Treatment of tuberculosis: update 2010

Yew, Wing Wai; Lange, Christoph; Leung, Chi Chiu

doi:10.1183/09031936.00033010

Cited by 96 publications

(71 citation statements)

References 201 publications

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“…For the whole population, median FVC was 2.23 L (95% CI 1.22-3.80 L) at study entry and 2.20 L (95% CI 0.99-4.71 L) after 48 weeks. The percentage of decliners seen in our study was lower than the 54% (p50.044) observed in the study by FLAHERTY et al [7], the 55% observed in the placebo group in the etanercept trial (48 weeks) [8] and the 52% reported in a Japanese pirfenidone trial (52 weeks) [9]. At least two measurements of FVC obtained before treatment were available in all patients.…”

Section: To the Editorscontrasting

confidence: 50%

Octreotide treatment of idiopathic pulmonary fibrosis: a proof-of-concept study

Crestani¹,

Chapron²,

Wallaert³

et al. 2012

European Respiratory Journal

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Section: To the Editorscontrasting

confidence: 50%

Octreotide treatment of idiopathic pulmonary fibrosis: a proof-of-concept study

Crestani¹,

Chapron²,

Wallaert³

et al. 2012

European Respiratory Journal

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“…Close monitoring of liver enzymes is necessary [106] and a pyrazinamide-free regimen is recommended in non-severe hepatic disease. In severe hepatic disease, an isoniazid-and pyrazinamide-free regimen (and even rifampicin-free) should be considered [96,100]. In severe hepatic disease or early after hepatic transplantation, a combination of ethambutol with a later generation fluoroquinolone (e.g moxifloxacin) might be a temporary solution until a more effective regimen can be administered.…”

Section: Special Situationsmentioning

confidence: 99%

“…Irrespective of whether a rifamycin is part of an anti-TB drug regimen, the risk of disease recurrence is low when treatment is extended beyond 12 months [99]. Isoniazid-free and pyrazinamide-free regimens similar to those used in immunocompetent individuals [96,100] should be used in case of resistance or intolerance.…”

Section: Treatment Of Active Tb In Transplant Recipientsmentioning

confidence: 99%

The risk of tuberculosis in transplant candidates and recipients: a TBNET consensus statement

Bumbăcea

Arend

Eyüboğlu³

et al. 2012

Eur Respir J

219

261

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Tuberculosis (TB) is a possible complication of solid organ and hematopoietic stem cell transplantation. The identification of candidates for preventive chemotherapy is an effective intervention to protect transplant recipients with latent infection with Mycobacterium tuberculosis from progressing to active disease. The best available proxy for diagnosing latent infection with M. tuberculosis is the identification of an adaptive immune response by the tuberculin skin test or an interferon-c based ex vivo assay. Risk assessment in transplant recipients for the development of TB depends on, among other factors, the locally expected underlying prevalence of infection with M. tuberculosis in the target population. In areas of high prevalence, preventive chemotherapy for all transplant recipients may be justified without immunodiagnostic testing while in areas of medium and low prevalence, preventive chemotherapy should only be offered to candidates with positive M. tuberculosis-specific immune responses. The diagnosis of TB in transplant recipients can be challenging. Treatment of TB is often difficult due to substantial interactions between anti-TB drugs and immunosuppressive medications. This management guideline summarises current knowledge on the prevention, diagnosis and treatment of TB related to solid organ and hematopoietic stem cell transplantation and provides an expert consensus on questions where scientific evidence is still lacking. KEYWORDS: Guideline, management, Mycobacterium tuberculosis, transplantation, tuberculosis T uberculosis (TB) is caused by the pathogenic species of the Mycobacterium tuberculosis complex. Only a minority of individuals who develop an adaptive immune response following infection with M. tuberculosis will ever develop TB, with the actual risk depending on the extent to which the host immune system provides a successful or inadequate response [1,2]. Therefore, individuals with impaired immune response, such as solid organ transplant (SOT) and hematopoietic stem cell transplant (HSCT) recipients, are more prone to develop TB than immunocompetent persons. TB in transplant recipients is more frequent compared to the general population (estimates from the last decades state 20-74 times as frequent in SOT [3,4] and twice as frequent in HSCT [5]), and more often fatal (up to 31% in SOT [6] and up to 50% in HSCT recipients [7]), thus adding effectiveness to interventions for its prevention, even in the face of difficulties, with treatment related to adverse drug events and drug-drug interactions. Active TB in transplant recipients can result from latent infection with M. tuberculosis (LTBI) in the transplant candidate or in the donor tissue, or from de novo post-transplant infection. These various scenarios prompt for targeted pre-transplant screening of both recipient and, if possible, donors to allow focused management of recipients selected for preventive intervention in the pre-and/or posttransplant period. The term ''preventive chemotherapy'' is used to denote treatmen...

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“…The new TB drug discovery pipeline appears promising; however, there are only two new classes of drugs, which are currently undergoing final phases of clinical trials and may be widely available in the next 2 yrs [19,21,22]. Recently, concerns have been raised about whether the use of new TB drugs should be prioritised for the treatment of drug-susceptible or drugresistant TB.…”

mentioning

confidence: 99%

“…Optimal usage of current TB drugs, expanding access and preventing the development of drug resistance remain top priorities [19].…”

mentioning

confidence: 99%