1
|
Lestari T, Fuady A, Yani FF, Putra IWGAE, Pradipta IS, Chaidir L, Handayani D, Fitriangga A, Loprang MR, Pambudi I, Ruslami R, Probandari A. The development of the national tuberculosis research priority in Indonesia: A comprehensive mixed-method approach. PLoS One 2023; 18:e0281591. [PMID: 36758064 PMCID: PMC9910756 DOI: 10.1371/journal.pone.0281591] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 01/26/2023] [Indexed: 02/10/2023] Open
Abstract
Ranked second in global tuberculosis (TB) incidence, Indonesia has developed a National Strategy for TB Prevention and Control 2020-2024 to accelerate the TB elimination program. Research and innovation are key pillars to support the program and need to be prioritised. This study aimed to develop updated national TB research priorities in Indonesia. This study was a mixed-methods study consisting of an open survey, a published literature survey, and Delphi survey. The open survey invited all related TB stakeholders to answer (a) the main barriers of the TB program and (b) the need for studies to support TB elimination. The published literature survey retrieved scientific articles published in national and international journals between 2015 and 2020 to identify gaps between published research and the current national strategy for TB control. The online survey and literature survey informed a panel of TB experts in a two-phase Delphi Survey to select the top 10 priority research topics. We identified 322 articles and analysed 1143 open survey responses. Through two-phases Delphi surveys, top ten research categories were listed: early TB detection; diagnosis and treatment of DR-TB; contact investigation; case detection and treatment of child TB; TB preventive therapy; government policy; laboratory for drug-sensitive- and drug-resistant-TB diagnosis; treatment adherence; diagnostic tool development; and community empowerment. This study also found the gap between stakeholders' interests and the importance of translating research into policy and practice. TB research priorities have been identified through the involvement of various stakeholders. The combination of an online survey, a published literature survey, and a Delphi survey was a rigorous methodology and was fit to build a systematic consensus about the priority of TB research.
Collapse
Affiliation(s)
- Trisasi Lestari
- Center for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Ahmad Fuady
- Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
- Primary Health Care Research and Innovation Center, Indonesian Medical Education and Research Institute, Faculty of Medicine Universitas Indonesia, Johar Baru, Jakarta, Indonesia
| | - Finny Fitry Yani
- Department of Child Health, Faculty of Medicine, Universitas Andalas, Padang, Indonesia
| | | | - Ivan Surya Pradipta
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Jawa Barat, Indonesia
| | - Lidya Chaidir
- Department of Biomedical Sciences, Faculty of Medicine, Universitas Padjajaran, Jawa Barat, Indonesia
| | - Diah Handayani
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Agus Fitriangga
- Department of Community Medicine, Faculty of Medicine, Universitas Tanjungpura, Kota Pontianak, Indonesia
| | | | - Imran Pambudi
- Ministry of Health Republic of Indonesia, Jakarta, Indonesia
| | - Rovina Ruslami
- Department of Biomedical Science, Faculty of Medicine, Universitas Padjadjaran, Jawa Barat, Indonesia
| | - Ari Probandari
- Department of Public Health, Faculty of Medicine, Universitas Sebelas Maret, Jawa Tengah, Indonesia
| |
Collapse
|
2
|
Seddon JA, Johnson S, Palmer M, van der Zalm MM, Lopez-Varela E, Hughes J, Schaaf HS. Multidrug-resistant tuberculosis in children and adolescents: current strategies for prevention and treatment. Expert Rev Respir Med 2020; 15:221-237. [PMID: 32965141 DOI: 10.1080/17476348.2021.1828069] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
INTRODUCTION An estimated 30,000 children develop multidrug-resistant (MDR) tuberculosis (TB) each year, with only a small proportion diagnosed and treated. This field has historically been neglected due to the perception that children with MDR-TB are challenging to diagnose and treat. Diagnostic and therapeutic developments in adults have improved pediatric management, yet further pediatric-specific research and wider implementation of evidence-based practices are required. AREAS COVERED This review combines the most recent data with expert opinion to highlight best practice in the evaluation, diagnosis, treatment, and support of children and adolescents with MDR-TB disease. A literature search of PubMed was carried out on topics related to MDR-TB in children. This review provides practical advice on MDR-TB prevention and gives updates on new regimens and novel treatments. The review also addresses host-directed therapy, comorbid conditions, special populations, psychosocial support, and post-TB morbidity, as well as identifying outstanding research questions. EXPERT OPINION Increased availability of molecular diagnostics has the potential to aid with the diagnosis of MDR-TB in children. Shorter MDR-TB disease treatment regimens have made therapy safer and shorter and further developments with novel agents and repurposed drugs should lead to additional improvements. The evidence base for MDR-TB preventive therapy is increasing.
Collapse
Affiliation(s)
- James A Seddon
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University , Stellenbosch, South Africa.,Section of Paediatric Infectious Diseases, Department of Infectious Diseases, Imperial College London , London, UK
| | - Sarah Johnson
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University , Stellenbosch, South Africa.,Section of Paediatric Infectious Diseases, Department of Infectious Diseases, Imperial College London , London, UK
| | - Megan Palmer
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University , Stellenbosch, South Africa
| | - Marieke M van der Zalm
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University , Stellenbosch, South Africa
| | - Elisa Lopez-Varela
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University , Stellenbosch, South Africa.,ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic - Universitat De Barcelona , Barcelona, Spain
| | - Jennifer Hughes
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University , Stellenbosch, South Africa
| | - H Simon Schaaf
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University , Stellenbosch, South Africa
| |
Collapse
|
3
|
Nahid P, Mase SR, Migliori GB, Sotgiu G, Bothamley GH, Brozek JL, Cattamanchi A, Cegielski JP, Chen L, Daley CL, Dalton TL, Duarte R, Fregonese F, Horsburgh CR, Ahmad Khan F, Kheir F, Lan Z, Lardizabal A, Lauzardo M, Mangan JM, Marks SM, McKenna L, Menzies D, Mitnick CD, Nilsen DM, Parvez F, Peloquin CA, Raftery A, Schaaf HS, Shah NS, Starke JR, Wilson JW, Wortham JM, Chorba T, Seaworth B. Treatment of Drug-Resistant Tuberculosis. An Official ATS/CDC/ERS/IDSA Clinical Practice Guideline. Am J Respir Crit Care Med 2020; 200:e93-e142. [PMID: 31729908 PMCID: PMC6857485 DOI: 10.1164/rccm.201909-1874st] [Citation(s) in RCA: 230] [Impact Index Per Article: 57.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background: The American Thoracic Society, U.S. Centers for Disease Control and Prevention, European Respiratory Society, and Infectious Diseases Society of America jointly sponsored this new practice guideline on the treatment of drug-resistant tuberculosis (DR-TB). The document includes recommendations on the treatment of multidrug-resistant TB (MDR-TB) as well as isoniazid-resistant but rifampin-susceptible TB.Methods: Published systematic reviews, meta-analyses, and a new individual patient data meta-analysis from 12,030 patients, in 50 studies, across 25 countries with confirmed pulmonary rifampin-resistant TB were used for this guideline. Meta-analytic approaches included propensity score matching to reduce confounding. Each recommendation was discussed by an expert committee, screened for conflicts of interest, according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology.Results: Twenty-one Population, Intervention, Comparator, and Outcomes questions were addressed, generating 25 GRADE-based recommendations. Certainty in the evidence was judged to be very low, because the data came from observational studies with significant loss to follow-up and imbalance in background regimens between comparator groups. Good practices in the management of MDR-TB are described. On the basis of the evidence review, a clinical strategy tool for building a treatment regimen for MDR-TB is also provided.Conclusions: New recommendations are made for the choice and number of drugs in a regimen, the duration of intensive and continuation phases, and the role of injectable drugs for MDR-TB. On the basis of these recommendations, an effective all-oral regimen for MDR-TB can be assembled. Recommendations are also provided on the role of surgery in treatment of MDR-TB and for treatment of contacts exposed to MDR-TB and treatment of isoniazid-resistant TB.
Collapse
|
4
|
Rao A, Nayak G, Kumari S, Kalthur SG, Mutalik SP, Mutalik S, Adiga SK, Kalthur G. Exposure to first line anti-tuberculosis drugs in prepubertal age reduces the quality and functional competence of spermatozoa and oocytes in Swiss albino mice. ENVIRONMENTAL TOXICOLOGY AND PHARMACOLOGY 2020; 73:103292. [PMID: 31765964 DOI: 10.1016/j.etap.2019.103292] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 10/14/2019] [Accepted: 10/24/2019] [Indexed: 06/10/2023]
Abstract
Prepubertal Swiss albino mice of both sex were administered with first-line anti-tuberculosis drugs (ATDs) viz; rifampicin, isoniazid, pyrazinamide, streptomycin and ethambutol intraperitoneally, for 4 weeks. Two weeks after the completion of treatment, male mice were sacrificed to collect caudal spermatozoa and female mice were superovulated with pregnant mare serum gonadotropin (PMSG) and human chorionic gonadotropin (hCG) to collect metaphase II (MII) oocytes from oviduct. Administration of ATDs not only decreased the count, motility and, nuclear maturity and also, increased the head abnormalities, mitochondrial damage and DNA damage in epididymal spermatozoa. Reduction in number of ovulated oocytes, increased degeneration rate and altered distribution pattern of cytoplasmic organelles was observed in oocytes of female mice. Presence of ATDs in in vitro maturation (IVM) medium increased abnormalities in meiotic resulted in abnormal spindle organization (except ethambutol) without affecting nuclear maturation. In conclusion, the result of this study indicates that ATDs have considerable adverse effects on the functional competence of male and female gametes, however, with varied degree of toxicity.
Collapse
Affiliation(s)
- Arpitha Rao
- Department of Clinical Embryology, Manipal 576104, Karnataka, India
| | - Guruprasad Nayak
- Department of Clinical Embryology, Manipal 576104, Karnataka, India
| | - Sandhya Kumari
- Department of Clinical Embryology, Manipal 576104, Karnataka, India
| | | | - Sadhana P Mutalik
- Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
| | - Srinivas Mutalik
- Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
| | | | | |
Collapse
|
5
|
Halicki PCB, Hädrich G, Boschero R, Ferreira LA, von Groll A, da Silva PEA, Dora CL, Ramos DF. Alternative Pharmaceutical Formulation for Oral Administration of Rifampicin. Assay Drug Dev Technol 2018; 16:456-461. [PMID: 30325673 DOI: 10.1089/adt.2018.874] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Tuberculosis (TB) is considered an emergency global public health, mainly due to the TB-HIV co-infection, bacillus dormancy stage, and emergence of resistant strains. In addition, the therapeutic toxicity and its pharmacokinetic interactions with other drugs may influence treatment non-compliance, low serum concentration of drugs, and, consequently, treatment failure. Strategies using nanotechnology represent a new tool for the therapy, since they are effective delivery systems due to the possibility of solubilization of hydrophobic compounds, enable the production of formulations for oral use, and, in addition, increase bioavailability of drugs. This study aimed to develop a nanoemulsion (NE) containing rifampicin (RIF-NE) and evaluate its in vitro antimycobacterial activity using Resazurin Microtiter Assay against three Mycobacterium tuberculosis strains: two susceptible and a multidrug-resistant. Using the hot solvent diffusion method associated with phase inversion technique was possible to develop a liquid formulation containing 500 μg/mL rifampicin (RIF), which is a hydrophobic compound, of average size 25 nm. The results showed that the minimum inhibitory concentration of the encapsulated RIF was equal to the free form of RIF, indicating that the process of production of NEs did not affect the activity of the compound. Thus, RIF-NE could be a promising alternative for oral administration of RIF, being considered a child-friendly pharmaceutical formulation. Its application could avoid the administration of unknown and/or non-ideal concentrations, being functional in the regimes of prevention and treatment of TB and, in addition, in the fight against drug resistance.
Collapse
Affiliation(s)
| | - Gabriela Hädrich
- Laboratório de Nanotecnologia, Centro de Microscopia Eletrônica da Zona Sul, Universidade Federal do Rio Grande-FURG, Rio Grande, Brazil
| | - Raphael Boschero
- Laboratório de Nanotecnologia, Centro de Microscopia Eletrônica da Zona Sul, Universidade Federal do Rio Grande-FURG, Rio Grande, Brazil
| | - Laís Andrade Ferreira
- Núcleo de Pesquisa em Microbiologia Médica, Faculdade de Medicina, Universidade Federal do Rio Grande-FURG, Rio Grande, Brazil
| | - Andrea von Groll
- Núcleo de Pesquisa em Microbiologia Médica, Faculdade de Medicina, Universidade Federal do Rio Grande-FURG, Rio Grande, Brazil
| | - Pedro Eduardo Almeida da Silva
- Núcleo de Pesquisa em Microbiologia Médica, Faculdade de Medicina, Universidade Federal do Rio Grande-FURG, Rio Grande, Brazil
| | - Cristiana Lima Dora
- Laboratório de Nanotecnologia, Centro de Microscopia Eletrônica da Zona Sul, Universidade Federal do Rio Grande-FURG, Rio Grande, Brazil
| | - Daniela Fernandes Ramos
- Núcleo de Pesquisa em Microbiologia Médica, Faculdade de Medicina, Universidade Federal do Rio Grande-FURG, Rio Grande, Brazil
| |
Collapse
|
6
|
Rao A, Nayak G, Kumari S, Prabhu AD, Khandige N, Kalthur SG, Mutalik S, Kalthur G, Adiga SK. Ethambutol induces testicular damage and decreases the sperm functional competence in Swiss albino mice. ENVIRONMENTAL TOXICOLOGY AND PHARMACOLOGY 2016; 47:28-37. [PMID: 27579587 DOI: 10.1016/j.etap.2016.08.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 08/10/2016] [Accepted: 08/12/2016] [Indexed: 06/06/2023]
Abstract
The present study reports the effect of ethambutol (EMB) on testicular function. Prepubertal and adult male Swiss albino mice were treated with 40, 80, 160mg/kg body weight of EMB, intraperitoneally, every alternate day for 4 weeks. After 2 weeks gap, mice were sacrificed to collect caudal spermatozoa. EMB treatment resulted in a dose-dependent decrease in the testicular weight, sperm count and motility while the percentage of sperm with head abnormalities, immature chromatin (P<0.001) and DNA damage increased (P<0.01). In addition, EMB treatment resulted in significant depletion of glutathione (P<0.05-P<0.01) and histopathological abnormalities such as large cells, vacuolation of tubules and isolated colonies of spermatogenic cells were observed. Oct4, 17β-Hsd and c-Kit mRNA was marginally elevated in EMB treated testes at the highest dose studied. In conclusion, the result of the present study indicates that EMB has adverse effect on testicular function and impairs the sperm functional competence.
Collapse
Affiliation(s)
- Arpitha Rao
- Department of Clinical Embryology, Level 2, Central Research Lab., Manipal 576104, Karnataka, India
| | - Guruprasad Nayak
- Department of Clinical Embryology, Level 2, Central Research Lab., Manipal 576104, Karnataka, India
| | - Sandhya Kumari
- Department of Clinical Embryology, Level 2, Central Research Lab., Manipal 576104, Karnataka, India
| | - Amratha D Prabhu
- Department of Clinical Embryology, Level 2, Central Research Lab., Manipal 576104, Karnataka, India
| | - Nalini Khandige
- Department of Biochemistry, Manipal 576104, Karnataka, India
| | | | - Srinivas Mutalik
- Manipal College of Pharmaceutical Sciences, Manipal University, Manipal 576104, Karnataka, India
| | - Guruprasad Kalthur
- Department of Clinical Embryology, Level 2, Central Research Lab., Manipal 576104, Karnataka, India.
| | - Satish Kumar Adiga
- Department of Clinical Embryology, Level 2, Central Research Lab., Manipal 576104, Karnataka, India
| |
Collapse
|