Mass phenotyping of isoniazid inactivators by automated determination of acetylisoniazid in urine.
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Biomedical subjects
Publications and source records attributed to L Eidus.
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Two groups of tuberculosis patients, phenotyped as either slow or fast inactivators of isoniazid, participated in a preliminary bioavailability study of a new INH-matrix preparation with sustained action. The absorption, excretion and metabolic patterns of the new form were compared with those of standard INH tablets in both sets of patients, using a crossover technique.The INH-matrix was more slowly absorbed by both slow and fast inctivators. When the latter were treated with 30 mg./kg. of the matrix formulation the blood levels attained were comparable with those observed in slow acetylators treated with 10 mg./kg. normal INH. Although this dose is three times that normally recommended with standard INH, blood levels remained within safe limits owing to the drug's slow release from the matrix.
A method is described for phenotyping of isoniazid inactivators. After a test dose of isoniazid, free isoniazid and its acetyl derivative are estimated in urine by the same colorimetric reaction.
In this investigation a simple urine test for phenotyping isoniazid inactivators is evaluated. In the new method, isoniazid is artificially acetylated in urine and determined by the same colour reaction as that used for acetylisoniazid. Comparative studies showed that the test is reliable and can be performed with accuracy and ease even in poorly equipped laboratories. In contrast to other urine tests, it does not require an expensive spectrophotometer, tedious hydrolysis processing of the samples, or standard curves. The results can be read on a plain colorimeter, or even without any instrument.
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Twenty patients with chronic pulmonary tuberculosis completed eight months of rifampin-ethambutol treatment. Half the patients received daily 600 mg. rifampin and 25 mg./kg. ethambutol for the first two months and subsequently 15 mg./kg. The others received the same dosage of ethambutol and 450 mg. rifampin daily. The average time of sputum conversion was seven weeks and 11 weeks in the two groups respectively. The patients tolerated these drug regimens well.Rifampin blood levels and urinary excretion were studied monthly during the therapy. They indicated that after a short period of treatment the elimination of this drug became faster owing to increased excretion of rifampin, and particularly of its desacetyl metabolite, in the bile. Liver damage resulted in a slower excretion rate. Rifampin should be taken on an empty stomach because simultaneous food intake reduces the peak blood concentration.
Phenotyping for isoniazid inactivation in Canadian Eskimos and Indians showed that the former are all fast acetylators, while only 63.4% of the Indians examined belonged to the same group. Further studies are suggested to confirm this initial finding.During the investigation metabolic studies were carried out to devise a reliable urine test for phenotyping of isoniazid inactivators, to replace the fall-off technique which required venipunctures. The simplicity of the new urine test makes it suitable for mass examinations.
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A simple spot test for the detection of PAS in urine has been described and its sensitivity compared with that of other methods such as the Ehrlich's reagent and the ferric chloride tests. In patients receiving 4 g. PAS the three methods gave similar results in urine specimens collected within eight hours. The new test is an inexpensive micro method which can easily be performed on a large scale. There is no reaction with sulfonamide or salicylic acid derivatives.