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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
Regimens towards treatment of TB disease must have multiple drugs, which are active against the bacteria. The standard of care for commencing TB disease treatment is four-drug therapy to obtain a bacteriological termination in pulmonary and extrapulmonary sites. Single-drug therapy can result in the development of bacterial resistance. In the same vein, the addition of a single drug to an anti-TB regimen that is failing can lead to increased resistance. The administration of two or more drugs to which in vitro susceptibility testing has been demonstrated helps prevent the emergence of Mtb that are resistant to the other drugs (CDC, 2013; Sotgiu et al., 2015). Directly observed therapy (DOT) is the preferred central management strategy for treatment of TB disease as recommended by CDC and even for treatment of LTBI provided resources are enough. Almost all the treatment regimens for drug-susceptible TB disease can be administered alternatingly by direct observation. Drug-resistant TB disease should be treated all the time with a daily regimen and under direct observation. Intermittent regimens are not recommended for treatment of multidrug-resistant (MDR) TB (CDC, 2013).
Tuberculosis
Published in Keith Struthers, Clinical Microbiology, 2017
It is essential that the patient on anti-TB treatment is closely monitored. Compliance over a long period is a problem, and directly observed therapy (DOT) can be used. Here the patient reports daily to a clinic and is observed taking the tablets. INH, pyrazinamide and rifampicin are potentially hepatotoxic, and baseline liver function tests (LFTs) are performed before treatment is started. It is important to have an index of suspicion and the patient with nausea and right upper quadrant tenderness must have liver functions checked. A bilirubin of >60 μmol/L and raised levels of aspartate transaminase (AST) and alanine transaminase (ALT) must prompt assessment of the patient and review of treatment. An alternative combination in the setting of deranged LFTs is ethambutol and streptomycin, bearing in mind that both these agents can be nephrotoxic. Optic neuritis is a side-effect associated with ethambutol. All patients on TB treatment are screened for hepatitis B and C infection.
Tuberculosis in Childhood
Published in Peter D O Davies, Stephen B Gordon, Geraint Davies, Clinical Tuberculosis, 2014
Directly observed therapy, short-course (DOTS) has become a cornerstone for tuberculosis control around the globe. Direct observation of therapy (DOT) is only one of five key elements. These include government commitment to sustained tuberculosis control activities, case detection by sputum smear microscopy, standardised treatment regimens of six to eight months for all confirmed smear-positive cases with DOT for at least two months, a regular uninterrupted supply of essential anti-tuberculosis drugs and a standardised recording and reporting system. DOTS has been adopted by 148 of 210 countries worldwide and almost 55% of the world’s population lives in countries providing DOTS. The WHO recommends that the DOTS strategy is applicable to all patients with tuberculosis, including children in whom high success rates (more than 95%) can be achieved [119]. Many countries have adopted a universal DOT policy, whereas others such as the United Kingdom use a selective policy for those who may be unreliable in taking their therapy [82].
Updated considerations in the diagnosis and management of tuberculosis infection and disease: integrating the latest evidence-based strategies
Published in Expert Review of Anti-infective Therapy, 2023
Daniel S. Graciaa, Marcos Coutinho Schechter, Krystle B. Fetalvero, Lisa Marie Cranmer, Russell R. Kempker, Kenneth G. Castro
For people with drug-susceptible TB (DS TB), standard treatment has long been a 6-month regimen consisting of INH, RIF, PZA, and EMB. This regimen (abbreviated 2HRZE/ 4HR) is administered as 2 months of all four drugs in an intensive phase, followed by 4 months of INH and RIF in a continuation phase (Table 1) [64]. As noted above, the evidence for this regimen is primarily drawn from several randomized clinical trials conducted by the BMRC and USPHS. A key component of successful treatment of people with DS TB has included ensuring adherence to treatment throughout the full course of therapy. Past studies by BMRC showed that the use of directly observed therapy (DOT) enabled outpatient care with excellent treatment outcomes. For several years, guidelines from WHO and CDC/ATS/IDSA recommended the use of DOT as standard of care for people with TB [65,66]. The use of DOT relied on trained nurses or ancillary health personnel, including trained community health workers or family members, to observe the ingestion of prescribed anti-TB drugs throughout the course of therapy.
Chapter 8: Drug-resistant tuberculosis
Published in Canadian Journal of Respiratory, Critical Care, and Sleep Medicine, 2022
Sarah K. Brode, Rachel Dwilow, Dennis Kunimoto, Dick Menzies, Faiz Ahmad Khan
The aforementioned comments pertain to the consideration of resistance at the time of initial diagnosis and treatment initiation. During the course of treatment, certain factors should make clinicians consider the possibility that drug resistance has been acquired (among patients with initially susceptible TB) or amplified (in patients starting with a form of drug-resistant TB). Progressive clinical and/or radiographic deterioration, failure of smears or cultures to convert in a timely fashion or reversion of smears or cultures from negative to positive should lead to suspicion of TB treatment failure (defined in Canada and the United States as continued or recurrent positive cultures after 4 or more months of treatment),55 which should trigger a review of prior DST results and performance of repeat DST on the most recently collected, on-treatment, culture-positive sample. Self-administered treatment, if used, should be abandoned in favor of directly observed therapy (DOT) and, in the event of possible drug malabsorption, serum drug concentrations should be measured.55 Depending upon the circumstances, consideration should be given to a change or expansion of the treatment regimen. If a decision is made to expand the regimen, then a minimum of two new drugs is suggested — it is inadvisable to add a single drug to a failing regimen. It is also advisable for the new drugs to be chosen from those to which the organism is known to be susceptible and/or those that the patient has never received.56
Effect of the School-Based Asthma Care for Teens (SB-ACT) program on asthma morbidity: a 3-arm randomized controlled trial
Published in Journal of Asthma, 2022
Jill S. Halterman, Kristin A. Riekert, Maria Fagnano, Paul J. Tremblay, Susan W. Blaakman, Reynaldo Tajon, Hongyue Wang, Belinda Borrelli
We also note that teens’ reported adherence to preventive medications continued to be high during the time of their receipt of directly observed therapy at school, but seem to drop once DOT was discontinued for many teens. It is possible that more intensive and prolonged counseling is necessary for this group to help them continue to self-manage over time. Further, since the DOT component was well received by the majority of teens (i.e.; 91% agreed that they were comfortable with the nurse giving them medications and 85% agreed that is was easy to go to the school health office to take their medication each day), it is also possible that maintaining DOT throughout the school year (and/or adding twice daily dosing) may be beneficial for teens while also recognizing that many in this age group are looking for increased independence.