Role of Treatment Cost on Transmission of Multidrug-Resistant Tuberculosis Into Iran

The emergence of multidrug-resistant tuberculosis poses a serious challenge to traditional drug therapy. In view of the relapse rate of up to 50% following medical management, there has been renewed interest in the role of surgery for this problem. We report our experience with lung resection for this condition. Over a 5-year period, resection was performed in 23 patients who were diagnosed with multidrug resistance after completing a course of standard chemotherapy and at least 3 months of second-line therapy. Pneumonectomy was performed in 17 patients and lobectomy in 6. There was no operative or postoperative mortality. Major complications developed in 4 patients (17.4%): 2 had post-pneumonectomy empyema and 2 underwent rethoracotomy for bleeding. Ten patients were sputum positive preoperatively, and only 1 remained positive after surgery. The patients were put on appropriate chemotherapy and followed up for 18 months. The cure rate was 95.6%. Pulmonary resection can be considered as an important adjunct to medical therapy in carefully selected patients: those who have localized disease with adequate pulmonary reserve, or who have multiple previous relapses, or whose sputum remains positive after 4 to 6 months of appropriate medical treatment. Surgery offers high cure rates with acceptable morbidity and mortality.

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Patients’ Perception of a Community Pharmacist-Managed Multidrug-Resistant Tuberculosis Program in Peru: A Public Health Perspective

INNOVATIONS in pharmacy ◽

10.24926/iip.v8i3.536 ◽

2017 ◽

Vol 8 (3) ◽

pp. 11 ◽

Cited By ~ 1

Author(s):

Sean O'Brien ◽

Jacy Downey

Keyword(s):

Public Health ◽

Community Pharmacist ◽

Community Pharmacists ◽

Multidrug Resistant ◽

Perceived Barriers ◽

The Public ◽

Resistant Tuberculosis ◽

Multidrug Resistant Tuberculosis ◽

Mdr Tb

Objectives: The primary objective is to investigate the public’s perception about the role of the community pharmacist in Peru’s directly observed treatment, short course (DOTS) program. The secondary objective is to assess perceived barriers that would prevent the public from utilizing community pharmacists in order to identify future opportunities for community pharmacists to increase adherence to multidrug-resistant tuberculosis (MDR-TB) therapy. Design: Qualitative study comprised of an 8 close-ended survey questionnaire. Setting: Healthcare clinics established by a medical mission group in Lima and surrounding communities, Peru, from July 13 to July 27, 2015. Participants: Patients 15 years of age and over who sought healthcare at the clinics. Main outcome measures: Public’s perception about the role of the community pharmacist in Peru and barriers that would prevent the public from seeking a community pharmacist. Results: Out of the 445 patients approached, 438 patients completed the survey, resulting in a 98% response rate. More than half (52%) of the respondents were likely to seek a community pharmacist to assist them in completing a MDR-TB medication regimen. Almost half (48%) of the respondents felt comfortable with assistance of a community pharmacist in completing an MDR-TB regimen. The physician was the first health care professional that was contacted for all medical situations, including drug-related questions (61%). Lack of privacy in the pharmacy (53%) and busyness of the pharmacists (52%) were the top perceived barriers for asking community pharmacists questions. Conclusion: This study highlights the need for pharmacist participation in Peru’s DOTS program. Furthermore, this investigation has identified several issues of concern related to current community pharmacy practice in Peru. Therefore, future efforts may be necessary to address these identified areas of opportunity to promote the community pharmacist’s role in health screening, drug therapy monitoring, and counseling to decrease the public health burden of MDR-TB. Conflict of Interest We declare no conflicts of interest or financial interests that the authors or members of their immediate families have in any product or service discussed in the manuscript, including grants (pending or received), employment, gifts, stock holdings or options, honoraria, consultancies, expert testimony, patents or royalties. Type: Original Research

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STUDI FENOMENOLOGI : DUKUNGAN TERHADAP KEPATUHAN MINUM OBAT PADA PENDERITA TUBERCULOSIS DENGAN MULTIDRUG-RESISTANT

Jurnal Delima Harapan ◽

10.31935/delima.v8i1.106 ◽

2021 ◽

Vol 8 (1) ◽

pp. 12-20

Author(s):

Murwanti Murwanti

Keyword(s):

Health Services ◽

Community Involvement ◽

Sampling Technique ◽

Phenomenological Approach ◽

Multidrug Resistant ◽

Spiritual Support ◽

Resistant Tuberculosis ◽

Multidrug Resistant Tuberculosis ◽

Mdr Tb

Background: Tuberculosis is an infectious disease if the patient does not complete therapeutic treatment can cause multidrug-resistant tuberculosis (MDR-TB). The role of the environment is needed to support treatment.The study aims to explore more deeply the family's support for medication adherence in patients with multidrug-resistant tuberculosis (TBC-MDR). Method: This type of research is qualitative using a descriptive phenomenological approach, in-depth interviews of 5 participants based on purposive sampling technique. Results: The results of the study found the role of the family towards TB-MDR patients manifested in emotional, physical, instrumental, and spiritual support. emotional support consists of positive and negative emotional. Community involvement after counseling was supportive but there were some who could not accept even families of MDR-TB sufferers were also shunned. The role of health services is to convey information, prepare medicines, supervise, motivate treatment, remind check schedules, refer to more complete facilities when needed, visit homes and ensure patients take medication if unable to come to the public health service. Conclusion: This study found 3 main themes, namely the role of comprehensive family, community involvement and the role of health services in mentoring TB-MDR patients.

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Solid Lipid Nanoparticles as Formulative Strategy to Increase Oral Permeation of a Molecule Active in Multidrug-Resistant Tuberculosis Management

Pharmaceutics ◽

10.3390/pharmaceutics12121132 ◽

2020 ◽

Vol 12 (12) ◽

pp. 1132

Author(s):

Antonella Obinu ◽

Elena Piera Porcu ◽

Sandra Piras ◽

Roberta Ibba ◽

Antonio Carta ◽

...

Keyword(s):

Solid Lipid Nanoparticles ◽

Oral Absorption ◽

Antitubercular Activity ◽

Multidrug Resistant ◽

Lipid Nanoparticles ◽

Particle Size Range ◽

Solid Lipid ◽

Resistant Tuberculosis ◽

Multidrug Resistant Tuberculosis

The role of mycobacterial efflux pumps in drug-resistant tuberculosis has been widely reported. Recently, a new compound, named SS13, has been synthesized, and its activity as a potential efflux inhibitor has been demonstrated. In this work, the chemical–physical properties of the SS13 were investigated; furthermore, a formulative study aimed to develop a formulation suitable for oral administration was performed. SS13 shows nonintrinsic antitubercular activity, but it increases the antitubercular activity of all the tested drugs on several strains. SS13 is insoluble in different simulated gastrointestinal media; thus, its oral absorption could be limited. Solid lipid nanoparticles (SLNs) were, therefore, developed by using two different lipids, Witepsol and/or Gelucire. Nanoparticles, having a particle size (range of 200–450 nm with regards to the formulation composition) suitable for intestinal absorption, are able to load SS13 and to improve its permeation through the intestinal mucosa compared to the pure compound. The cytotoxicity is influenced by the concentration of nanoparticles administered. These promising results support the potential application of these nanocarriers for increasing the oral permeation of SS13 in multidrug-resistant tuberculosis management.

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Safety and Efficacy of Delamanid in the Treatment of Multidrug-Resistant Tuberculosis (MDR-TB)

Clinical Medicine Insights Therapeutics ◽

10.4137/cmt.s11675 ◽

2013 ◽

Vol 5 ◽

pp. CMT.S11675 ◽

Cited By ~ 5

Author(s):

Stephen K. Field

Keyword(s):

Multidrug Resistant ◽

Phase Iii ◽

Drug Resistant ◽

Resistant Tuberculosis ◽

Multidrug Resistant Tuberculosis ◽

Improved Outcomes ◽

Resistance Patterns ◽

Mdr Tb ◽

Phase Iii Study

Globally, the incidence of tuberculosis (TB) is declining but the proportion of drug-resistant cases has increased. Strains resistant to both isoniazid and rifampin, and possibly other antibiotics, called multidrug-resistant (MDR), are particularly difficult to treat. Poorer outcomes, including increased mortality, occur in patients infected with MDR strains and the costs associated with treatment of MDR-TB are substantially greater. The recent recognition of MDR-TB and strains with more complex resistance patterns has stimulated the development of new TB medications including fluoroquinolones, oxazolidinones, diarylquinolines, nitroimidazopyrans, ethylenediamines, and benzothiazinones. Bedaquiline, a diarylquinoline, was approved for the treatment of MDR-TB in 2012. Addition of delamanid to WHO-approved treatment improved outcomes for MDR-TB and for extensively drug-resistant TB in a large randomized, controlled phase II clinical trial and is undergoing evaluation in a large international phase III study. This review will focus on MDR-TB and the role of delamanid in its treatment.

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Gyrase Mutations Are Associated with Variable Levels of Fluoroquinolone Resistance in Mycobacterium tuberculosis

Journal of Clinical Microbiology ◽

10.1128/jcm.02775-15 ◽

2016 ◽

Vol 54 (3) ◽

pp. 727-733 ◽

Cited By ~ 41

Author(s):

Maha R. Farhat ◽

Karen R. Jacobson ◽

Molly F. Franke ◽

Devinder Kaur ◽

Alex Sloutsky ◽

...

Keyword(s):

Multidrug Resistant ◽

Open Reading Frames ◽

Fluoroquinolone Resistance ◽

Test Results ◽

Resistant Tuberculosis ◽

Multidrug Resistant Tuberculosis ◽

Disease Mutations ◽

The Individual ◽

Selection Of

Molecular diagnostics that rapidly and accurately predict resistance to fluoroquinolone drugs and especially later-generation agents promise to improve treatment outcomes for patients with multidrug-resistant tuberculosis and prevent the spread of disease. Mutations in thegyrgenes are known to confer most fluoroquinolone resistance, but knowledge about the effects ofgyrmutations on susceptibility to early- versus later-generation fluoroquinolones and about the role of mutation-mutation interactions is limited. Here, we sequenced the fullgyrAandgyrBopen reading frames in 240 multidrug-resistant and extensively drug-resistant tuberculosis strains and quantified their ofloxacin and moxifloxacin MIC by testing growth at six concentrations for each drug. We constructed a multivariate regression model to assess both the individual mutation effects and interactions on the drug MICs. We found thatgyrBmutations contribute to fluoroquinolone resistance both individually and through interactions withgyrAmutations. These effects were statistically significant. In these clinical isolates, severalgyrAandgyrBmutations conferred different levels of resistance to ofloxacin and moxifloxacin. Consideration ofgyrmutation combinations during the interpretation of molecular test results may improve the accuracy of predicting the fluoroquinolone resistance phenotype. Further, the differential effects ofgyrmutations on the activity of early- and later-generation fluoroquinolones requires further investigation and could inform the selection of a fluoroquinolone for treatment.

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Clofazimine as a Treatment for Multidrug-Resistant Tuberculosis: A Review

Scientia Pharmaceutica ◽

10.3390/scipharm89020019 ◽

2021 ◽

Vol 89 (2) ◽

pp. 19

Author(s):

Rhea Veda Nugraha ◽

Vycke Yunivita ◽

Prayudi Santoso ◽

Rob E. Aarnoutse ◽

Rovina Ruslami

Keyword(s):

Multidrug Resistant ◽

Tb Treatment ◽

Resistant Tuberculosis ◽

Multidrug Resistant Tuberculosis ◽

Mdr Tb ◽

Repurposed Drugs ◽

Group 5 ◽

Poor Outcomes ◽

Group B

Multidrug-resistant tuberculosis (MDR-TB) is an infectious disease caused by Mycobacterium tuberculosis which is resistant to at least isoniazid and rifampicin. This disease is a worldwide threat and complicates the control of tuberculosis (TB). Long treatment duration, a combination of several drugs, and the adverse effects of these drugs are the factors that play a role in the poor outcomes of MDR-TB patients. There have been many studies with repurposed drugs to improve MDR-TB outcomes, including clofazimine. Clofazimine recently moved from group 5 to group B of drugs that are used to treat MDR-TB. This drug belongs to the riminophenazine class, which has lipophilic characteristics and was previously discovered to treat TB and approved for leprosy. This review discusses the role of clofazimine as a treatment component in patients with MDR-TB, and the drug’s properties. In addition, we discuss the efficacy, safety, and tolerability of clofazimine for treating MDR-TB. This study concludes that the clofazimine-containing regimen has better efficacy compared with the standard one and is also well-tolerated. Clofazimine has the potential to shorten the duration of MDR-TB treatment.

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The Correlation Between Interleukin-10 1082G/A Gene Polimorphism Late Onset with Nephrotoxicity Secondary to Antituberculosis Treatment in Multidrug Resistant Tuberculosis Patients

Jurnal Respirologi Indonesia ◽

10.36497/jri.v39i4.71 ◽

2019 ◽

Vol 39 (4) ◽

pp. 215-219

Author(s):

Harsini Harsini ◽

Reviono Reviono ◽

Umarudin Umarudin

Keyword(s):

Late Onset ◽

Interleukin 10 ◽

Multidrug Resistant ◽

Protective Role ◽

Tuberculosis Patients ◽

Resistant Tuberculosis ◽

Multidrug Resistant Tuberculosis ◽

Antituberculosis Treatment ◽

Mdr Tb

Backgrounds: Tuberculosis controlling programme has become more complex with MDR-TB problem. Interleukin 10 (IL-10) 1082G/A gene polimorphism correlates with IL-10 secretion as anti-inflammatory cytokine which plays important role in pathogenesis of MDR-TB infection. The management of MDR-TB which used aminoglycosides could cause nephrotoxic effect to the patients. The protective role of IL-10 from IL-10 1082 G/A genotype to nephrotoxicity due to kanamycin still becomes a prolem nowadays. Methods: This study was a retorspective cohort study of MDR-TB patients who underwent treatment in Dr. Moewardi Hospital in 2011-2015. Results: Subjects of the study were 89 MDR-TB patients with IL-10 1082 G/A genotype polimorphism. The proportions of IL-10 1082 G/A genotype were AA genotype of 13.48%, GG of 4.49%, and GA of 82.2%. Statistic test showed that the onset of nephrotoxicity in GG genotype was faster than GA and AA genotype Conclusions: Interleukin 10 1082 G/A gene polymorphism had no significant correlation with nephrotoxicity onset in MDR-TB patients treated with kanamycin in Dr. Moewardi hospital. (J Respir Indo. 2019; 39(4): 215-9)

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