Treating children for drug-resistant tuberculosis in Tajikistan with Group 5 medications

Swaminathan, A.; Cros, Philipp du; Seddon, James A; Quinnell, Sarah; Bobokhojaev, Oktam; Dusmatova, Zulfiya; Achar, Jay

doi:10.5588/ijtld.15.0666

Cited by 15 publications

(6 citation statements)

References 1 publication

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“…Ichthyosis is less common and improves with intensive efforts at applying lubricants during treatment. As noted, QT interval prolongation may occur and is especially important to monitor by ECG if given together with other QT interval–prolonging medication (68, 83, 110–112, 114, 115). Clofazimine may have cross-resistance with bedaquiline, which may need to be considered when building a regimen for MDR-TB (75).…”

Section: Drugs and Drug Classesmentioning

confidence: 99%

Treatment of Drug-Resistant Tuberculosis. An Official ATS/CDC/ERS/IDSA Clinical Practice Guideline

Nahid¹,

Mase²,

Migliori³

et al. 2019

Am J Respir Crit Care Med

329

342

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jointly sponsored this new practice guideline on the treatment of drug-resistant tuberculosis (DR-TB). The document includes recommendations on the treatment of multidrug-resistant TB (MDR-TB) as well as isoniazid-resistant but rifampin-susceptible TB. Methods: Published systematic reviews, meta-analyses, and a new individual patient data meta-analysis from 12,030 patients, in 50 studies, across 25 countries with confirmed pulmonary rifampinresistant TB were used for this guideline. Meta-analytic approaches included propensity score matching to reduce confounding. Each recommendation was discussed by an expert committee, screened for conflicts of interest, according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. Results: Twenty-one Population, Intervention, Comparator, and Outcomes questions were addressed, generating 25 GRADE-based recommendations. Certainty in the evidence was judged to be very low, because the data came from observational studies with significant loss to follow-up and imbalance in background regimens between comparator groups. Good practices in the management of MDR-TB are described. On the basis of the evidence review, a clinical strategy tool for building a treatment regimen for MDR-TB is also provided. Conclusions: New recommendations are made for the choice and number of drugs in a regimen, the duration of intensive and continuation phases, and the role of injectable drugs for MDR-TB. On the basis of these recommendations, an effective all-oral regimen for MDR-TB can be assembled. Recommendations are also provided on the role of surgery in treatment of MDR-TB and for treatment of contacts exposed to MDR-TB and treatment of isoniazid-resistant TB.

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Section: Drugs and Drug Classesmentioning

confidence: 99%

Treatment of Drug-Resistant Tuberculosis. An Official ATS/CDC/ERS/IDSA Clinical Practice Guideline

Nahid¹,

Mase²,

Migliori³

et al. 2019

Am J Respir Crit Care Med

329

342

View full text Add to dashboard Cite

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“…The need for parenteral administration and the doubtful efficacy against M. tuberculosis make these drugs add-on agents and not core components of the MDR-TB regimen. There are some observational studies outlining the use of these drugs in children which have reported tolerability and acceptable safety profile when used for XDR-TB [51–53]. …”

Section: What Regimen To Start?mentioning

confidence: 99%

Current therapies for the treatment of multidrug-resistant tuberculosis in children in India

Mukherjee

Lodha

Kabra

2017

Expert Opinion on Pharmacotherapy

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Introduction: Multidrug-resistant tuberculosis (MDR-TB) is a serious life threatening condition affecting children as well as adults worldwide. Timely diagnosis and effective treatment, both of which are complex in children, are the prerogatives for a favorable outcome.Areas covered: This review covers epidemiology, treatment regimen and duration, newer drugs and adverse events in children with MDR-TB. Special note has been made of epidemiology and principles of treatment followed in Indian children.Expert opinion: High index of suspicion is essential for diagnosing childhood MDR-TB. If there is high probability, a child can be diagnosed as presumptive MDR-TB and started on empiric treatment in consultation with experts. However, every effort should be made to confirm the diagnosis. Backbone of an effective MDR-TB regimen consists of four 2nd line anti-TB drugs plus pyrazinamide; duration being 18–24 months. The newer drugs delamanid and bedaquiline can be used in younger children if no other alternatives are available after consultation with experts. Wider availability of these drugs should be ensured for benefit to all concerned. More research is required for development of new and repurposed drugs to combat MDR-TB. Children need to be included in clinical trials for such life-saving drugs, so that nobody is denied the benefits.

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“…Extensive safety monitoring accompanied treatment and revealed transient thrombocytopenia at 6 months and peripheral neuropathy at 8 months, necessitating discontinuation of the drug. 139 The South African experience in seven children at comparable or lower doses (20 mg/kg daily <10 years, 300 mg daily ! 10 years) revealed a higher incidence of adverse events occurring in the subset of children with co-morbid HIV infection leading the authors to propose that lower doses might be equally effective and mitigate toxicities.…”

Section: Linezolidmentioning

confidence: 99%

Pharmacology of Mycobacterial Drugs in Children

Goldman

Abdel‐Rahman

2017

J Pediatr Infect Dis

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To effectively treat tuberculosis (TB), optimization of therapy guided by an understanding of pharmacokinetic-pharmacodynamic principles represents the strategy most likely to influence favorable patient outcomes. However, challenges are often encountered during TB treatment given the concomitant administration of multiple drugs, some with poorly defined therapeutic targets, for prolonged durations. Treatment is further complicated in children as many antitubercular drugs have not been extensively studied in the pediatric population where the impact of human development on drug disposition is relevant, but poorly understood. In this review, the pharmacokinetics (PK) of antitubercular drugs will be reviewed in the context of the pediatric population. Observed differences between adults and children with respect to TB therapy will be highlighted, and future considerations to enhance our understanding of TB drugs used in children will be explored.

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Treating children for drug-resistant tuberculosis in Tajikistan with Group 5 medications

Cited by 15 publications

References 1 publication

Treatment of Drug-Resistant Tuberculosis. An Official ATS/CDC/ERS/IDSA Clinical Practice Guideline

Treatment of Drug-Resistant Tuberculosis. An Official ATS/CDC/ERS/IDSA Clinical Practice Guideline

Current therapies for the treatment of multidrug-resistant tuberculosis in children in India

Pharmacology of Mycobacterial Drugs in Children

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