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Application of Next-Generation Plant-Derived Nanobiofabricated Drugs for the Management of Tuberculosis
Published in Richard L. K. Glover, Daniel Nyanganyura, Rofhiwa Bridget Mulaudzi, Maluta Steven Mufamadi, Green Synthesis in Nanomedicine and Human Health, 2021
Charles Oluwaseun Adetunji, Olugbenga Samuel Michael, Muhammad Akram, Kadiri Oseni, Ajayi Kolawole Temidayo, Osikemekha Anthony Anani, Akinola Samson Olayinka, Olerimi Samson E, Wilson Nwankwo, Iram Ghaffar, Juliana Bunmi Adetunji
These principles form the generally acceptable standardized regimens recommended by the World Health Organization (Sotgiu et al., 2015). Treatment of the drug-resistant tuberculosis also has its peculiar guidelines on the prescription of an efficacious drug regimen depending on the outcome of the drug susceptibility testing. It is also necessary to ensure microbiological monitoring of the efficacy of the prescribed regimen. This can be carried out by the evaluation of the sputum smear and culture conversion, particularly at the end of the intensive and continuation treatment phases.
Drug-Resistant Tuberculosis
Published in Lloyd N. Friedman, Martin Dedicoat, Peter D. O. Davies, Clinical Tuberculosis, 2020
Keertan Dheda, Aliasgar Esmail, Anzaan Dippenaar, Robin Warren, Jennifer Furin, Christoph Lange
The optimal timing for surgery is after culture conversion so that the risk for bronchial stump breakdown is diminished. However, this is a theoretical concern and when culture conversion cannot be achieved by medical treatment, surgical treatment should not be delayed. Patients undergoing elective lung resection should improve their physical fitness prior to and post-surgery using physio- and respiratory therapy.
Clarithromycin
Published in M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson, Kucers’ The Use of Antibiotics, 2017
For those patients who cannot tolerate higher dose clarithromycin and those with less severe disease, intermittent, 3 times weekly therapy is an alternative (Griffith et al., 2000). This includes (1) clarithromycin 1000 mg, (2) ethambutol 25 mg/kg, and (3) rifampicin 600 mg, each given three times weekly (Griffith et al., 2007). Conversion to sputum culture negativity after six months was 78% (32/41) in one study of this regimen (Griffith et al., 2000) and proved comparable to the outcome of daily therapy (86% sputum culture conversion) in a subsequent larger cohort (Wallace et al., 2014).
Nontuberculous mycobacterial lung disease caused by Mycobacterium avium complex - disease burden, unmet needs, and advances in treatment developments
Published in Expert Review of Respiratory Medicine, 2021
Jakko van Ingen, Marko Obradovic, Mariam Hassan, Beth Lesher, Erin Hart, Anjan Chatterjee, Charles L. Daley
Successful treatment of NTM-LD requires administration of a multidrug regimen typically including 3 to 5 antibiotics [1]. Patients often receive 18 to 24 months of treatment as guideline recommendations are to continue treatment for 12 months following culture conversion [1]. Patients who continue to have positive sputum cultures after 6 months of guideline-based therapy (GBT) are considered to have refractory disease, as defined by the 2020 NTM clinical practice guidelines developed jointly by the American Thoracic Society (ATS), the European Respiratory Society (ERS), the European Society of Clinical Microbiology and Infectious Diseases (ESCMID), and the Infectious Diseases Society of America (IDSA) (i.e. the 2020 NTM guidelines) [1]. Patients with refractory disease can be treated for several years [13]. Treatment of NTM-LD is complicated by adverse drug effects and suboptimal treatment success rates often associated with currently recommended multidrug regimens [63]. In addition to pharmacological treatment, a holistic approach to NTM-LD care that includes pulmonary rehabilitation and exercise programs to improve exercise capacity and reduce breathlessness, dietary and nutritional management for frail patients, and psychological, social and educational support are important to maintain patient engagement in the long-term treatment program and improve outcomes [64].
Evolutionary journey of programmatic services and treatment outcomes among drug resistant tuberculosis (DR-TB) patients under National TB Elimination Programme in India (2005-2020)
Published in Expert Review of Respiratory Medicine, 2021
Kuldeep Singh Sachdeva, Malik Parmar, Yogesh Patel, Ritu Gupta, Sandeep Rathod, Sandeep Chauhan, Sridhar Anand, Ranjani Ramachandran
India enrolled 620 eligible MDR TB patients (primarily XDR TB, MDR/XDR TB failures & non-responders and MDR TB plus FQ or SLI resistance) under Bedaquiline Conditional Access Programme (BDQ-CAP) between June 2016 and August 2017 [31,35]. The programmatic data analysis of the treatment outcomes revealed that there were, 349 (56%) males; 554 (89%) between 18–50 years and 240 (39%) severely malnourished. There were 354 (57%) with MDRFQ; 31 (5%) with MDRSLI and 101 (16%) with XDR TB. In the interim analysis [35], 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 BDQ was discontinued permanently in 27 (4%) patients. Seventy-three (12%) deaths were reported, most of them (56%) occurring within the first 6 months of treatment.
Amikacin liposome inhalation suspension as a treatment for patients with refractory mycobacterium avium complex lung infection
Published in Expert Review of Respiratory Medicine, 2021
From the data available to date, the low success rate challenges the current guideline-based therapy for MAC lung disease, ranging from 32% to 65%, with treatment interrupted in 12–16% of the cases due to side effects [19,20,21–23]. For patients that developed macrolide resistance, the culture conversion rates are only 15%–36%, while the 5-year mortality is up to 47% [52,53]. There are limited alternative therapy can be given if patients failed to respond to the guidelines-based therapy. For macrolide-resistant MAC lung disease, recently published BTS guidelines recommended the addition of intravenous streptomycin or amikacin to the standard antibiotic treatment [18]. In our opinion, this intravenous option is challenging in view that permanent intravenous catheters are needed because of the prolonged therapy. In addition, in comparison with inhalation therapies, systemic administration will lead to lower concentrations in affected areas with a higher incidence of systemic toxicities.