scholarly journals Tuberculosis: Development of New Drugs and Treatment Regimens

2021 ◽  
Vol 7 (1) ◽  
pp. 36
Author(s):  
Soedarsono Soedarsono
Keyword(s):  
Treatment Guidelines ◽  
New Drugs ◽  
World Health ◽  
Health Crisis ◽  
Treatment Regimens ◽  
Tb Treatment ◽  
Repurposed Drugs ◽  
Latent Tb Infection ◽  
Health Organization ◽  
Who Guideline

Tuberculosis (TB) still becomes a public health crisis. Drug-resistant TB (DR-TB) becomes a concern as the increasing DR-TB cases in countries with high TB burden. The 2017 World Health Organization (WHO) guideline recommended a combination of TB treatment consisting of 2 months of intensive phase with isoniazid (H), rifampisin (R), pyrazinamid (Z), and ethambutol (E), followed by 4 months of continuation phase with HR daily. WHO has updated DR-TB treatment guidelines several times. In 2016, WHO recommended shorter regimen and individual regimen based on certain conditions. The most updated 2020 WHO guideline recommended the short regimen consisting of all oral drugs as well as changes in the grouping of medicines used in DR-TB regimens in longer/individual regimens. Bedaquiline, delamanid, pretomanid, and sutezolid are new drugs which have been studied for their uses as anti-TB drugs (ATD). Bedaquilin and delamanid, which have passed phase 3 trials, have been approved and recommended by WHO for DR-TB treatment. Repurposed drugs have been used for DR-TB treatment during the time of evaluation of drugs list and regimens for DR-TB treatment. Fluoroquinolones, clofazimine, linezolid, carbapenem, amoxicillin/clavulanic acid are repurposed drugs. TB and DR-TB management will be updated at any time, based on the latest findings in studies, to evaluate and improve the effectiveness of current treatments. Prevention of active TB disease by the treatment of latent TB infection (LTBI) is also a critical component of the end TB strategy by WHO. Therefore, the development of new drugs for the LTBI treatment is also needed.

Multidisciplinary advisory teams to manage multidrug-resistant tuberculosis: the example of the French Consilium

2019 ◽  
Vol 23 (10) ◽  
pp. 1050-1054
Author(s):  
L. Guglielmetti ◽  
J. Jaffré ◽  
C. Bernard ◽  
F. Brossier ◽  
N. El Helali ◽  
...  
Keyword(s):  
Multidrug Resistant ◽  
New Drugs ◽  
World Health ◽  
Advisory Committees ◽  
Treatment Regimens ◽  
Tb Treatment ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Mdr Tb ◽  
Health Organization

SETTING: The World Health Organization (WHO) recommends that multidrug-resistant tuberculosis (MDR-TB) treatment should be managed in collaboration with multidisciplinary advisory committees (consilia). A formal national Consilium has been established in France since 2005 to provide a centralised advisory service for clinicians managing MDR-TB and extensively drug-resistant (XDR-TB) cases.OBJECTIVE: Review the activity of the French TB Consilium since its establishment.DESIGN: Retrospective description and analysis of the activity of the French TB Consilium.RESULTS: Between 2005 and 2016, 786 TB cases or contacts of TB cases were presented at the French TB Consilium, including respectively 42% and 79% of all the MDR-TB and XDR-TB cases notified in France during this period. Treatment regimens including bedaquiline and/or delamanid were recommended for 42% of the cases presented at the French TB Consilium since 2009. Patients were more likely to be presented at the French TB Consilium if they were born in the WHO Europe Region, had XDR-TB, were diagnosed in the Paris region, or had resistance to additional drugs than those defining XDR-TB.CONCLUSION: The French TB Consilium helped supervise appropriate management of MDR/XDR-TB cases and facilitated implementation of new drugs for MDR/XDR-TB treatment.

scholarly journals Guidelines on controlling latent tuberculosis infection to support tuberculosis elimination

2021 ◽  
Vol 23 (1) ◽  
pp. 28-36
Author(s):  
P Godoy
Keyword(s):  
Treatment Guidelines ◽  
Latent Tuberculosis ◽  
Homeless People ◽  
Risk Groups ◽  
World Health ◽  
Sufficient Evidence ◽  
Short Treatment ◽  
Short Period ◽  
Latent Tb Infection ◽  
Health Organization

Objectives: Latent TB infection (LTBI) affects 25% of the world’s population. As long as this reservoir exists, the elimination of TB will not be feasible. The Assembly of the World Health Organization adopted the “Global End TB” strategy for the elimination of TB in 2014. The objective of this review is to present strategies for risk groups that are candidates for the detection and treatment of LTBI. Material and method: There is sufficient evidence of screening in: immunocompromised people (HIV-infected, biological therapies, alternative renal therapy, organ transplantation), recent immigrants, inmates in prison, people injecting drugs and homeless people, and workers from at-risk settings. Tests to diagnose LTBI include tuberculin skin test (TST) and gamma release assay interferon (IGRA). There is no reference test and the choice of one or the other will depend on logistical considerations, such as avoiding injection (TST) or not needing a second visit (IGRA). Treatment of LTBI is based on the use of isoniazide and rifampicin in short period of 3 or 4 months, using associations of rifampicin and isoniazide or rifampicin alone. Discussion: Given the estimated high prevalence of LTBI, renewed efforts are required to reduce the number of people with LTBI that includes a registration and monitoring system to observer progress, increased testing, and the use of short treatment guidelines.

scholarly journals Integration of drug safety monitoring in tuberculosis treatment programmes: country experiences

2019 ◽  
Vol 28 (153) ◽  
pp. 180115
Author(s):  
Edine Tiemersma ◽  
Susan van den Hof ◽  
Gunta Dravniece ◽  
Fraser Wares ◽  
Yohannes Molla ◽  
...  
Keyword(s):  
Drug Safety ◽  
Safety Monitoring ◽  
New Drugs ◽  
World Health ◽  
Middle Income ◽  
Beneficial Effects ◽  
Tb Treatment ◽  
Resistant Tuberculosis ◽  
Drug Safety Monitoring ◽  
Health Organization

New drugs and shorter treatments for drug-resistant tuberculosis (DR-TB) have become available in recent years and active pharmacovigilance (PV) is recommended by the World Health Organization (WHO) at least during the early phases of implementation, with active drug safety monitoring and management (aDSM) proposed for this. We conducted a literature review of papers reporting on aDSM. Up to 18 April, 2019, results have only been published from one national aDSM programme. Because aDSM is being introduced in many low- and middle-income countries, we also report experiences in introducing it into DR-TB treatment programmes, targeting the reporting of a restricted set of adverse events (AEs) as per WHO-recommended aDSM principles for the period 2014–2017. Early beneficial effects of active PV for TB patients include increased awareness about the occurrence, detection and management of AEs during TB treatment, and the increase of spontaneous reporting in some countries. However, because PV capacity is low in most countries and collaboration between national TB programmes and national PV centres remains weak, parallel and coordinated co-development of the capacities of both TB programmes and PV centres is needed.

scholarly journals ADME and Pharmacokinetic Properties of Remdesivir: Its Drug Interaction Potential

2021 ◽  
Vol 14 (7) ◽  
pp. 655
Author(s):  
Subrata Deb ◽  
Anthony Allen Reeves ◽  
Robert Hopefl ◽  
Rebecca Bejusca
Keyword(s):  
Drug Interaction ◽  
Ebola Virus ◽  
Treatment Guidelines ◽  
Treatment Options ◽  
World Health ◽  
Nucleoside Triphosphate ◽  
Treatment Regimens ◽  
Global Pandemic ◽  
The World ◽  
Health Organization

On 11 March 2020, the World Health Organization (WHO) classified the Coronavirus Disease 2019 (COVID-19) as a global pandemic, which tested healthcare systems, administrations, and treatment ingenuity across the world. COVID-19 is caused by the novel beta coronavirus Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Since the inception of the pandemic, treatment options have been either limited or ineffective. Remdesivir, a drug originally designed to be used for Ebola virus, has antiviral activity against SARS-CoV-2 and has been included in the COVID-19 treatment regimens. Remdesivir is an adenosine nucleotide analog prodrug that is metabolically activated to a nucleoside triphosphate metabolite (GS-443902). The active nucleoside triphosphate metabolite is incorporated into the SARS-CoV-2 RNA viral chains, preventing its replication. The lack of reported drug development and characterization studies with remdesivir in public domain has created a void where information on the absorption, distribution, metabolism, elimination (ADME) properties, pharmacokinetics (PK), or drug-drug interaction (DDI) is limited. By understanding these properties, clinicians can prevent subtherapeutic and supratherapeutic levels of remdesivir and thus avoid further complications in COVID-19 patients. Remdesivir is metabolized by both cytochrome P450 (CYP) and non-CYP enzymes such as carboxylesterases. In this narrative review, we have evaluated the currently available ADME, PK, and DDI information about remdesivir and have discussed the potential of DDIs between remdesivir and different COVID-19 drug regimens and agents used for comorbidities. Considering the nascent status of remdesivir in the therapeutic domain, extensive future work is needed to formulate safer COVID-19 treatment guidelines involving this medication.

scholarly journals Hepatitis C: A Pharmacological Therapeutic Update

2021 ◽  
Vol 10 (8) ◽  
pp. 1568
Author(s):  
Sonia Santander Ballestín ◽  
David Gómez Martín ◽  
Sara Lorente Pérez ◽  
María José Luesma Bartolomé
Keyword(s):  
Hepatitis C ◽  
Treatment Guidelines ◽  
Phase Iii ◽  
World Health ◽  
Technical Data ◽  
Treatment Regimens ◽  
Phase Ii Studies ◽  
Pubmed Database ◽  
Health Organization ◽  
Direct Acting

(1) Background: Hepatitis C is a high-prevalence disease, representing a global impact health problem. Lately, many changes have been made in treatment guidelines because of the commercialization of second-generation direct-acting antivirals due to their high effectiveness, few side effects and pangenotypic action. We address the pharmacological possibilities available and compare them with the current recommendations of the World Health Organization (WHO). (2) Methods: The search for articles was made through the PubMed database using different search strategies and we consulted technical data sheets of the treatments that have been included in the study. (3) Results: Combinations of “glecaprevir/pibrentasvir”, “sofosbuvir/velpatasvir” and “sofosbuvir/velpatasvir/voxilaprevir” have been recently incorporated. Phase II studies have shown that they are safe and effective therapies with very comfortable posologies and easy therapeutic adherence; furthermore, they suppose shorter treatment duration. Subsequently, phase III studies have shown they were effective for previously treated or compensated cirrhotic patients that previously had more complex treatment regimens. (4) Conclusions: These results suppose a simplification in Hepatitis C therapeutic approach, and open new study possibilities.

scholarly journals Summary of Guidelines for Managing Histoplasmosis among People Living with HIV

2021 ◽  
Vol 7 (2) ◽  
pp. 134
Author(s):  
Freddy Perez ◽  
Diego Caceres ◽  
Nathan Ford ◽  
Giovanni Ravasi ◽  
Beatriz Gomez ◽  
...  
Keyword(s):  
Maintenance Therapy ◽  
Treatment Guidelines ◽  
Severe Disease ◽  
World Health ◽  
People Living With Hiv ◽  
Tb Treatment ◽  
Health Organization ◽  
Policy Guidance ◽  
Living With Hiv ◽  
Laboratory Assay

Histoplasmosis is a frequent fungal opportunistic infection in people living with HIV (PLHIV), associated every year to a total of 5% to 15% of AIDS-related deaths among this population. In 2020, the first global guidelines for diagnosing and managing disseminated histoplasmosis among PLHIV was published. This document recommends (1) detection of circulating Histoplasma antigens as the recommended laboratory assay to diagnose histoplasmosis among PLHIV; (2) the use of liposomal amphotericin for induction therapy in severe or moderately severe disease, followed by a maintenance therapy with itraconazole for 12 months; a shorter maintenance therapy could be considered if the patient is clinically stable and if immune status has improved; (3) antiretroviral therapy initiation as soon as possible among patients with histoplasmosis without involvement of central nervous system; and (4) that for the treatment of co-infection with histoplasmosis and tuberculosis (TB), treatment of TB should be initiated according to the World Health Organization treatment guidelines. Appropriate health education of providers, supportive supervision, and policy guidance for the care of PLHIV are required.

Antimicrobial peptides for the treatment of pulmonary tuberculosis, allies or foes?

2018 ◽  
Vol 24 (10) ◽  
pp. 1138-1147
Author(s):  
Bruno Rivas-Santiago ◽  
Flor Torres-Juarez
Keyword(s):  
Pulmonary Tuberculosis ◽  
Antimicrobial Peptides ◽  
Experimental Models ◽  
New Drugs ◽  
World Health ◽  
Public Health Issue ◽  
Health Organization ◽  
Drug Resistant Strains

Tuberculosis is an ancient disease that has become a serious public health issue in recent years, although increasing incidence has been controlled, deaths caused by Mycobacterium tuberculosis have been accentuated due to the emerging of multi-drug resistant strains and the comorbidity with diabetes mellitus and HIV. This situation is threatening the goals of World Health Organization (WHO) to eradicate tuberculosis in 2035. WHO has called for the creation of new drugs as an alternative for the treatment of pulmonary tuberculosis, among the plausible molecules that can be used are the Antimicrobial Peptides (AMPs). These peptides have demonstrated remarkable efficacy to kill mycobacteria in vitro and in vivo in experimental models, nevertheless, these peptides not only have antimicrobial activity but also have a wide variety of functions such as angiogenesis, wound healing, immunomodulation and other well-described roles into the human physiology. Therapeutic strategies for tuberculosis using AMPs must be well thought prior to their clinical use; evaluating comorbidities, family history and risk factors to other diseases, since the wide function of AMPs, they could lead to collateral undesirable effects.

Recent developments and opportunities in fighting COVID-19

Coronaviruses ◽  
2020 ◽  
Vol 01 ◽  
Author(s):  
Vikram Rao ◽  
Subrat Kumar Bhattamisra
Keyword(s):  
World Health ◽  
Diagnostic Tools ◽  
Extensive Literature ◽  
Angiotensin Converting Enzyme 2 ◽  
Recent Developments ◽  
Therapeutic Molecules ◽  
Discharged Patients ◽  
Extensive Literature Search ◽  
Repurposed Drugs ◽  
Health Organization

Background: COVID-19, a Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-Cov-2) was first diagnosed in the patients from Wuhan, China in December 2019. Within couple of months of infection, it was declared as pandemic by World health organization. COVID-19 has become the most contagious infection with a serious threat to global health. In this review, we aimed to discuss the pathogenesis, diagnostics, current treatments and potential vaccines for COVID-19. Methods: An extensive literature search was conducted using keywords “COVID-19”; “Coronavirus”; “SARS-Cov-2”; “SARS” in public domains of Google, Google scholar, PubMed, and ScienceDirect. Selected articles were used to construct this review. Results: SARS-Cov-2 uses the Spike (S) protein on its surface to recognize the receptor on angiotensin-converting enzyme 2 (ACE2) and bind with 10-folds greater affinity than SARS-Cov-1. Molecular assays and immunoassays are the most frequently used tests whereas computed tomography (CT) scans, Artificial intelligence enabled diagnostic tools were also used in patients. In therapeutic treatment, few drugs were repurposed and there are 23 therapeutic molecules including the repurposed drugs are in different stages of clinical trial. Similarly, development of vaccines is also in the pipeline. Few countries have managed well to contain the spread by rapid testing and identifying the clusters. Conclusion: Till now, the acute complications and mortality of COVID-19 has been linked to the pre-existing comorbid conditions or age. Besides the development of therapeutic strategies that includes drugs and vaccine, the long term implication of COVID-19 infection in terms of the disorder/disability in the cured/discharged patients is a new area to investigate.

scholarly journals Potential Prophylactic Treatments for COVID-19

Viruses ◽  
2021 ◽  
Vol 13 (7) ◽  
pp. 1292
Author(s):  
Noam Ben-Zuk ◽  
Ido-David Dechtman ◽  
Itai Henn ◽  
Libby Weiss ◽  
Amichay Afriat ◽  
...  
Keyword(s):  
World Health ◽  
Pharmaceutical Drugs ◽  
Mild Disease ◽  
Clinical Background ◽  
Repurposed Drugs ◽  
Prophylactic Use ◽  
Health Organization ◽  
Medical Indications ◽  
Respiratory Droplets ◽  
Near Future

The World Health Organization declared the SARS-CoV-2 outbreak a Public Health Emergency of International Concern at the end of January 2020 and a pandemic two months later. The virus primarily spreads between humans via respiratory droplets, and is the causative agent of Coronavirus Disease 2019 (COVID-19), which can vary in severity, from asymptomatic or mild disease (the vast majority of the cases) to respiratory failure, multi-organ failure, and death. Recently, several vaccines were approved for emergency use against SARS-CoV-2. However, their worldwide availability is acutely limited, and therefore, SARS-CoV-2 is still expected to cause significant morbidity and mortality in the upcoming year. Hence, additional countermeasures are needed, particularly pharmaceutical drugs that are widely accessible, safe, scalable, and affordable. In this comprehensive review, we target the prophylactic arena, focusing on small-molecule candidates. In order to consolidate a potential list of such medications, which were categorized as either antivirals, repurposed drugs, or miscellaneous, a thorough screening for relevant clinical trials was conducted. A brief molecular and/or clinical background is provided for each potential drug, rationalizing its prophylactic use as an antiviral or inflammatory modulator. Drug safety profiles are discussed, and current medical indications and research status regarding their relevance to COVID-19 are shortly reviewed. In the near future, a significant body of information regarding the effectiveness of drugs being clinically studied for COVID-19 is expected to accumulate, in addition to information regarding the efficacy of prophylactic treatments.

scholarly journals COVID-19 PANDEMIC UPDATES AND PERSPECTIVES. NEED FOR AN INTEGRATED AND EQUITABLE APPROACH.

2021 ◽  
Author(s):  
Grigoris Gerotziafas ◽  
Mariella Catalano ◽  
Ioannis Theodorou ◽  
Patrick van Dreden ◽  
Vincent Marechal ◽  
...  
Keyword(s):  
Mitigation Strategies ◽  
World Health ◽  
Learning Technology ◽  
Pharmacological Interventions ◽  
Health Crisis ◽  
Patients At Risk ◽  
Physical Barriers ◽  
Risk Of Disease ◽  
One Year ◽  
Health Organization

One year after the declaration of the COVID-19 pandemic by the World Health Organization (WHO) and despite the implementation of mandatory physical barriers and social distancing, humanity remains challenged by a long-lasting and devastating public health crisis. Non-pharmacological interventions (NPI) are efficient mitigation strategies. The success of these intense NPI is dependent on the approval and commitment of the population. The launch of a mass vaccination program in many countries in late December 2020 with mRNA vaccines, adenovirus-based vaccines, and inactivated virus vaccines has generated hope for the end of the pandemic. Current issues: The continuous appearance of new pathogenic viral strains and the ability of vaccines to prevent infection and transmission raise important concerns as we try to achieve community immunity against SARS-CoV-2 and its variants. The need of a second and even third generation of vaccines and the possibility of potentially harmful side-effects of the vaccines (i.e. venous thromboembolism ) have already been acknowledged. Perspectives: There is a critical and urgent need for a balanced and integrated strategy for the management of the COVID-19 outbreaks organized on three axes: (1) Prevention of the SARS-CoV-2 infection, (2) Detection and early diagnosis of patients at risk of disease worsening, and (3) Anticipation of medical care (PDA). Conclusion: The “PDA strategy” integrated into state policy for the support and expansion of health systems and introduction of digital organization (i.e. telemedicine, artificial intelligence and machine learning technology) is of major importance for the preservation of citizens’ health and life world-wide.

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