scholarly journals Plasma Levels of Rifampin Correlate with the Tuberculosis Drug Activity Assay

2018 ◽  
Vol 62 (5) ◽  
Author(s):  
Katarina Niward ◽  
Linnea Ek Blom ◽  
Lina Davies Forsman ◽  
Judith Bruchfeld ◽  
Erik Eliasson ◽  
...  
Keyword(s):  
Therapeutic Drug Monitoring ◽  
Plasma Levels ◽  
Treatment Initiation ◽  
Therapeutic Drug ◽  
Activity Assay ◽  
First Line ◽  
Resource Limited Settings ◽  
Drug Activity ◽  
Tb Treatment ◽  
Resource Limited

ABSTRACT The plasma tuberculosis drug activity (TDA) assay may be an alternative tool for therapeutic drug monitoring in resource-limited settings. In tuberculosis (TB) patients ( n = 30), TDA and plasma levels of first-line drugs were analyzed 2 h postdose, 2 weeks after treatment initiation. Patients with plasma levels of rifampin lower than 8 mg/liter had a significantly lower median TDA (1.40 versus 1.68, P = 0.0013). TDA may be used to identify TB patients with suboptimal rifampin levels during TB treatment.

scholarly journals Therapeutic Drug Monitoring of Nevirapine in Resource‐Limited Settings

2008 ◽  
Vol 47 (10) ◽  
pp. 1339-1344 ◽  
Author(s):  
Rafaëlla F. A. L’homme ◽  
Eva P. Muro ◽  
Jacqueline A. H. Droste ◽  
Liselotte R. Wolters ◽  
Noor W. J. van Ewijk‐Beneken Kolmer ◽  
...  
Keyword(s):  
Therapeutic Drug Monitoring ◽  
Drug Monitoring ◽  
Therapeutic Drug ◽  
Resource Limited Settings ◽  
Resource Limited

scholarly journals Challenges in the Management of Disseminated Progressive Histoplasmosis in Human Immunodeficiency Virus-Infected Patients in Resource-Limited Settings

2015 ◽  
Vol 2 (1) ◽  
Author(s):  
Richard A. Murphy ◽  
Lilishia Gounder ◽  
Thandekile C. Manzini ◽  
Pratistadevi K. Ramdial ◽  
Carmen Castilla ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Therapeutic Drug Monitoring ◽  
Liposomal Amphotericin ◽  
Treatment Options ◽  
Diagnostic Tools ◽  
Therapeutic Drug ◽  
Resource Limited Settings ◽  
Resource Limited ◽  
Immunodeficiency Virus ◽  
African Context

Abstract The diagnosis of histoplasmosis in patients with human immunodeficiency virus in southern Africa is complicated by the nonspecific presentation of the disease in this patient group and the unavailability of sensitive diagnostics including antigen assays. Treatment options are also limited due to the unavailability of liposomal amphotericin and itraconazole, and the inability to perform therapeutic drug monitoring further confounds management. We present 3 clinical cases to illustrate the limits of diagnosis and management in the southern African context, and we highlight the need for additional diagnostic tools and treatment options in resource-limited settings.

scholarly journals Discordance of the Repeat GeneXpert MTB/RIF test for Rifampicin Resistance Detection among Patients Initiating MDR-TB Treatment in Uganda

2020 ◽  
Author(s):  
Willy Ssengooba ◽  
Jean Iragena ◽  
Kevin Komakech ◽  
Iginitius Okello ◽  
Joanitah Nalunjogi ◽  
...  
Keyword(s):  
Treatment Initiation ◽  
Sputum Sample ◽  
Drug Susceptibility ◽  
Drug Susceptibility Testing ◽  
Smear Microscopy ◽  
First Line ◽  
Tb Treatment ◽  
Mulago National Referral Hospital ◽  
Mdr Tb ◽  
National Referral Hospital

Abstract We recruited all patients with Xpert Rifampicin-Resistant (RR)-TB detected, referred to the MDR-TB ward at Mulago National Referral Hospital, Kampala, Uganda for MDR-TB treatment initiation between September 2017 and October 2019. Using baseline samples collected for patients screened for STREAM 2 trial, smear microscopy, repeat Xpert test and first-line MTBDRplus assay were done. Culture-based drug-susceptibility testing was done on discordant samples. We analysed for factors associated with discordant results and false RR as determined as no RR detected by at least two of the methods used (reference standard). Of 126/130 patients who had results of repeat Xpert, 97 (77.0%) had M. tuberculosis detected of which 81 (83.5%) had RR-detected, 1 (1.0%) indeterminate. A total of 10/96 (10.4%) patients were rifampicin susceptible by at least two of the methods. Having false Xpert RR was associated with low bacillary load measured by high cycle threshold (Ct) value i.e. low (Ct 22–28) and very low (Ct > 28) of the initial Xpert test 0.09 (0.05; 0.01–1.08) and 0.02 (0.01; 0.01–0.35) respectively. Our results show that a repeat Xpert test on another sputum sample for patients with initial low M. tuberculosis detected RR-detected, would exclude 10% of the TB patients from unnecessary MDR-TB treatment initiation.

scholarly journals Simplified Dosing Regimens for Gentamicin in Neonatal Sepsis

2021 ◽  
Vol 12 ◽  
Author(s):  
S. D’Agate ◽  
F. Tshinanu Musuamba ◽  
E. Jacqz-Aigrain ◽  
O. Della Pasqua
Keyword(s):  
Body Weight ◽  
Bacterial Infections ◽  
Drug Disposition ◽  
External Validation ◽  
World Health ◽  
Fixed Dose ◽  
Therapeutic Drug ◽  
Resource Limited Settings ◽  
Young Infants ◽  
Resource Limited

Background: The effectiveness of antibiotics for the treatment of severe bacterial infections in newborns in resource-limited settings has been determined by empirical evidence. However, such an approach does not warrant optimal exposure to antibiotic agents, which are known to show different disposition characteristics in this population. Here we evaluate the rationale for a simplified regimen of gentamicin taking into account the effect of body size and organ maturation on pharmacokinetics. The analysis is supported by efficacy data from a series of clinical trials in this population.Methods: A previously published pharmacokinetic model was used to simulate gentamicin concentration vs. time profiles in a virtual cohort of neonates. Model predictive performance was assessed by supplementary external validation procedures using therapeutic drug monitoring data collected in neonates and young infants with or without sepsis. Subsequently, clinical trial simulations were performed to characterize the exposure to intra-muscular gentamicin after a q.d. regimen. The selection of a simplified regimen was based on peak and trough drug levels during the course of treatment.Results: In contrast to current World Health Organization guidelines, which recommend gentamicin doses between 5 and 7.5 mg/kg, our analysis shows that gentamicin can be used as a fixed dose regimen according to three weight-bands: 10 mg for patients with body weight <2.5 kg, 16 mg for patients with body weight between 2.5 and 4 kg, and 30 mg for those with body weight >4 kg.Conclusion: The choice of the dose of an antibiotic must be supported by a strong scientific rationale, taking into account the differences in drug disposition in the target patient population. Our analysis reveals that a simplified regimen is feasible and could be used in resource-limited settings for the treatment of sepsis in neonates and young infants with sepsis aged 0–59 days.

Optimizing treatment outcome of first-line anti-tuberculosis drugs: the role of therapeutic drug monitoring

2016 ◽  
Vol 72 (8) ◽  
pp. 905-916 ◽  
Author(s):  
Roger K. Verbeeck ◽  
Gunar Günther ◽  
Dan Kibuule ◽  
Christian Hunter ◽  
Tim W. Rennie
Keyword(s):  
Treatment Outcome ◽  
Therapeutic Drug Monitoring ◽  
Drug Monitoring ◽  
Therapeutic Drug ◽  
First Line
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