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Management of Spinal Tuberculosis in Young Children
Published in Alaaeldin (Alaa) Azmi Ahmad, Aakash Agarwal, Early-Onset Scoliosis, 2021
S. Rajasekaran, Sri Vijay Anand, Ajoy Prasad Shetty, Rishi Mugesh Kanna
Drug resistance is a major global threat. The prime reasons for the emergence of drug-resistant tuberculosis are inadequate and incomplete treatment, poor compliance, and spread of resistant strains. The need for prolonged treatment with second-line ATT, which is costlier, has more adverse effects, a poor success rate, and high mortality. All cases of TB are to be notified, and DST should be done in all feasible cases to diagnose resistant cases early, and all drug resistance cases should be referred to a suitable specialist. Current WHO guidelines recommend a minimum of four drugs to which the child is not exposed, including a fluoroquinolone, an injectable agent (minimum of 4–6 months after culture conversion), and at least two agents from the three remaining second-line anti-TB drug classes, including cycloserine, thioamides, and p-aminosalicylic acid, in an initial phase of at least 6 months, followed by at least three of the most active and best-tolerated drugs in a 12- to 18-month continuation phase. Second-line ATT drugs with dosage and safety profiles are enumerated in Table 8g.3. HIV-infected children who develop TB should be referred to a specialist for concomitant antiretroviral therapy (ART). A careful evaluation for CD4 count, viral load, and the possibility of drug interactions must be taken into account.
Infections and Their Mimics in Returning Travelers in the Critical Care Unit
Published in Cheston B. Cunha, Burke A. Cunha, Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
Elise Kochoumian, Jonathon Moore, Bushra Mina, Kevin Cahill
The Centers for Disease Control and Prevention and Infectious Diseases (CDC) Society of America have established guidelines for the management of pulmonary and extrapulmonary TB as well as treatment in special populations, including those with resistant strains and HIV. First-line antimicrobial therapy of pulmonary TB consists of an intensive 2-month course of isoniazid, rifampin, ethambutol, and pyrazinamide, followed by a continuation phase of daily isoniazid and rifampicin for 18 additional weeks [82]. Clinically, a clinician must consider infection with a resistant M. tuberculosis strain if the patient originates from a high-risk region, has undergone a treatment course of first-line anti-TB drugs, or fails to respond to standard anti-TB regimens [71,72]. If resistance is suspected, additional testing with rapid molecular tests assessing for genetic mutations should be conducted, and a new regimen should be considered, which includes at least four second-line drugs, such as fluoroquinolones, amikacin, capreomycin, kanamycin, ethionamide/prothionamide, cycloserine, linezolid, clofazimine, delamanid, bedaquiline, p-aminosalicylic acid, imipenem-cilastatin/meropenem, amoxicillin-clavulanate, thioacetazone, given over at least 18 months [72,84].
Absorption of Macromolecules by Mammalian Intestinal Epithelium
Published in Shayne C. Gad, Toxicology of the Gastrointestinal Tract, 2018
P-Aminosalicylic acid (PAS) and tetracycline have also been demonstrated to be absorbed by way of the lymphatics. Both of the silicone oils, drugs are also rapidly distributed throughout the extracellular fluid, including lymph, when administered by the intravenous route.19 Thus, care must be taken in interpretation of data in which accountability of a substance in lymph is used to determine absorption through lymphatics after peroral dosing. Other materials shown to be absorbed by way of the lymphatics include 3-methylcholanthrene, polychlorinated biphenyls, and benzpyrene.
The pharmacotherapeutic management of pulmonary tuberculosis: an update of the state-of-the-art
Published in Expert Opinion on Pharmacotherapy, 2022
Ginenus Fekadu, Dilys Yan-wing Chow, Joyce H.S. You
The 2020 WHO guidelines updated the composition of longer regimens for MDR/RR-TB with a 3-group approach: Group A medicines are bedaquiline, levofloxacin or moxifloxacin, and linezolid; group B medicines are clofazimine, and cycloserine or terizidone; and group C medicines are ethambutol, delamanid, pyrazinamide, imipenem–cilastatin or meropenem, amikacin or streptomycin, ethionamide or prothionamide, and p-aminosalicylic acid [10]. Longer regimens lasting for 18 to 20 months are appropriate for most patients with MDR/RR-TB, and are the preferred treatment options for those who are not a suitable candidate for the shorter all-oral regimen. All medicines in group A and group B were found to achieve statistically significant association with reduced risks of unfavorable treatment outcomes. The current 2020 WHO guidelines considered all group A medicines to be highly effective and strongly recommended all three agents in group A (plus one of the group B medicines) to be used in the regimen unless there is contraindications. Group C medicines are recommended to be included to fulfill a 4- to 5-drug regimen when the medicines in group A or group B are not suitable for the patient to use [10]. The clinical effectiveness and safety of these key anti-TB agents are described below.
Manganese-induced neurodegenerative diseases and possible therapeutic approaches
Published in Expert Review of Neurotherapeutics, 2020
Airton C. Martins, Priscila Gubert, Gustavo R. Villas Boas, Marina Meirelles Paes, Abel Santamaría, Eunsook Lee, Alexey A. Tinkov, Aaron B. Bowman, Michael Aschner
The substance para-aminosalicylic acid (also known as PAS, 4-amino-2-hydroxybenzoic acid or 4-aminosalicylic acid) is used as antibacterial drug for treatment of tuberculosis [115]. PAS consists of carboxyl, hydroxyl and amine groups, providing favorable chelating properties for metals [101]. This substance was tested for three and a half months in a patient chronically and occupationally exposed to Mn, and authors observed improvement in clinical symptoms such as tremor in hands, handwriting ability, and walking [116]. In fact, another study followed one woman who was exposed for 21 years to airborne Mn and, after treatment with PSA, all clinical symptoms and signs of manganism at the time of treatment were improved, while 17 years after treatment, clinically normal conditions were observed [114].
3D printing in the design of pharmaceutical dosage forms
Published in Pharmaceutical Development and Technology, 2019
E. B. Souto, J. C. Campos, S. C. Filho, M. C. Teixeira, C. Martins-Gomes, A. Zielinska, C. Carbone, A. M. Silva
There are also more specific challenges that might have to be overcome for each printing method. For laser-based systems, it is important to find different starting materials which should be both safer and more diverse in order to provide different drug release profiles. Both in DoD and PAM 3D-printing methods, drying processes or the methods themselves need to be altered because as they are being done, post-treatments extend the manufacturing process, potentiating degradation of the incorporated API. FFF’s main disadvantage is the use of high temperatures, which can give rise to stability problems, or polymorphism issues. Aiming to overcome this disadvantage, Kollamaram et al. (2018) optimized the application of FDM technology to print thermolabile drugs. Authors used ramipril, a drug used to treat hypertension, as a model, due to its low melting temperature. When exposed to high temperatures ramipril tends to degrade and produce impurities. By modifying the excipient, the authors achieved a stable final product, without loss of the drug trough temperature degradation and with immediate release (Kollamaram et al. 2018). The same excipient formulation and further procedure was then applied to 4-aminosalicylic acid, a drug known to degrade when printed by FDM technology, with similar results as those obtained for ramipril (Kollamaram et al. 2018). As for powder-based technologies, poor mechanical resistance of objects printed using this technology continues to be a big concern, even though Spritam® was produced using DoP and its high porosity gave this formulation a competitive advantage over other fast-disintegrating tablets (Norman et al. 2016).