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PubMed2003

[A study on the clinical efficacy of a combination regimen with levofloxacin and capreomycin in the treatment of multi-drug resistant pulmonary tuberculosis].

OBJECTIVE: To study the clinical efficacy of a combination therapy with levofloxacin (LVFX), capreomycin (CPM) and other second-line antituberculosis drugs in the treatment of multi-drug resistant pulmonary tuberculosis (MDR-TB). METHODS: 177 patients with MDR-TB were assigned to a study group (88 cases), treated with LVFX, CPM, pyrazinamide (PZA), rifapentine (RFT) and pasiniazid (PSZ); or a control group, treated with streptomycin (SM), ethambutol (EMB), PZA, RFT and PSZ. The course of treatment was 21 months. RESULTS: 82 cases in the study group and 79 cases in the control group completed the treatment. The sputum negative conversion rate in the study group (83%) was significantly higher than that in the control group (58%) (P < 0.01). The radiographic improvement rate was 50% in the study group, significantly higher than that in the control group (28%) (P < 0.01). The closure rate of the lung cavities in the study group (63%) was higher than that in the control group (42%) (P < 0.05). No significant difference was found in side-effects between the two groups (31% in the study group, and 35% in the control group respectively) (P > 0.05). CONCLUSION: The regimen including LEVX, CPM and other second-line anti-TB drugs was effective and safe for patients with MDR-TB.

Adolescent↗
PubMed2003

[Characteristics and treatment outcomes of INH-resistant or RFP-resistant tuberculosis].

BACKGROUND: As an effective regimen for isoniazid-resistant but rifampicin-susceptible tuberculosis (INHr-TB), the use of a 6-month three or four-drug treatment regimen including refampicin (or rifampin) and pyrazinamide has been recommended by many experts of the world. On the other hand, treatment regimen for rifampicin-resistant but isoniazide-susceptible tuberculosis (RFPr-TB) has not been well established because of the small number of such patients. In Japan the standard regimen has not been established even for INHr-TB, and the treatment has been done by each physician on the empirical bases. OBJECTIVES: To determine the adequate therapy of INH-resistant TB or RFP-resistant TB. DESIGN: Retrospective cohort study. SUBJECTIVES: Hundred and eleven INHr-TB patients (4.9%) and 5 RFPr-TB patients (0.2%) out of 2252 new smear-positive tuberculosis patients who were admitted to our hospital from 1994 to 1998. RESULTS: Patients with previous tuberculosis history was found in 35 of 111 INHr-TB (31.5%) patients, of which 13 (37.1%) were re-treated within 3 years. On the other hand 146 patients (21.1%) of all new culture-positive tuberculosis patients (N = 690) treated in our hospital from 1997 to 1999 had the previous tuberculosis history of which only 8 patients (5.5%) were retreated within 3 years while 115 patients relapsed more than 10 years after the onset of previous tuberculosis history. The frequency of recurrence within 3 years after the onset of previous tuberculosis history was, significantly higher (p < 0.0001) in cases of INHr-TB (13/111 [11.7%]) than in cases of newly registered ones (8/690 [1.2%]), and the fact indicates that the incidence of tuberculosis recurrence was higher in INHr-TB patients than in pan-sensitive TB patients when the previous treatment was discontinued or insufficiently implemented. The resistance pattern of the INHr-strains were as follows. INH alone 40 (36.0%), SM-resistant 47 (42.3%), TH resistant 19 (17.1%), EB-resistant 18 (16.2%), KM-resistant 6 (5.4%), and others 3 (2.7%). Therefore the mean number (+/- SD) of resistant drugs excluding INH was 1.4 +/- 0.7. Eighteen out of 71 (25.4%) strains with low grade INH-resistance (0.1 microgram/ml complete resistance) had also TH-resistance, while only one out of 40 (2.5%) strains with high grade INH-resistance (1 microgram/ml resistance) was resistant to TH (p = 0.005). Of 111 INHr-TB patients, 9 patients (8.1%) discontinued treatment by themselves, 17 patients (15.3%) admitted to another hospital, and 17 patients (15.3%) died. The patients who died (age [M +/- SD] 66.4 +/- 14.0 yrs) were older than those who were alive (48.7 +/- 17.8, p < 0.001), and were too seriously ill to accept sufficient chemotherapy, and therefore their deaths were not considered to be related to INH resistance. The treatment outcomes of the remaining 68 patients who were followed in our hospital were summarized as follows. 1) Treatment failure occurred in 3 patients, of whom 2 patients could not be treated with full dose rifampicin in the initial phase of treatment because of side effects to liver or accompanying idiopathic thrombocytepenic purpura (ITP). Two out of these 3 patients developed multi-drug resistant tuberculosis (MDR-TB). Success rate of treatment was 65/68 (95.6%). 2) Alterations of regimens after knowing INHr-TB were done in 41 of 65 patients (63.0%) with treatment success in all cases. The susceptible drugs used were 65 (100%) for RFP, 62 (95.4%) for EB, 23 (35.4%) for PZA, 26 (40.0%) for SM, 32 (49.2%) for new quinolone (NQ). 3) The sputum culture conversion rates two months after starting chemotherapy with (N = 16) and without (N = 52) PZA were 13/16 (81.3%) and 31/52 (59.6%), respectively. 4) After the completion of treatment, relapse occurred in 4 patients during follow-up period (1-39 months). The recurrence occurred in 3 out of 20 patients (15%) treated with INH and two susceptible drugs, none out of 13 with three susceptible drugs (0%), 1 out of 20 with INH and three susceptible drugs (5%), and none out of 11 with more than 4 susceptible drugs (0%), and the fact indicates that there was no significant advantage to add INH of usual dose to the regimens. 5) The durations of treatment were not less than 9 months except one case. When 3 or more susceptible drugs were used, the recurrence rate in the group of treatment duration 9-12 months was 0/12 and that in the group of treatment duration more than 12 months was 1/33. Even in the groups without PZA in the initial 2 months of treatment, the recurrence rate in the group of treatment duration 9-12 month was 0/8, and that in the group of treatment duration more than 12 months was 0/22. The fact indicates that 12 months therapy was sufficient irrespective of the use of PZA. 6) One of 5 RFPr-TB patients discontinued treatment by himself. Remaining 4 patients were treated by 4.5 +/- 0.5 susceptible drugs including INH for more than 20 months (21.7 +/- 2.8 months) after sputum culture conversion with the successful result of treatment and no relapses during the followup period for 3-60 months. CONCLUSION: For INHr-TB, even when PZA can't be used because of adverse effects or resistance, 3 or 4 susceptible drugs regimens including RFP for 12 months were effective. For RFPr-TB, the treatment with 4 or more susceptible drugs for 20 months after sputum culture conversion might be adequate.

Adult↗
PubMed2003

[Assessment of the use of a multicomponent drug in the treatment of new cases of pulmonary tuberculosis].

The multicomponent drug Mairin-P that contains isoniazid, 60 mg, rifampicin, 120 mg, pyrazinamide, 300 mg, and ethambutol hydrochloride, 225 mg, has been pharmacokinetically and clinically studied. There was no significant difference in the pharmacokinetic parameters of rifampicin as a component of Mairin-P and in combination with antitubercuous agents as free dosage forms. Treatment of first detected patients with pulmonary tuberculosis who isolate drug-sensitive Mycobacterium tuberculosis with Mairin-P is as effective as conventional treatment regimens with antituberculous drugs. Adverse reactions, including non-correctable one, due to the use of Mairin-P occur less frequently than to that of antituberculous drugs.

Adolescent↗
PubMed2004

Completing tuberculosis prophylaxis in jail: targeting treatment and comparison of rifampin/pyrazinamide with isoniazid regimens.

SETTING: A county jail. OBJECTIVE: To characterize the treatment of latent tuberculosis infection and the impact on treatment completion of the 2-month rifampin and pyrazinamide regimen as compared to the traditional 6- to 12-month isoniazid regimen among persons incarcerated at a county correctional facility. DESIGN: Retrospective review of tuberculosis records from January 1998 to December 2000. RESULTS: Of 2127 inmates who were tuberculin skin test positive, 146 were started on treatment. This was generally limited to those expected to remain incarcerated long enough to complete the course of treatment. Completion rates were 88% (67/76) for the 2-month and 74% (51/69) for the 6- to 12-month courses (P = 0.03), and 82% overall. The two regimens were similarly tolerated, but inmates on isoniazid were more likely to be released (despite longer projected incarceration) and not complete treatment once in the community. Thirty-seven per cent of persons for whom treatment was not indicated by the previous guidelines should have had treatment by the new guidelines. CONCLUSION: The 2-month rifampin/pyrazinamide regimen had a higher completion rate than the longer isoniazid regimen, without additional toxicity, and allowed more patients to be treated. Latent tuberculosis treatment targeted to those able to complete the regimen in jail yields high completion rates.

Antitubercular Agents↗
PubMed2004

Drug resistance trends among previously treated tuberculosis patients in a national registry in Peru, 1994-2001.

SETTING: National mycobacteriology reference laboratory in Peru conducting routine testing of susceptibility to isoniazid, rifampin, ethambutol, pyrazinamide, and streptomycin, in Mycobacterium tuberculosis isolates from previously treated patients. OBJECTIVE: To determine the percentage of isolates resistant to each of five anti-tuberculosis agents and to ascertain in these data the presence of trends of clinical relevance. DESIGN: Retrospective study of a national registry of M. tuberculosis isolates from patients referred for drug susceptibility testing between 1994 and 2001. RESULTS: Among 14,736 isolates tested, 10,837 (73.5%, 95%CI 72.8-74.3) demonstrated anti-tuberculosis resistance, and 8455 (57.4%, 95%CI 56.6-58.2) demonstrated resistance to at least both isoniazid and rifampin, by convention defined as multidrug-resistant tuberculosis (MDR-TB). A significant increasing trend could be discerned for resistance to each of the drugs tested and in isolates classified as MDR-TB (P < 0.001 for trend). Additional clinically relevant trends were found in polyresistance and multidrug resistance percentages. CONCLUSIONS: Data from a national reference laboratory can be used to inform the design of retreatment regimens.

Antitubercular Agents↗
PubMed2004

Disposition of uric acid upon administration of ofloxacin alone and in combination with other anti-tuberculosis drugs.

Disposition of uric acid upon administration of ofloxacin (O) alone and in combination with other anti-tuberculosis drugs, rifampicin (R), isoniazid (H) and pyrazinamide (Z) was studied. Twelve male healthy volunteers were investigated on four different occasions with the four drugs alone or in combinations. A partially balanced incomplete block design was adopted and the subjects were randomly allocated to each group. Uric acid concentration in urine samples excreted over 0-8 hr, were determined after coding the samples. There was significant decrease in the group receiving Z when compared to other groups. Though there was a decrease in uric acid excretion in the group receiving O, it was not statistically significant. Rifampicin and H seem to increase the uric acid excretion. The incidence of arthralgia was mainly due to Z and not due to either O or other drugs in the treatment of pulmonary tuberculosis.

Adult↗
PubMed2004

[Scrofuloderma. a clinical case].

Scrofuloderma is a form of colliquative cutaneous tuberculosis resulting from the spread of an underlying focus, generally represented by lymphnodes; osteoarticular tubercular locations or epididimus locations can also lead to ulcerative cutaneous involvement. We report the case of a female patient aged 12 who had been in Italy for 15 days following her arrival from Marocco. In the left clavicular region she presented an ulcerated lesion with palpable lymphnodes on the corresponding side of the neck. Histopathological examination of one of the involved lymphnodes suggested a mycobacteriosis; differential diagnosis was carried out between MAIS (M. avium, M. intracellulare, M. scrofulaceum) group mycobacteria infection and tuberculosis. Bacteriological research in the lymphnode of alcohol-acid resistant bacilli gave a negative result, while cultural examination and protein chain reaction pointed to M. tuberculosis. The patient was subjected to combined treatment based on rifampycin, isoniazide, etambutolol and pyrazinamide. At the present time, tuberculosis is an important public health problem in developing countries. In western countries such as the United Kingdom, which have been open to immigration for a longer time, scrofuloderma is present with higher prevalence in immigrants from Asia and Africa; in these immigrant populations, this tubercular form involves a wide age segment between the ages of 10 and 50. In the autochthonous population the highest incidence is in subjects aged more than 50. In Italy too, extra-communitary immigration has also contributed, with a delay compared to other western countries, to bring tuberculosis back into the public eye after a period of decades during which it was wrongly considered to have disappeared.

Antibiotics, Antitubercular↗
PubMed2004

Successful treatment of multidrug-resistant tuberculosis following drug-induced hepatic necrosis requiring liver transplant.

A 28-year-old female developed multidrug-resistant (MDR) tuberculous lymphadenitis following a trip to India. She was initially treated with a four-drug regimen of first-line anti-tuberculosis medications, but when sensitivities indicated resistance to isoniazid and rifampin, her regimen was altered to ciprofloxacin (CFX), pyrazinamide (PZA) and ethambutol. She subsequently developed a rash, flu-like symptoms and fever, which progressed to acute hepatic necrosis despite discontinuation of medication. The clinical presentation and subsequent investigations suggested a hypersensitivity reaction, possibly related to the quinolone. The patient subsequently had an orthoptic liver transplant; second-line anti-tuberculosis medications were restarted to which she responded clinically and radiologically. Our findings raise the possibility that the CFX and PZA combination was responsible for the hepatic necrosis. The patient also illustrates that active, even MDR tuberculosis is not a contraindication to hepatic transplant.

Adult↗
PubMedDate not supplied

Enlarged cervical lymph nodes and elevated liver chemistry tests: a therapeutic dilemma.

We describe the case of a 36-years-old male patient, originating from India, who presented with enlarged cervical lymph nodes and elevated liver chemistry tests. Histologically necrosing granulomas were observed in the lymph nodes, and PCR revealed DNA from mycobacterium tuberculosis. However, in the liver biopsy granulomatous hepatitis without central necrosis was seen. With a positive PCR for mycobacteria from liver tissue and no evidence for other hepatic diseases we started drug treatment with standard quadruple regimen consisting of isoniazid, rifampicin, ethambutol, and pyrazinamide. Five days after onset of therapy, liver chemistry tests rose 10-fold, forcing us to interrupt treatment. Gradual step-wise re-exposition with the same medication after return of liver chemistry tests to baseline was well tolerated without any further side effects. Liver involvement of tuberculosis can have many facets and may be treated by gradual dosing of standard drugs.

Adult↗
PubMedDate not supplied

[Treatment of tuberculosis-disease].

The treatment of all forms of tuberculosis-disease is a daily antibiotic intake. Rest, interruption of occupational activity may be decided according to the patient's clinical state and/or socioeconomic condition. The standard regimen is six months long. It consists in the daily administration, during six months, of isoniazide (5 mg/kg/day) and rifampicine (10 mg/kg/day) in a single intake while fasting (30 minutes to 1 hour before meals or 2 hours after). During the first two months (initial phase), the treatment also includes pyrazinamide (25 mg/kg) and ethambutol (15 mg/kg). Only isoniazide and rifampicine are continued during the four following months (continuation phase). The antimycobacterial treatment is as effective among HIV positive patients as in other patients. The frequency of relapse after treatment is similar when treatment is completed. The same therapeutic protocol can thus be employed among patients infected by HIV. It is not necessary, in cases of tuberculosis with susceptible bacilli, to continue the treatment beyond six months if the standard treatment was observed.

Anti-Bacterial Agents↗
PubMed2005

Treatment outcome of multidrug-resistant tuberculosis among Vietnamese immigrants.

OBJECTIVE: To review the outcome for MDR-TB treatment among potential migrants from Vietnam. SETTING: All cases of documented MDR-TB treated by the International Organization of Migration (IOM) in Vietnam from 1989 to 2000 were reviewed. METHODS: MDR-TB was defined as isoniazid- and rifampicin-resistant Mycobacterium tuberculosis. All cases of TB treated by the IOM and recorded in the computerised database were reviewed to identify MDR-TB cases. Demographics, chest radiograph results, drug resistance, drug use and dosage, duration of treatment, and outcome were analysed. RESULTS: Forty-four cases of MDR-TB were identified. Treatment consisted of ambulatory directly observed treatment with an 8-drug protocol: isoniazid, rifampicin, pyrazinamide, ethambutol, capreomycin, ethionamide, ofloxacin and cycloserine. This initial protocol was modified due to drug availability or drug intolerance. Patients were treated with a median of 8 drugs (range 6-12). Mean duration of treatment for MDR-TB was 23.0 (SD+/-11.4) months. Thirty-eight (86%) patients were cured and emigrated, one failed treatment (2%), three were lost to follow-up (7%) and two died (4%). CONCLUSION: Treatment for MDR-TB provided by the IOM was effective in preparing a low-income population for migration.

Capreomycin↗
PubMed2004

Evaluation of modified short course chemotherapy in active pulmonary tuberculosis patients with human immunodeficiency virus infection in University College Hospital, Ibadan, Nigeria--a preliminary report.

Over the period, 1st October 1999 to 30th April 2002 a clinical trial of the modified short-course chemotherapy (SCC) in newly diagnosed cases of pulmonary tuberculosis with human immunodeficiency virus (HIV) infection in Ibadan, Nigeria was carried out. The modified SCC used was adopted by World Health Organisation (WHO)/International Union against Tuberculosis and Lung Diseases (IUALTD) for developing countries and also by the Nigerian National Tuberculosis and Leprosy Control Programmed (NTLCP). The regimen used consisted of ethambutol (E), isoniazid (H), rifampicin (R) and pyrazinamide (Z) in the intensive phase of 2 months. The continuation phase was 6 months of ethambutol (E) and isoniazid(H), i.e. 2EHRZ/6EH. Sputum conversion was 90% at the second month of treatment and there was no bacteriological relapse after 18 months of follow-up. Side effects were few and consisted mainly of acne vulgaris in 20 (22.5%) of 89 patients during the continuation phase. It is concluded that this modified 8-month chemotherapy regimen adopted by NTLCP is efficacious in treatment of smear positive pulmonary tuberculosis (PTB) patients with background HIV infection.

Acne Vulgaris↗
PubMed1992

Tuberculosis in the 1990's: resurgence, regimens, and resources.

Physicians in the United States must maintain vigilance for the 25,000 annual new cases of tuberculosis, concentrated in the elderly, in immigrants, in migrant and minority populations, and in immunosuppressed patients. Tuberculosis rates in the South remain above the national average. Physicians diagnosing tuberculosis may also treat the disease, working with health departments, which can assist with drugs, follow-up tests, and contact investigation. Powerful short-course regimens have been standard treatments since 1986. The preferred combination is isoniazid, rifampin, and pyrazinamide daily for 2 months, followed by isoniazid and rifampin for 4 more months. A 9-month regimen of isoniazid and rifampin is equally effective. Supplementation or extension of these regimens is mandatory when drug resistance or immunosuppression, respectively, is likely. Isoniazid prophylaxis for 6 to 12 months continues to be a vital but often neglected preventive measure for those infected with Mycobacterium tuberculosis, but without active disease.

Acquired Immunodeficiency Syndrome↗
PubMed2005

[Two pregnant immigrant women with tuberculous peritonitis].

Two primigravid immigrant women aged 20 and 24 years were diagnosed with tuberculous peritonitis. The cases showed a significant delay in diagnosis. This was probably the cause for the premature birth and death of one foetus. The other child was diagnosed with congenital tuberculosis several months after birth and was successfully treated. The women were treated with the usual combination ofisoniazid, rifampicin, ethambutol and pyrazinamide. The unfamiliarity with this clinical picture is a problem in countries with a low incidence of tuberculosis. In both cases the final diagnosis was made by the characteristic image seen during laparoscopy. An early diagnosis and also an early start with tuberculostatic drugs are important for a favourable outcome of pregnancy. Pregnancy and breast-feeding are no contraindications for treatment with tuberculostatic drugs.

Adult↗
PubMedDate not supplied

[Mycobacterium bovis tuberculosis in a female patient with AIDS].

M. bovis, the agent of bovine tuberculosis, was in other times, the main ethiological agent of tuberculosis (TBC) in industrialized countries. At the moment, the human cases have become not very frequent, except in those countries where the illness is even endemic. In patients with immunodeficiency syndrome, it usually presents as a systemic illness. We present the case of a woman with AIDS and disseminated TBC caused by M. bovis. The isolated micobacteria turned out to be resistant to rifampin and pyrazinamide. She was treated with isoniazid, ethambutol and ofloxacin with good clinical evolution. This case turned out to be the first isolation of M. bovis in a patient with AIDS, in Muñiz hospital.

AIDS-Related Opportunistic Infections↗
PubMed2006

[Treatment outcome of patients with multidrug-resistant pulmonary tuberculosis during pregnancy].

PURPOSE: To know the treatment outcome of patients with multidrug-resistant tuberculosis (MDR-TB) during gestation. METHOD: Retrospective study of 3 cases of pregnant women, who were treated for MDR-TB with a regimen including pyrazinamide, ethambutol, para-aminosalicylic acid, cycloserine and amoxicillin-clavulanic acid. RESULT: All patients showed a good response to anti-tuberculosis chemotherapy without any serious adverse effect, and were culture-negative at the time of delivery. Two patients delivered vaginally at weeks 40, and one patient delivered surgically at weeks 38. All newborns were healthy, and their tuberculin skin tests and placental tissue examinations were negative for tuberculosis. CONCLUSION: MDR-TB can be successfully treated during pregnancy by using a regimen including effective second-line anti-tuberculosis drugs.

Adult↗
PubMed1991

[Uric acid and arterial hypertension. II. Evaluation of uric acid transport in the nephrons in primary arterial hypertension].

In forty patients with mild to moderate essential hypertension correlation between serum uric acid as well as renal excretion of urate and the transport of uric acid in nephron was evaluated. Quantity of the separate phases of uric acid transport in nephron was calculated based upon pharmacological tests with pyrazinamide and benzbromarone. The results obtained in twenty normotensive subjects were assumed to be a normal values. Positive correlation between serum uric acid and presecretory reabsorption of urate was found in hypertensive patients. However presecretory reabsorption of urate did not significantly differ between hypertensive patients with concomitant hyperuricemia and normotensive subjects. Tubular secretion of uric acid was significantly lower in hypertensive patients in comparison with normotensive subjects. Plasma uric acid correlated inversely++ with tubular secretion of urate in patients with essential hypertension. There was no difference in postsecretory reabsorption of uric acid between the groups. Plasma uric acid did not correlate with postsecretory reabsorption of urate in hypertensive patients. These findings suggest that decreased uric acid clearance in hypertension with concomitant hyperuricemia is connected with impaired tubular secretion of urate.

Adult↗
PubMed1991

[Effectiveness of tocopherol and anti-hypoxic agents in liver damage caused by antitubercular agents].

Two-week administration of isoniazid, rifampicin (50 mg/kg and pyrazinamide (1,5 g/kg) to white rats brings about liver affection characterized by a higher activity of alanine and aspartate aminotransferases, lipid peroxidation activation and bile production inhibition. With the liver affected by antituberculous drugs, protective action is provided by acetate tocopherol an antioxidant, and piracetam riboxin and pyriditol, antihypoxic agents.

Animals↗