SEARCH · Search PubMed

Results for “PYRAZINAMIDE”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

SourceResearch connectionFrom yearThrough year

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,621 records · Page 90Linked to original sources

PubMed2004

Outcome of treatment of multidrug resistant tuberculosis.

Multidrug resistant tuberculosis (MDRTB) is a growing problem worldwide. It is an emerging problem in Sri Lanka too although the exact data are not known. This report describes treatment and outcome of 14 MDRTB patients. All have had previous anti-tuberculosis treatment. Out of 32 previous treatment episodes, treatment has been either irregular or defaulted in 26(81%), which has largely contributed to the emergence of drug resistance. Treatment commenced with a combination of second line anti-tuberculosis drugs, namely, amikacin, ciprofloxacin, ethionamide, clofazimine and pyrazinamide. Four patients were considered cured, another four failed treatment, five defaulted treatment and one died. Previous sensitivity to second line drugs and proper isolation facilities were not available. Preparedness to face the threat of MDRTB is essential. Measures should be taken to reduce the rate of defaulters of anti-tuberculosis treatment, and facilities to treat MDRTB should be expanded.

Adult↗

PubMed1999

Antimycobacterial therapy.

Tuberculosis is a major cause of illness and death worldwide. The epidemic of the acquired immunodeficiency syndrome and the increased number of other immunocompromised hosts have led to a remarkable increase in Mycobacterium avium-intracellulare complex infections. Adequate diagnostic, prevention, and treatment measures are available; however, resources for implementing these measures are limited. Processes for using these limited resources are not always well organized. This review of prevention and treatment of tuberculosis, including the six major recommendations from the Centers for Disease Control and Prevention, treatment of certain other mycobacterial infections, and information on some antimycobacterial agents, such as isoniazid, rifampin, rifabutine, pyrazinamide, and ethambutol, was written mainly for primary-care providers.

Antitubercular Agents↗

PubMedDate not supplied

Primary multi-drug resistant tuberculosis presented as lymphadenitis in a patient without HIV infection.

Primary multi-drug resistant extrapulmonary tuberculosis is an uncommon form of the disease, but it seems that by increasing the number drug resistant tuberculosis around the world, the number of cases of primary multi-drug resistant tuberculosis with extrapulmonary presentation also is going to rise. In this report, we describe a 19-year old, HIV negative man with primary multi-drug resistant TB lymphadenitis, presented with cervical lymphadenopathy and sinus discharge at the site of involved lymph nodes. The Acid Fast Bacilli (AFB) smear of sputum was negative but the AFB smear of discharged fluid as well as the excisional biopsy of the lymph nodes confirmed the M. tuberculosis infection. The patient underwent the treatment with a combination of isoniazide, clofazimine, pyrazinamide, ofloxacin and amikacin with promising results. By increasing the number of drug resistant tuberculosis patients around the world, appropriate diagnosis and treatment of different presentations of the disease need a special attention.

Adult↗

PubMed2006

[Tuberculosis in the elderly in a general hospital in the Region of Madrid, 1994-2003].

INTRODUCTION: Tuberculosis in the elderly is a health problem that is on the increase nowadays in industrialised countries. The aim of this study is to describe epidemiological, clinical and microbiological characteristics of tuberculosis in elderly patients in a general hospital in the Region of Madrid from 1994 to 2003. METHODS: Only microbiologically and/or histopathologically confirmed tuberculosis were studied. Epidemiological, clinical and microbiological variables were analyzed. Microbiological and histopathological laboratory results and medical records were collected. RESULTS: The proportion of cases occurring among the elderly rose from 12.4% between 1994 and 1998 to 17.8% between 1999 and 2003 (p <0.05). A total of 160 tuberculosis cases were studied: 92.5% were microbiologically (culture) confirmed and 7.5% histopathologically confirmed. The average time to culture positivity was 18.8 days (SD: 6.5). 88.7% isolates were susceptible to streptomycin, isoniazid, rifampin, ethambutol, and pyrazinamide. The main locations of tuberculosis were pulmonary (59.4%), ganglionary (11.9%) and genitourinary (10.0%). A positive smear in the sputum was discovered for 52.6% of pulmonary tuberculosis. The most prevalent risk factors were immunosuppression (14.8%) and diabetes mellitus (12.3%). Neither of them were VIH, intravenous drug users or immigrants. 50.7% cases were hospitalized. CONCLUSIONS: Tuberculosis in the elderly is on the increase in our region nowadays. The epidemiological pattern of tuberculosis in the elderly differs from that observed in younger patients. Therefore specific control and prevention strategies are needed in order to reduce tuberculosis incidence in aged populations.

Aged↗

PubMed1986

Central nervous system tuberculosis with the acquired immunodeficiency syndrome and its related complex.

Central nervous system tuberculosis occurred in three patients with the acquired immunodeficiency syndrome (AIDS) and seven patients with AIDS-related complex who were evaluated for 48 months. Nine patients were intravenous drug abusers and one was Haitian. Five patients had cerebral-ring-enhancing lesions and three had hypodense areas. The clinical spectrum included meningitis in two patients, multiple cerebral abscesses in one, and tuberculomas in four. All Mycobacterium tuberculosis isolates were sensitive to standard antituberculous drugs. All patients received treatment with isoniazid, rifampin, and pyrazinamide; six patients also received streptomycin. Three patients with AIDS died of opportunistic infection preceded by central nervous system tuberculosis. Among the patients with the AIDS-related complex, three improved with treatment, three were lost to follow-up, and one died. Tuberculosis should be considered in the differential diagnosis of central nervous system mass lesions in intravenous drug abusers with AIDS or AIDS-related complex. Because patients with tuberculosis can be cured, biopsy of accessible brain mass lesions should be mandatory. Preventive therapy may be indicated in drug abusers without disease.

Acquired Immunodeficiency Syndrome↗

PubMed1980

Immunopotentiating effect of fungal glucans as revealed by frequency limitation of postchemotherapy relapse in experimental mouse tuberculosis.

Two kinds of fungal glucan, particulate yeast glucan (PYG) and lentinan, were examined for their immunopotentiating effect illustrated by reduced frequency of post-chemotherapy relapse in experimental mouse tuberculosis. Infected mice were treated by intensive chemotherapy with a three-drug combination [Streptomycin (SM) + isoniazid (INH) + rifampicin (RFP), ethambutol (EB) + INH + RFP, or SM + INH + pyrazinamide (PZA)] for 5 months. After termination of chemotherapy, the mice of each treated group were divided into three subgroups to receive or not to receive glucan for 4 weeks and again for 4 weeks after a month interval. During this 3-month period and the succeeding 5 months, the mice were subjected to occasional sacrifice to examine the growth of latent tubercle bacilli in the lung and spleen by cultivation of tissue homogenates. The results indicated that the regimens with SM + INH + RFP and EB + INH + RFP were highly effective in eliminating persistent tubercle bacilli down to undetectable levels. However, later multiplication of the latent bacilli was observed during the advanced postchemotherapy period. The application of PYG was most effective in prevention of this type of relapse in the spleen, but not so in the lung. Lentinan effect was manifested in the lung, but not in the spleen.

Adjuvants, Immunologic↗

PubMedDate not supplied

[The efficacy of treating patients with destructive pulmonary tuberculosis with liver involvement].

A follow-up of 53 patients with destructive pulmonary tuberculosis presenting with and without concomitant hepatic pathology revealed a negative influence on the effectiveness of treatment of pulmonary tuberculosis of both toxic hepatitis and exacerbation of chronic hepatic pathology. Measures that are not to be prescribed in aggravated hepatologic medical history include employment of combinations of isoniazid with rifampycin or pyrazinamide, with intravenous administration of izoniazid being recommended together with, a complex institution of hepatoprotector therapy to be received during the course of antituberculous treatment.

Adult↗

PubMed1999

[Clinical evaluation of new quinolones as antituberculosis drugs].

Compared with the recent rapid advances in the diagnosis of tuberculosis, advances in the treatment of tuberculosis have been quite slow. For example, as long as six months are required for initial treatment, even with addition of pyrazinamide in the first two months to isoniazid, rifampicin, and streptomycin or ethambutol. Moreover, it is not always easy to treat patients who cannot receive standard agents including isoniazid and rifampicin due to adverse effects of these drugs or drug resistance. For these reasons, the development of new agents with potent antituberculosis activities and fewer adverse effects is urgently desired. However, at present, few new antituberculosis agents are being developed, and new quinolones are considered the most promising new antituberculosis agents due to their lack of cross-resistance to previously existing antituberculosis agents, their excellent in vitro and in vivo antituberculous activities, and good pharmacokinetics. We therefore reviewed experimental studies and clinical reports useful for evaluation of potential clinical use of new quinolones as antituberculosis drugs. Our conclusions are summarized below: 1) Of nine new quinolones on the market, ofloxacin, ciprofloxacin, aparfloxacin and levofloxacin have excellent in vitro and in vivo antituberculous activities without cross-resistance to previously existing antituberculosis agents. 2) Ofloxacin appears to be useful clinically for intractable multidrug-resistant tuberculosis. The incidence and severity of adverse effects of ofloxacin were very low on longterm administration. 3) Ofloxacin resistance emerged from two to four months after initiation of administration of ofloxacin, and ofloxacin exhibited cross-resistance to other new quinolones. 4) The usefulness of new quinolones for initial treatment of tuberculosis is unclear. 5) New quinolones should be used to treat patients with drug-resistant tuberculosis and those patients for whom adverse effects have limited the use of standard agents. However, monotherapy with new quinolones is not recommended, due to the significant risk of emergence of quinolone resistance. 6) Not only ofloxacin, ciprofloxacin, sparfloxacin and levofloxacin, which are on the market, but also gatifloxacin, CS-940, Du-6859a and other newly developed new quinolones are candidates for new antituberculosis agents. However, careful study not only of antituberculous activities and pharmacokinetic but also drug interactions and chronic cumulative toxicities due to long-term administration are needed prior to clinical application of these drugs.

Anti-Infective Agents↗

PubMed1999

Identification of Mycobacterium shimoidei by molecular techniques: case report and summary of the literature.

A 53-year-old woman from Melbourne, Australia, with squamous cell carcinoma of the oesophagus was shown by computed tomography (CT) scan to have a left apical cavity and inflammatory changes in the right lung consistent with aspiration. Acid-fast bacilli isolated from bronchial washings were identified biochemically first as Mycobacterium terrae, but later as M. shimoidei on the basis of 1) restriction fragment analysis and 2) sequencing of polymerase chain reaction (PCR) amplified 16S rDNA. Nine other descriptions of patients with M. shimoidei isolates were collated. The salient feature of isolates considered to be pathogenic was pulmonary cavitation. Most patients had underlying lung disease, including past tuberculosis or malignancy. Six of eight patients died of progressive respiratory illness, although the contribution of M. shimoidei was not always clear, and two patients improved. One patient with the acquired immune-deficiency syndrome (AIDS) died with Salmonella enteritidis and M. shimoidei isolated from blood cultures. One isolate was regarded as a coloniser. There are insufficient clinical or sensitivity data on which to base recommendations for therapy, but a combination of ethambutol, rifabutin and pyrazinamide could be considered.

AIDS-Related Opportunistic Infections↗

PubMed1999

Replacement of streptomycin by ethambutol in the intensive phase of tuberculosis treatment: no effect on compliance.

SETTING: Seven tuberculosis clinics in the National Tuberculosis Programme of Madagascar. OBJECTIVE: To compare the treatment efficacy and tolerance of regimens including either streptomycin or ethambutol for patient compliance during initial treatment of smear-positive tuberculosis. DESIGN: The 1023 patients included in the study were randomly divided into two treatment groups-one to receive streptomycin (S), isoniazid (H), rifampicin (R) and pyrazinamide (Z) (SHRZ), and the other to receive EHRZ, where streptomycin was replaced by ethambutol (E). During the 2-month intensive phase, drug delivery was completely supervised. The same 6-month continuation regimen was then given in both groups. Follow-up consisted of a clinical and bacteriological examination at the end of the second, fifth and eighth months. RESULTS: There was no significant difference between the two regimens as regards compliance with treatment, the number of patients lost or who died, or for bacteriological response during the intensive phase. EHRZ was better tolerated. During the continuation phase, the results of the two groups remained comparable, but treatment failures occurred earlier in the patients who had received streptomycin. CONCLUSION: Patient compliance was not better with streptomycin. The ethambutol-containing regimen was as efficient as the other, and better tolerated. There is no argument for preferring streptomycin in the intensive phase of treatment of smear-positive tuberculosis.

Adolescent↗

PubMed1998

[Hepato-splenic and peritoneal tuberculosis. A difficult diagnosis].

Peritoneal tuberculosis is a rare extra-pulmonary location of Mycobacterium tuberculosis infection arising in the gastrointestinal tract mostly as a complication of the pulmonary location or seldom as a primary involvement. The authors report the case of a 18-year old girl admitted in 1996 to the Infectious Diseases Department of the Umberto I Hospital, "La Sapienza" State University of Rome for the persistence of fever and dry cough, despite a protracted antibiotic treatment performed in previous hospital admissions for a suspicious diagnosis of a "broncho-pneumonia". As the fever didn't decrease and a pain at the right ilium arose, an anti-tuberculous chemotherapeutic treatment was performed (isoniazid and rifampicin), that improved the state of the patient. The pain was resolved by means of a celioscopic operation, showing the evidence of various white nodes on the peritoneal, hepatic and lienal surfaces; all these pathognomonic signs and the anti-tuberculous chemotherapy confirmed the diagnosis of "hepatic, lienal and peritoneal tuberculosis". The patient was subsequently admitted to our institute, where an anti-tuberculous treatment (isoniazid, rifampicin and pyrazinamide) was performed, which caused a further resolution of the clinical and radiological picture.

Adolescent↗

PubMed1999

Medical therapy of bone and joint tuberculosis in 1998.

Some measure of agreement and no little debate continue to surround the management of bone and joint tuberculosis. There is a consensus that the first phase of antituberculous chemotherapy should consist of three drugs (isoniazid, rifampin, and pyrazinamide) or four drugs (plus ethambutol) given for two to three months. When neither resistance nor side effects occur, isoniazid and rifampin should be continued as maintenance therapy. Patient compliance is well-recognized as requiring special attention because of its large impact on treatment outcomes. Provided strict patient selection criteria and close medical supervision are used, spinal cord compression can be treated nonsurgically with four antituberculous drugs, immobilization and, in many cases, a glucocorticoid. In spinal tuberculosis without neurological signs, immobilization is not always necessary, except when the cervical spine is involved. The optimal duration of antituberculous chemotherapy required for complete recovery of bone and joint tuberculosis is still debated. Twelve months is the duration currently recommended by most experts. Shorter durations, of six to nine months, have been advocated in adults. A critical analysis of the literature shows that proof is still lacking of the equivalence between six- to nine-month and 12- to 18-month treatments. In particular, trials conducted under the aegis of the Medical Research Council of the United Kingdom failed to resolve this issue because of methodological inadequacies regarding sample size and statistical analysis. The large sample size and long follow-up needed to obtain conclusive data would probably require a multicenter international study.

Antitubercular Agents↗

PubMedDate not supplied

Instructive case report. A 26-year-old Indian woman with seizures and multiple intracranial mass lesions.

We describe the case of a 26-year-old Indian woman who presented to our institution with seizures and papilledema. Her diagnosis was originally thought to be neurocysticercosis, but later confirmed to be intracranial tuberculoma. Antituberculous therapy with isoniazid, rifampin, pyrazinamide and ethambutol was initiated. Improvement in the patient's neurological symptoms with diminution in size of the intracerebral lesions was observed. This case illustrates the difficulty in distinguishing intracranial tuberculoma from neurocysticercosis. Radiological features that distinguish these two diseases are described. Both diseases must be considered in regions endemic for tuberculosis and cysticercosis.

Adult↗

PubMed1999

Immunotherapy with Mycobacterium vaccae in patients with newly diagnosed pulmonary tuberculosis: a randomised controlled trial. Durban Immunotherapy Trial Group.

BACKGROUND: Mycobacterium vaccae, an environmental saprophyte, has immunogenic properties that enhance the host immune response. Immunotherapy with M. vaccae has been suggested to shorten short-course antituberculosis chemotherapy. We tested the hypothesis that the addition of M. vaccae to standard short-course antituberculosis chemotherapy would decrease the time to achieve a negative sputum culture. METHODS: Patients with newly diagnosed tuberculosis were randomly assigned an injection of saline (placebo) or M. vaccae on day 8. All patients received antituberculosis chemotherapy with rifampicin, isoniazid, pyrazinamide, and ethambutol. Sputum samples were checked by microscopy and culture every week for the first 8 weeks and monthly until the end of chemotherapy at 6 months. The primary outcome was the time to a negative sputum culture in the first 8 weeks. Intention-to-treat analysis was used and time to sputum clearance was assessed by log-rank test and Cox's proportional-hazards regression. FINDINGS: 172 patients received M. vaccae and 175 patients received placebo. At 8 weeks, 70 patients in the M. vaccae group and 65 patients in the placebo group had a negative culture; there was no difference between groups in the time to a negative culture (p=0.83). There was no interaction between HIV status and treatment. INTERPRETATION: M. vaccae immunotherapy has no benefit when added to standard antituberculosis chemotherapy.

AIDS-Related Opportunistic Infections↗

PubMed1999

Pharmacokinetics of isoniazid under fasting conditions, with food, and with antacids.

STUDY OBJECTIVES: To determine the intra- and intersubject variability in and the effects of food or antacids on the pharmacokinetics of isoniazid (INH). DESIGN: Randomized, four-period cross-over Phase I study in 14 healthy male and female volunteers. Subjects ingested single doses of INH 300 mg under fasting conditions twice, with a high-fat meal, and with aluminum-magnesium antacid. They also received standard doses of rifampin, pyrazinamide, and ethambutol. RESULTS: Serum was collected for 48 hours, and assayed by high performance liquid chromatography (HPLC). Data were analyzed using noncompartmental methods and a compartmental analysis using nonparametric expectation maximization. Both fasting conditions produced similar results: a mean INH Cmax of 5.53 +/- 2.92 microg/ml, Tmax of 1.02 +/- 1.10 hours, and AUC0-infinity of 20.16 +/- 12.45 microg x hr/ml. These findings are similar to those reported previously. Antacids did not alter these parameters significantly (Cmax of 5.62 +/- 2.53 microg/ml, Tmax of 0.71 +/- 0.56 hours, and AUC0-infinity of 20.27 +/- 11.39 microg x hr/ml). In contrast, the high-fat meal recommended by the Food and Drug Administration reduced INH Cmax by 51% (2.73 +/- 1.70 microg/ml), nearly doubled Tmax (1.93 +/- 1.61 hours), and reduced AUC0-infinity by 12% (17.72 +/- 10.32 microg x hr/ml). CONCLUSIONS: These changes in Cmax, Tmax, and AUC0-infinity can be avoided by giving INH on an empty stomach whenever possible.

Adult↗

PubMed1999

Anti-tuberculosis drug resistance surveillance in Uganda 1996-1997.

SETTING: Drug resistance surveillance conducted by the National Tuberculosis and Leprosy Control Programme (NTLP) Uganda from 1996-1997 in collaboration with the Armauer Hansen Institute/German Leprosy Relief Association (GLRA), Germany, for the WHO/IUATLD Global Project on Anti-Tuberculosis Drug Resistance Surveillance. OBJECTIVE: To determine the prevalence of primary and acquired anti-tuberculosis drug resistance in Uganda. DESIGN: The survey area covered three GLRA-supported operational NTLP zones, corresponding to 50% of the Ugandan population. A representative random sampling of individual patients was chosen as sampling procedure. Altogether 586 smear-positive TB patients (537 new cases and 49 previously treated cases) were included in the survey. RESULTS: For primary resistance the results were as follows: isoniazid (H) 6.7%, rifampicin (R) 0.8%, ethambutol (E) 6.1%, streptomycin (S) 13.4%, thioacetazone (T) 3.2%, pyrazinamide (Z) 0%, multidrug resistance (MDR) 0.5%; for acquired resistance they were: H 37.8%, R 4.4%, S 22.2%, E 11.1%, T 20.0%, Z 0%, and MDR 4.4%. CONCLUSION: According to these data the NTLP Uganda has been effective in preventing high levels of primary drug resistance. If it is assumed that the sampling process reflects the distribution of new patients and previously treated patients in the study areas, the amount of acquired resistance (any resistance) in the community of smear-positive patients is approximately 5%. To further monitor programme performance the NTLP will embark on a nationwide survey in 1998/1999.

Adolescent↗

PubMedDate not supplied

Management of pulmonary tuberculosis PTB: regimen employed in Lagos, Nigeria.

The regimen(s) employed for the management of pulmonary tuberculosis (PTB) by health institutions in Lagos State, Nigeria was determined. Results from the 134 health institutions, showed that only 71.7% of the 120 (89.6%) health institutions with records of PTB, manage these cases. 28.3% refer diagnosed cases to referral (chest) centres. 4.7% administered multiple regimen and 93.0%, single regimen of different drug combinations for different treatment periods/durations. The study showed that 36.9% of the health institutions in Lagos employed a short course chemotherapy (SCC) treatment of between 6 to 9 months duration, while 32.2% employ the longer course of chemotherapy with duration of treatment not less than 10 months. Majority, employed the SCC regimen of 6 months duration using 2SRHZ/4RH combination. Most of the institutions employed a regimen outside the national adopted 8 months regimen that consist of four drugs: streptomycin (S), or ethambutol (E), rifampicin (R), isoniazid (H), and pyrazinamide (Z) for the first two months of intensive treatment and two drugs of isoniazid (H) and thiacetazone (T), for the final continuation phase of six months. (i.e. a regimen of 2S or ERHZ/6TH). The overall results, showed there is no commonly accepted PTB treatment regimen in Lagos and the national adopted regimen is not favoured by many health institutions. There is the need for the development of a standard, generally accepted, affordable and cost effective treatment regimen for the state and country, for effective monitoring and coordination.

Antitubercular Agents↗

PubMed1999

The threat of multidrug-resistant tuberculosis: results of 1 yr of surveillance in the Lombardy region of Italy.

A descriptive multicentre study based on laboratory data was carried out in patients with culture-confirmed tuberculosis (TB) who were cared for between September 1995 and August 1996 in 14 general hospitals with at least one human immunodeficiency virus (HIV) ward, a hospital specializing in TB or a large chest clinic, all in the Lombardy region of Italy. For each culture positive for Mycobacterium tuberculosis, the results of susceptibility tests to the five first-line anti-TB drugs were collected; other information collected included: the patient's name, the ward/service where the patient was staying and the characteristics of the culture (biological sample, date of arrival and type of mycobacterium isolated). Foreign-born persons were identified through their names; acquired immune deficiency syndrome (AIDS) patients were identified through record linkage with the National AIDS Registry. Given that only one-quarter of the laboratories performed pyrazinamide-susceptibility tests, resistance to this drug was not analysed. Of the isolates tested, 28.1% were resistant to at least one drug, i.e. single-drug-resistant (SDR) and 12.9% were multidrug-resistant (MDR). The frequency of SDR and MDR strains showed considerable variation by healthcare centre (range 0.0-94.3% and 0.0-37.1%, respectively). In three hospitals, the time of occurrence and the susceptibility pattern of the MDR-TB isolates indicated that clusters of the disease occurred. The frequency of both SDR and MDR strains was significantly higher among AIDS patients (48.8% and 23.6%, respectively) than among foreign-born persons (30.2% and 6.9%) or persons belonging to no known risk group (98.3% and 11.3%). The frequency of drug resistance observed in this study is much higher than that reported in other European surveys and is comparable only to that observed in New York, before the implementation of an effective control programme. Acquired immune deficiency syndrome patients are at very high risk of multidrug-resistant tuberculosis: effective containment and infection control practices should be rigorously implemented to prevent the occurrence of this alarming phenomenon.

Antitubercular Agents↗