) values for MIC determinations for linezolid and delpazolid at 1.0 mg/liter and 2.0 mg/liter, respectively. Although no significant difference in resistance rates was observed between linezolid and delpazolid among XDR-TB isolates (P > 0.05), statistical analysis revealed a significantly greater proportion of linezolid-resistant isolates than delpazolid-resistant isolates within the MDR-TB group (P = 0.036). Seven (53.85%) of 13 linezolid-resistant isolates were found to harbor mutations within the three target genes. Additionally, 1 isolate exhibited an amino acid substitution (Arg126His) within the protein encoded by rplD that contributed to high-level resistance to linezolid (MIC of >16 mg/liter), compared to a delpazolid MIC of 0.25. In conclusion, in vitro susceptibility testing revealed that delpazolid antibacterial activity was comparable to that of linezolid. A novel mutation within rplD that endowed M. tuberculosis with linezolid, but not delpazolid, resistance was identified.
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Effect of bedaquiline on mortality in South African patients with drug-resistant tuberculosis: a retrospective cohort study. THE LANCET RESPIRATORY MEDICINE 2018; 6:699-706. [PMID: 30001994 DOI: 10.1016/s2213-2600(18)30235-2] [Citation(s) in RCA: 156] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 05/24/2018] [Accepted: 05/31/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND Addition of bedaquiline to treatment for multidrug-resistant tuberculosis was associated with an increased risk of death in a phase 2b clinical trial, resulting in caution from WHO. Following a compassionate access programme and local regulatory approval, the South African National Tuberculosis Programme began widespread use of bedaquiline in March, 2015, especially among patients with extensively drug resistant tuberculosis for whom no other effective treatment options were available. We aimed to compare mortality in patients on standard regimens with that of patients on regimens including bedaquiline. METHODS In this retrospective cohort study, we analysed patient data from the South African rifampicin-resistant tuberculosis case register (EDRweb), and identified additional mortality using the national vital statistics register. We excluded patients who started treatment before July 1, 2014, or after March 31, 2016; patients younger than 15 years or older than 75 years; patients without documented rifampicin resistance, and patients with pre-extensively drug-resistant tuberculosis (multidrug-resistant tuberculosis with further resistance to a second-line injectable or fluoroquinolone). We compared all-cause mortality between patients who received bedaquiline in treatment regimens and those who did not. Patients who did not receive bedaquiline had kanamycin or capreomycin and moxifloxacin as core medicines in their regimen. We estimated hazard ratios for mortality separately for multidrug-resistant or rifampicin-resistant tuberculosis and extensively drug-resistant tuberculosis and adjusted using propensity score quintile strata for the potential confounders of sex, age, HIV and antiretroviral therapy status, history of prior tuberculosis, valid identification number, and year and province of treatment. FINDINGS 24 014 tuberculosis cases were registered in the EDRweb between July 1, 2014, and March 31, 2016. Of these, 19 617 patients initiated treatment and met our analysis eligibility criteria. A bedaquiline-containing regimen was given to 743 (4·0%) of 18 542 patients with multidrug-resistant or rifampicin-resistant tuberculosis and 273 (25·4%) of 1075 patients with extensively drug-resistant tuberculosis. Among 1016 patients who received bedaquiline, 128 deaths (12·6%) were reported, and there were 4612 deaths (24·8%) among 18 601 patients on the standard regimens. Bedaquiline was associated with a reduction in the risk of all-cause mortality for patients with multidrug-resistant or rifampicin-resistant tuberculosis (hazard ratio [HR] 0·35, 95% CI 0·28-0·46) and extensively drug-resistant tuberculosis (0·26, 0·18-0·38) compared with standard regimens. INTERPRETATION Our retrospective cohort analysis of routinely reported data in the context of high HIV and extensively drug-resistant tuberculosis prevalence showed that bedaquiline-based treatment regimens were associated with a large reduction in mortality in patients with drug-resistant tuberculosis, compared with the standard regimen. FUNDING None.
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Hashemian SMR, Farhadi T, Ganjparvar M. Linezolid: a review of its properties, function, and use in critical care. DRUG DESIGN DEVELOPMENT AND THERAPY 2018; 12:1759-1767. [PMID: 29950810 PMCID: PMC6014438 DOI: 10.2147/dddt.s164515] [Citation(s) in RCA: 177] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Linezolid can be considered as the first member of the class of oxazolidinone antibiotics. The compound is a synthetic antibiotic that inhibits bacterial protein synthesis through binding to rRNA. It also inhibits the creation of the initiation complex during protein synthesis which can reduce the length of the developed peptide chains, and decrease the rate of reaction of translation elongation. Linezolid has been approved for the treatment of infections caused by vancomycin-resistant Enterococcus faecium, hospital-acquired pneumonia caused by Staphylococcus aureus, complicated skin and skin structure infections (SSSIs), uncomplicated SSSIs caused by methicillin-susceptible S. aureus or Streptococcus pyogenes, and community-acquired pneumonia caused by Streptococcus pneumoniae. Analysis of high-resolution structures of linezolid has demonstrated that it binds a deep cleft of the 50S ribosomal subunit that is surrounded by 23S rRNA nucleotides. Mutation of 23S rRNA was shown to be a linezolid resistance mechanism. Besides, mutations in specific regions of ribosomal proteins uL3 and uL4 are increasingly associated with linezolid resistance. However, these proteins are located further away from the bound drug. The methicillin-resistant S. aureus and vancomycin-resistant enterococci are considered the most common Gram-positive bacteria found in intensive care units (ICUs), and linezolid, as an antimicrobial drug, is commonly utilized to treat infected ICU patients. The drug has favorable in vitro and in vivo activity against the mentioned organisms and is considered as a useful antibiotic to treat infections in the ICU.
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Affiliation(s)
- Seyed Mohammad Reza Hashemian
- Chronic Respiratory Disease Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Tayebeh Farhadi
- Chronic Respiratory Disease Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mojdeh Ganjparvar
- Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran
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Esmail A, Sabur NF, Okpechi I, Dheda K. Management of drug-resistant tuberculosis in special sub-populations including those with HIV co-infection, pregnancy, diabetes, organ-specific dysfunction, and in the critically ill. J Thorac Dis 2018; 10:3102-3118. [PMID: 29997980 DOI: 10.21037/jtd.2018.05.11] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Tuberculosis remains a major problem globally, and is the leading cause of death from an infectious agent. Drug-resistant tuberculosis threatens to marginalise the substantial gains that have recently been made in the fight against tuberculosis. Drug-resistant TB has significant associated morbidity and a high mortality, with only half of all multidrug-resistant TB patients achieving a successful treatment outcome. Patients with drug-resistant TB in resource-poor settings are now gaining access to newer and repurposed anti-tuberculosis drugs such as bedaquiline, delamanid and linezolid. However, with ever increasing rates of co-morbidity, there is little guidance on how to manage complex patients with drug-resistant TB. We address that knowledge gap, and outline principles underpinning the management of drug-resistant TB in special situations including HIV co-infection, pregnancy, renal disease, liver disease, diabetes, and in the critically ill.
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Affiliation(s)
- Aliasgar Esmail
- 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
| | - Natasha F Sabur
- 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.,Division of Respirology, Department of Medicine, St. Michael's Hospital and West Park Healthcare Centre, Toronto, Canada
| | - Ikechi Okpechi
- Division of Nephrology, Department of Medicine University of Cape Town, Cape Town, South Africa
| | - 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.,Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa
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Schnippel K, Firnhaber C, Berhanu R, Page-Shipp L, Sinanovic E. Adverse drug reactions during drug-resistant TB treatment in high HIV prevalence settings: a systematic review and meta-analysis. J Antimicrob Chemother 2018; 72:1871-1879. [PMID: 28419314 DOI: 10.1093/jac/dkx107] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Accepted: 03/13/2017] [Indexed: 01/16/2023] Open
Abstract
Objectives To estimate the prevalence of adverse drug reactions or events (ADR) during drug-resistant TB (DR-TB) treatment in the context of settings with high HIV prevalence (at least 20% of patients). Methods We conducted a systematic review and meta-analysis of articles in PubMed and Scopus. Pooled proportions of patients experiencing adverse events and relative risk with 95% CI were calculated. Results The search yielded 24 studies, all observational cohorts. Ten reported on the number of patients experiencing ADR and were included in the meta-analysis representing 2776 study participants of whom 1943 were known to be HIV infected (70.0%). An average of 83% (95% CI: 82%-84%) of patients experienced one or more ADR. Among the seven articles ( n = 664 study participants) with information on occurrence of severe ADR, 24% (95% CI: 21%-27%) of patients experienced at least one severe ADR during drug-resistant TB treatment. Sixteen of the 24 studies analysed the relative risk of ADR by HIV infection, nine of which found no statistically significant association between HIV infection and occurrence of drug-related ADR. There was insufficient information to disaggregate risk by concomitant treatment with HIV antiretrovirals or by immunosuppression (CD4 count). Conclusions No randomized clinical trials were found for WHO-recommended treatment of drug-resistant TB treatment where at least 20% of the cohort was coinfected with HIV. Nearly all patients (83%) experience ADR during DR-TB treatment. While no significant association between ADR and HIV coinfection was found, further research is needed to determine whether concomitant antiretrovirals or immunosuppression increases the risks for HIV-infected patients.
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Affiliation(s)
- Kathryn Schnippel
- Health Economics Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Right to Care, Johannesburg, South Africa
| | - Cynthia Firnhaber
- Right to Care, Johannesburg, South Africa.,Clinical HIV Research Unit, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Rebecca Berhanu
- Division of Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, NC, USA.,Health Economics & Epidemiology Research Office, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Edina Sinanovic
- Health Economics Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Ferlazzo G, Mohr E, Laxmeshwar C, Hewison C, Hughes J, Jonckheere S, Khachatryan N, De Avezedo V, Egazaryan L, Shroufi A, Kalon S, Cox H, Furin J, Isaakidis P. Early safety and efficacy of the combination of bedaquiline and delamanid for the treatment of patients with drug-resistant tuberculosis in Armenia, India, and South Africa: a retrospective cohort study. THE LANCET. INFECTIOUS DISEASES 2018; 18:536-544. [PMID: 29452942 DOI: 10.1016/s1473-3099(18)30100-2] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 11/10/2017] [Accepted: 12/11/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND Bedaquiline and delamanid have been approved for treatment of multidrug-resistant (MDR) tuberculosis in the past 5 years. Because of theoretical safety concerns, patients have been unable to access the two drugs in combination. Médecins Sans Frontières has supported the use of combination bedaquiline and delamanid for people with few treatment options since 2016. We describe early safety and efficacy of regimens containing the bedaquiline and delamanid combination in patients with drug-resistant tuberculosis in Yerevan, Armenia; Mumbai, India; and Khayelitsha, South Africa. METHODS We retrospectively analysed a cohort of all patients who received 6-12 months of oral bedaquiline and delamanid in combination (400 mg bedaquiline once per day for 2 weeks, then 200 mg bedaquiline three times per week and 100 mg delamanid twice per day) in MSF-supported projects. We report serious adverse events, QTc corrected using the Fridericia formula (QTcF) interval data, and culture conversion data during the first 6 months of treatment. FINDINGS Between Jan 1, 2016, and Aug 31, 2016, 28 patients (median age 32·5 years [IQR 28·5-40·5], 17 men) were included in the analysis. 11 (39%) of 28 patients were HIV-positive. 24 patients (86%) had isolates resistant to fluoroquinolones; 14 patients (50%) had extensively drug-resistant tuberculosis. No patient had an increase of more than 500 ms in their QTcF interval. Four patients (14%) had six instances of QTcF increase of more than 60 ms from baseline but none permanently discontinued the drugs. 16 serious adverse events were reported in seven patients. Of 23 individuals with positive baseline cultures, 17 (74%) converted to negative by month 6 of treatment. INTERPRETATION Use of the bedaquiline and delamanid combination appears to reveal no additive or synergistic QTcF-prolonging effects. Access to bedaquiline and delamanid in combination should be expanded for people with few treatment options while awaiting the results of formal clinical trials. FUNDING Médecins Sans Frontières (MSF).
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Affiliation(s)
- Gabriella Ferlazzo
- Médecins Sans Frontières (MSF), Southern Africa Medical Unit (SAMU), Cape Town, South Africa
| | - Erika Mohr
- MSF, Khayelitsha, Cape Town, South Africa
| | | | | | | | | | | | | | | | | | | | - Helen Cox
- University of Cape Town (UCT), Division of Medical Microbiology and Center for Infectious Disease Epidemiology and Research, Cape Town, South Africa
| | - Jennifer Furin
- Harvard Medical School, Department of Global Health & Social Medicine, Boston, MA, USA
| | - Petros Isaakidis
- Médecins Sans Frontières (MSF), Southern Africa Medical Unit (SAMU), Cape Town, South Africa.
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36
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Optimal Management of Drug-Resistant Tuberculosis and Human Immunodeficiency Virus: an Update. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2018. [DOI: 10.1007/s40506-018-0145-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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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: 1.9] [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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Singh B, Cocker D, Ryan H, Sloan DJ. Linezolid for drug-resistant tuberculosis. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2017. [DOI: 10.1002/14651858.cd012836] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Bhagteshwar Singh
- Royal Liverpool University Hospital; Tropical and Infectious Diseases Unit; Liverpool UK
- Liverpool School of Tropical Medicine; Department of Clinical Sciences; Liverpool UK
| | - Derek Cocker
- Liverpool School of Tropical Medicine; Department of Clinical Sciences; Liverpool UK
- Northwick Park Hospital; Watford Road Harrow Middlesex UK HA1 3UJ
| | - Hannah Ryan
- Royal Liverpool University Hospital; Tropical and Infectious Diseases Unit; Liverpool UK
- Liverpool School of Tropical Medicine; Department of Clinical Sciences; Liverpool UK
| | - Derek J Sloan
- Liverpool School of Tropical Medicine; Department of Clinical Sciences; Liverpool UK
- University of St Andrews; School of Medicine; North Haugh St Andrews UK
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39
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Mok J, Kang H, Hwang SH, Park JS, Kang B, Lee T, Koh WJ, Yim JJ, Jeon D. Interim outcomes of delamanid for the treatment of MDR- and XDR-TB in South Korea. J Antimicrob Chemother 2017; 73:503-508. [DOI: 10.1093/jac/dkx373] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Accepted: 09/12/2017] [Indexed: 12/12/2022] Open
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40
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Jeon D. WHO Treatment Guidelines for Drug-Resistant Tuberculosis, 2016 Update: Applicability in South Korea. Tuberc Respir Dis (Seoul) 2017; 80:336-343. [PMID: 28905529 PMCID: PMC5617849 DOI: 10.4046/trd.2017.0049] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 07/02/2017] [Accepted: 07/12/2017] [Indexed: 12/29/2022] Open
Abstract
Despite progress made in tuberculosis control worldwide, the disease burden and treatment outcome of multidrug-resistant tuberculosis (MDR-TB) patients have remained virtually unchanged. In 2016, the World Health Organization released new guidelines for the management of MDR-TB. The guidelines are intended to improve detection rate and treatment outcome for MDR-TB through novel, rapid molecular testing and shorter treatment regimens. Key changes include the introduction of a new, shorter MDR-TB treatment regimen, a new classification of medicines and updated recommendations for the conventional MDR-TB regimen. This paper will review these key changes and discuss the potential issues with regard to the implementation of these guidelines in South Korea.
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Affiliation(s)
- Doosoo Jeon
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea.
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41
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Harausz EP, Garcia-Prats AJ, Seddon JA, Schaaf HS, Hesseling AC, Achar J, Bernheimer J, Cruz AT, D'Ambrosio L, Detjen A, Graham SM, Hughes J, Jonckheere S, Marais BJ, Migliori GB, McKenna L, Skrahina A, Tadolini M, Wilson P, Furin J. New and Repurposed Drugs for Pediatric Multidrug-Resistant Tuberculosis. Practice-based Recommendations. Am J Respir Crit Care Med 2017; 195:1300-1310. [PMID: 27854508 DOI: 10.1164/rccm.201606-1227ci] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
It is estimated that 33,000 children develop multidrug-resistant tuberculosis (MDR-TB) each year. In spite of these numbers, children and adolescents have limited access to the new and repurposed MDR-TB drugs. There is also little clinical guidance for the use of these drugs and for the shorter MDR-TB regimen in the pediatric population. This is despite the fact that these drugs and regimens are associated with improved interim outcomes and acceptable safety profiles in adults. This review fills a gap in the pediatric MDR-TB literature by providing practice-based recommendations for the use of the new (delamanid and bedaquiline) and repurposed (linezolid and clofazimine) MDR-TB drugs and the new shorter MDR-TB regimen in children and adolescents.
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Affiliation(s)
- Elizabeth P Harausz
- 1 U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Anthony J Garcia-Prats
- 2 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
- 3 Centre for International Child Health, Imperial College London, United Kingdom
| | - H Simon Schaaf
- 2 Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Anneke C Hesseling
- 2 Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Jay Achar
- 4 Manson Unit, Médecins Sans Frontières, London, United Kingdom
| | | | | | - Lia D'Ambrosio
- 7 Salvatore Maugeri Foundation, Tradate, Italy.,8 Public Health Consulting Group, Lugano, Switzerland
| | - Anne Detjen
- 9 United Nations Children's Fund, New York, New York
| | - Stephen M Graham
- 10 Centre for International Child Health, University of Melbourne Department of Paediatrics and Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia
| | | | | | - Ben J Marais
- 12 Children's Hospital at Westmead, University of Sydney, Sydney, Australia
| | | | - Lindsay McKenna
- 13 Treatment Action Group, HIV/TB Project, New York, New York
| | - Alena Skrahina
- 14 Republican Research and Practical Centre for Pulmonology and TB, Minsk, Belarus; and
| | - Marina Tadolini
- 15 Unit of Infectious Diseases, Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Peyton Wilson
- 16 Department of Medicine, Boston Children's Hospital, Boston, Massachusetts; and
| | - Jennifer Furin
- 17 Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
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Monedero I, Bhavaraju R, Mendoza-Ticona A, Sánchez-Montalvá A. The paradigm shift to end tuberculosis. Are we ready to assume the changes? Expert Rev Respir Med 2017; 11:565-579. [PMID: 28562103 DOI: 10.1080/17476348.2017.1335599] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Tuberculosis (TB) is the number one infectious disease killer and exemplifies the most neglected of them. Drug-susceptible TB presents with high mortality especially in atypical forms, disproportionally affecting immunosuppressed and vulnerable populations. The drug-resistant TB (DR-TB) epidemic, a world crisis, is sustained and increased through person-to-person transmission in households and the community. TB diagnostics and treatment in recent years are highly evolving fields. New rapid molecular tests are changing the perspectives in diagnosis and resistance screening. Also, new drugs and shorter regimens for DR-TB are appearing. For the first time in recent history, a large number of randomized control trials are incoming. Areas covered: This article reviews most TB advances including new diagnostic tests, drugs, and regimens and outlines upcoming drug trials while disclosing the potential gaps the in development of patient-centered systems and current organizational challenges leading to a delay in the uptake of these innovations. Expert commentary: Innovations are occurring, but not many are implemented on a wide scale in developing countries. TB health systems and staff are not getting updated in parallel. More efforts and funds are needed not only to implement current novelties but also to research for future solutions to eliminate TB.
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Affiliation(s)
- Ignacio Monedero
- a TB-HIV Department. International Union against Tuberculosis and Lung Disease (The Union) , Paris , France
| | - Rajita Bhavaraju
- b Global Tuberculosis Institute, Rutgers, The State University of New Jersey , Newark , NJ , USA
| | - Alberto Mendoza-Ticona
- a TB-HIV Department. International Union against Tuberculosis and Lung Disease (The Union) , Paris , France.,c Clinical Research Department , Asociación Civil IMPACTA , Lima , Peru
| | - Adrián Sánchez-Montalvá
- d Infectious diseases department, Tropical Medicine Unit, PROCIS (International Health Program of the Catalan Health Institute) , Vall d'Hebron University Hospital,Universistat Autònoma de Barcelona , Barcelona , Spain
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Codecasa LR, Toumi M, D’Ausilio A, Aiello A, Damele F, Termini R, Uglietti A, Hettle R, Graziano G, De Lorenzo S. Cost-effectiveness of bedaquiline in MDR and XDR tuberculosis in Italy. JOURNAL OF MARKET ACCESS & HEALTH POLICY 2017; 5:1283105. [PMID: 28265350 PMCID: PMC5328329 DOI: 10.1080/20016689.2017.1283105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 12/15/2016] [Accepted: 12/22/2016] [Indexed: 06/06/2023]
Abstract
Objective: To evaluate the cost-effectiveness of bedaquiline plus background drug regimens (BR) for multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) in Italy. Methods: A Markov model was adapted to the Italian setting to estimate the incremental cost-effectiveness ratio (ICER) of bedaquiline plus BR (BBR) versus BR in the treatment of MDR-TB and XDR-TB over 10 years, from both the National Health Service (NHS) and societal perspective. Cost-effectiveness was evaluated in terms of life-years gained (LYG). Clinical data were sourced from trials; resource consumption for compared treatments was modelled according to advice from an expert clinicians panel. NHS tariffs for inpatient and outpatient resource consumption were retrieved from published Italian sources. Drug costs were provided by reference centres for disease treatment in Italy. A 3% annual discount was applied to both cost and effectiveness. Deterministic and probabilistic sensitivity analyses were conducted. Results: Over 10 years, BBR vs. BR alone is cost-effective, with ICERs of €16,639/LYG and €4081/LYG for the NHS and society, respectively. The sensitivity analyses confirmed the robustness of the results from both considered perspectives. Conclusion: In Italy, BBR vs. BR alone has proven to be cost-effective in the treatment of MDR-TB and XDR-TB under a range of scenarios.
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Affiliation(s)
- Luigi R. Codecasa
- Regional TB Reference Centre, Villa Marelli Institute/ASST Niguarda Ca’ Granda, Milano, Italy
| | - Mondher Toumi
- Faculty of Medicine, Public Health Department, Aix-Marseille University, Marseille, France
| | | | | | | | | | | | | | - Giorgio Graziano
- Post-graduate Residency School in Hygiene and Preventive Medicine, University of Palermo, Palermo, Italy
| | - Saverio De Lorenzo
- E. Morelli Hospital ASST, Reference Center for MDR-TB and HIV-TB, Sondalo, Italy
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Connolly MP, Goodwin E, Schey C, Zummo J. Toxoplasmic encephalitis relapse rates with pyrimethamine-based therapy: systematic review and meta-analysis. Pathog Glob Health 2017; 111:31-44. [PMID: 28090819 PMCID: PMC5375610 DOI: 10.1080/20477724.2016.1273597] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Toxoplasmic encephalitis (TE) is caused by Toxoplasma gondii infection and can be a life-threatening disease in immunocompromised patients. This study evaluated the rate of relapse associated with pyrimethamine-based maintenance therapy (i.e. secondary prophylaxis) in patients with human immunodeficiency virus (HIV) or AIDs treated prior to and after the common use (i.e. 1996) of highly active antiretroviral therapy (HAART) (pre-HAART and post-HAART, respectively). PubMed, Google Scholar, and Cochrane databases were searched to 6 June 2016 using search terms: pyrimethamine, Daraprim, Fansidar, Metakelfin, Fansimef, 5-(4-chlorophenyl)-6-ethyl-2,4-pyrimidinediamine, encephalitis, cerebral, toxoplasmosis, toxoplasmic, and gondii. Single-arm cohort, retrospective, and randomized studies were included. Twenty-six studies with 1,596 patients were included in the analysis; twenty pre-HAART (n = 1,228) studies and six post-HAART (n = 368) were performed. Pooled proportions test for pyrimethamine-based therapy from pre-HAART studies indicated a relapse rate of 19.2% and 18.9% from the fixed-effects and random-effects models, respectively. The relapse rate in the post-HAART studies was 11.1% (fixed and random effects). Continuous therapy was suggestive of lower incidence of relapse compared with intermittent therapy in the pre-HAART era (range, 18.7 to 17.3% vs. 20.9 to 25.6%, respectively). These findings indicate that the likelihood of relapse associated with pyrimethamine-based therepy in patients with HIV and TE decreased after the introduction of HAART to approximately 11%. The findings have important implications as relapse may affect a patient’s disease severity and prognosis, increase utilization of health care resources, and result in additional health care expenditure.
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Affiliation(s)
- Mark P Connolly
- a Unit of PharmacoEpidemiology & PharmacoEconomics, Department of Pharmacy , University of Groningen , Groningen , The Netherlands.,b Health Economics , Global Market Access Solutions LLC , Mooresville , NC , USA
| | | | - Carina Schey
- a Unit of PharmacoEpidemiology & PharmacoEconomics, Department of Pharmacy , University of Groningen , Groningen , The Netherlands.,b Health Economics , Global Market Access Solutions LLC , Mooresville , NC , USA
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Sloan DJ, Lewis JM. Management of multidrug-resistant TB: novel treatments and their expansion to low resource settings. Trans R Soc Trop Med Hyg 2016; 110:163-72. [PMID: 26884496 PMCID: PMC4755422 DOI: 10.1093/trstmh/trv107] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Despite overall progress in global TB control, the rising burden of multidrug-resistant TB (MDR-TB) threatens to undermine efforts to end the worldwide epidemic. Of the 27 countries classified as high burden for MDR-TB, 17 are in ‘low’ or ‘low–middle’ income countries. Shorter, all oral and less toxic multidrug combinations are required to improve treatment outcomes in these settings. Suitability for safe co-administration with HIV drugs is also desirable. A range of strategies and several new drugs (including bedaquiline, delamanid and linezolid) are currently undergoing advanced clinical evaluations to define their roles in achieving these aims. However, several clinical questions and logistical challenges need to be overcome before these new MDR-TB treatments fulfil their potential.
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Affiliation(s)
- Derek J Sloan
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool L14 3PE, UK
| | - Joseph M Lewis
- Wellcome Trust Liverpool Glasgow Centre for Global Health Research, University of Liverpool L69 3GF, UK Tropical and Infectious Disease Unit, Royal Liverpool University Hospital, Liverpool L7 8XP, UK
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Zhao W, Zheng M, Wang B, Mu X, Li P, Fu L, Liu S, Guo Z. Interactions of linezolid and second-line anti-tuberculosis agents against multidrug-resistant Mycobacterium tuberculosis in vitro and in vivo. Int J Infect Dis 2016; 52:23-28. [DOI: 10.1016/j.ijid.2016.08.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 06/02/2016] [Accepted: 08/27/2016] [Indexed: 10/21/2022] Open
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Early Bactericidal Activity of AZD5847 in Patients with Pulmonary Tuberculosis. Antimicrob Agents Chemother 2016; 60:6591-6599. [PMID: 27550361 DOI: 10.1128/aac.01163-16] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 08/15/2016] [Indexed: 01/27/2023] Open
Abstract
AZD5847 is an oxazolidinone antibiotic with in vitro activity against Mycobacterium tuberculosis The objective of this study was to evaluate the antimycobacterial activity, safety, and pharmacokinetics of AZD5847 in patients with pulmonary tuberculosis. Groups of 15 treatment-naive, sputum smear-positive adults with pulmonary tuberculosis were randomly assigned to receive AZD5847 at one of four doses (500 mg once daily, 500 mg twice daily, 1,200 mg once daily, and 800 mg twice daily) or daily standard chemotherapy. The primary efficacy endpoint was the mean daily rate of change in the log10 number of CFU of M. tuberculosis per milliliter of sputum, expressed as the change in log10 number of CFU per milliliter of sputum per day. The mean 14-day activity of the combination of isoniazid, rifampin, ethambutol, and pyrazinamide (-0.163 log10 CFU/ml sputum/day; 95% confidence interval [CI], -0.193, -0.133 log10 CFU/ml sputum/day) was consistent with that found in previous studies. AZD5847 at 500 mg twice daily significantly decreased the number of CFU on solid medium (-0.039; 95% CI, -0.069, -0.009; P = 0.0048). No bactericidal activity was detected at doses of AZD5847 of 500 mg once daily (mean early bactericidal activity [EBA], 0.02 [95% CI, -0.01, 0.05]), 1,200 mg once daily (mean EBA, 0.02 [95% CI, -0.01, 0.05]), and 800 mg twice daily (mean EBA, 0.02 [95% CI, -0.01, 0.05]). AZD5847 at doses of both 500 mg and 800 mg twice daily also showed an increase in the time to a positive culture in MGIT liquid culture medium. Two serious adverse events (grade 4 thrombocytopenia and grade 4 hyperbilirubinemia) occurred in patients receiving AZD5847 at higher doses. AZD5847 dosed twice daily kills tubercle bacilli in the sputum of patients with pulmonary tuberculosis and has modest early bactericidal activity. (This study has been registered at ClinicalTrials.gov under registration no. NCT01516203.).
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Rendon A, Tiberi S, Scardigli A, D'Ambrosio L, Centis R, Caminero JA, Migliori GB. Classification of drugs to treat multidrug-resistant tuberculosis (MDR-TB): evidence and perspectives. J Thorac Dis 2016; 8:2666-2671. [PMID: 27867538 DOI: 10.21037/jtd.2016.10.14] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Adrian Rendon
- Center for Research, Prevention and Treatment of Respiratory Infections, University Hospital Dr José Eleuterio Gonzalez, Monterrey, N.L., Mexico;; Latin American Thoracic Association (ALAT)
| | - Simon Tiberi
- Division of Infection, Barts Health NHS Trust, London, UK
| | - Anna Scardigli
- The Global Fund to Fight Aids, Tuberculosis and Malaria, Geneva, Switzerland
| | - Lia D'Ambrosio
- Maugeri Institute, IRCCS, Tradate, Italy;; Public Health Consulting Group, Lugano, Switzerland
| | | | - Jose A Caminero
- Pneumology Department, University Hospital of Gran Canaria "Dr. Negrin", Las Palmas Gran Canaria, Spain
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Mafukidze A, Harausz E, Furin J. An update on repurposed medications for the treatment of drug-resistant tuberculosis. Expert Rev Clin Pharmacol 2016; 9:1331-1340. [DOI: 10.1080/17512433.2016.1208562] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Agyeman AA, Ofori-Asenso R. Efficacy and safety profile of linezolid in the treatment of multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis: a systematic review and meta-analysis. Ann Clin Microbiol Antimicrob 2016; 15:41. [PMID: 27334498 PMCID: PMC4917997 DOI: 10.1186/s12941-016-0156-y] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 06/08/2016] [Indexed: 12/13/2022] Open
Abstract
Background Treatment options for drug-resistant tuberculosis are still limited. Linezolid has been recommended for treatment of patients with multidrug-resistant (MDR) or extensively-drug-resistant (XDR) tuberculosis, although uncertainties remain regarding its safety and tolerability in these circumstances. Objective To systematically evaluate the existing evidence regarding the efficacy and tolerability of linezolid in the treatment of MDR or XDR tuberculosis. Methods We conducted a systematic review and meta-analysis in accordance with the PRISMA guidelines. Searches were conducted in PubMed, Web of Science and EMBASE followed by direct search of abstracts in the International Journal of Tuberculosis and Lung Disease to retrieve primary studies published between January 2000 and January 2016 assessing linezolid efficacy and safety in the treatment of drug-resistant TB. We evaluated the occurrence of outcomes including culture conversion, treatment success and incidence of adverse events such as myelosuppression and neuropathy. Results Twenty-three (23) studies conducted in fourteen (14) countries and involving 507 patients were retrieved. Only 1 randomized controlled trial was identified and none of the identified studies involved participants from Africa. The pooled proportion for treatment success was 77.36 % (95 % CI = 71.38–82.83 %, I2 = 37.6 %) with culture conversion rate determined as 88.45 % (95 % CI = 83.82–92.38 %, I2 = 45.4 %). There was no strong evidence for both culture conversion (p = 0.0948) and treatment success (p = 0.0695) between linezolid daily doses ≤ 600 and > 600 mg. Only myelosuppression showed a strong statistical significance (p < 0.0001) between dose comparisons. The incidence of neuropathy and other adverse events leading to permanent discontinuation of linezolid also showed no significance upon dose comparisons (p = 0.3213, p = 0.9050 respectively). Conclusion Available evidence presents Linezolid as a viable option in the treatment of MDR/XDR TB although patients ought to be monitored closely for the incidence of major adverse events such as myelosuppression and neuropathy. Additionally, highly powered randomized controlled trials including participants from endemic regions are urgently needed to better inform the magnitude and significance of Linezolid treatment effect in MDR and XDR TB patients. Electronic supplementary material The online version of this article (doi:10.1186/s12941-016-0156-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Akosua Adom Agyeman
- Research Unit, Health Policy Consult, Weija, P. O. Box WJ 537, Accra, Ghana.
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