Multi-drug-resistant tuberculosis medical therapy: Difference between revisions
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======Bedaquiline | ======Bedaquiline====== | ||
* | *Bedaquiline is an oral diarylquinoline recently approved by the FDA (Dec 2012) for the treatment of MDR TB when other alternatives are not available.<ref name="Bedaquiline">{{cite web| url=http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6209a1.htm?s_cid=rr6209a1_e| title=Provisional CDC Guidelines for the Use and Safety Monitoring of Bedaquiline Fumarate (Sirturo) for the Treatment of Multidrug-Resistant Tuberculosis 2013}}</ref> | ||
*This drug should be used with clinical expert consultation as part of combination therapy (minimum four-drug treatment regimen) and administered by direct observation to adults aged ≥18 years with a diagnosis of pulmonary MDR TB.<ref name="Bedaquiline"></ref> | |||
*'''Dosage:''' 400 mg daily PO for 2 weeks, followed by 200 mg three times a week for 22 weeks. | *'''Dosage:''' 400 mg daily PO for 2 weeks, followed by 200 mg three times a week for 22 weeks.<ref name="Bedaquiline"></ref> | ||
==References== | ==References== |
Revision as of 12:57, 26 September 2014
Multi-drug-resistant tuberculosis Microchapters |
Differentiating Multi-drug-resistant tuberculosis from other Diseases |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Medical Therapy Adapted from WHO 2013 Treatment of Tuberculosis: Guidelines – 4th ed. [1]
- MDR-TB is defined as resistance to isoniazid and rifampicin, with or without resistance to other first-line drugs.
- Medical treatment for MDR-TB consists of at least 4 drugs that have shown effectiveness against MDR. Within these 4 drugs must be included at least one drug from each group.
- Treatment duration will depend on the culture results. The duration of therapy should be > 18 months after culture is negative.
- Chronic cases with severe pulmonary disease may require more than 24 months of therapy.
- Empirical treatment should start immediately and the regimen should be modified according to the DST (Drug susceptibility testing) results.
- Drugs in each group must be used, in order of preference, as shown below.[2]
- The following treatment regimens show daily dosing for each drug.
▸ Click on the following categories to expand treatment regimens.
MDR Tuberculosis ▸ Adults ▸ Children |
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Drugs Used in Drug-Resistant Tuberculosis
Groups | Drugs |
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Group 1: First-line oral drugs |
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Group 2: Injectable drugs |
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Group 3: Fluoroquinolones | |
Group 4: Oral bacteriostatic second-line drugs |
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Group 5: Agents with unclear role in treatment of drug resistant-TB |
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Adapted from WHO 2013 Treatment of Tuberculosis: Guidelines – 4th ed.[1] |
Bedaquiline
- Bedaquiline is an oral diarylquinoline recently approved by the FDA (Dec 2012) for the treatment of MDR TB when other alternatives are not available.[4]
- This drug should be used with clinical expert consultation as part of combination therapy (minimum four-drug treatment regimen) and administered by direct observation to adults aged ≥18 years with a diagnosis of pulmonary MDR TB.[4]
- Dosage: 400 mg daily PO for 2 weeks, followed by 200 mg three times a week for 22 weeks.[4]
References
- ↑ 1.0 1.1 1.2 1.3 "2013 WHO Treatment of Tuberculosis: Guidelines for National Programmes (4th Edition)".
- ↑ Caminero, José A; Sotgiu, Giovanni; Zumla, Alimuddin; Migliori, Giovanni Battista (2010). "Best drug treatment for multidrug-resistant and extensively drug-resistant tuberculosis". The Lancet Infectious Diseases. 10 (9): 621–629. doi:10.1016/S1473-3099(10)70139-0. ISSN 1473-3099.
- ↑ "WHO Guidance for national tuberculosis programmes on the management of tuberculosis in children, 2014" (PDF).
- ↑ 4.0 4.1 4.2 "Provisional CDC Guidelines for the Use and Safety Monitoring of Bedaquiline Fumarate (Sirturo) for the Treatment of Multidrug-Resistant Tuberculosis 2013".