1
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Maranchick NF, Peloquin CA. Role of therapeutic drug monitoring in the treatment of multi-drug resistant tuberculosis. J Clin Tuberc Other Mycobact Dis 2024; 36:100444. [PMID: 38708036 PMCID: PMC11067344 DOI: 10.1016/j.jctube.2024.100444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024] Open
Abstract
Tuberculosis (TB) is a leading cause of mortality worldwide, and resistance to anti-tuberculosis drugs is a challenge to effective treatment. Multi-drug resistant TB (MDR-TB) can be difficult to treat, requiring long durations of therapy and the use of second line drugs, increasing a patient's risk for toxicities and treatment failure. Given the challenges treating MDR-TB, clinicians can improve the likelihood of successful outcomes by utilizing therapeutic drug monitoring (TDM). TDM is a clinical technique that utilizes measured drug concentrations from the patient to adjust therapy, increasing likelihood of therapeutic drug concentrations while minimizing the risk of toxic drug concentrations. This review paper provides an overview of the TDM process, pharmacokinetic parameters for MDR-TB drugs, and recommendations for dose adjustments following TDM.
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Affiliation(s)
- Nicole F. Maranchick
- Infectious Disease Pharmacokinetics Lab, Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL, USA
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
| | - Charles A. Peloquin
- Infectious Disease Pharmacokinetics Lab, Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL, USA
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
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2
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Simeon S, Garcia-Cremades M, Savic R, Solans BP. Pharmacokinetic-pharmacodynamic modeling of tuberculosis time to positivity and colony-forming unit to assess the response to dose-ranging linezolid. Antimicrob Agents Chemother 2024:e0019024. [PMID: 39016594 DOI: 10.1128/aac.00190-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 06/08/2024] [Indexed: 07/18/2024] Open
Abstract
According to the World Health Organization, the number of tuberculosis (TB) infections and the drug-resistant burden worldwide increased by 4.5% and 3.0%, respectively, between 2020 and 2021. Disease severity and complexity drive the interest for undertaking new clinical trials to provide efficient treatment to limit spread and drug resistance. TB Alliance conducted a phase 2 study in 106 patients to guide linezolid (LZD) dose selection using early bactericidal activity over 14 days of treatment. LZD is highly efficient for drug-resistant TB treatment, but treatment monitoring is required since serious adverse events can occur. The objective of this study was to develop a pharmacokinetic-pharmacodynamic (PKPD) model to analyze the dose-response relationship between linezolid exposure and efficacy biomarkers. Using time to positivity (TTP) and colony-forming unit (CFU) count data, we developed a PKPD model in six dosing regimens, differing on LZD dosing intensity. A one-compartment model with five transit absorption compartments and non-linear auto-inhibition elimination described best LZD pharmacokinetic characteristics. TTP and CFU logarithmic scaled [log(CFU)] showed a bactericidal activity of LZD against Mycobacterium tuberculosis. TTP was defined by a model with two significant covariates: the presence of uni- and bilateral cavities decreased baseline TTP value by 24%, and an increase on every 500 mg/L/h of cumulative area under the curve increased the rate at which TTP and CFU change from baseline by 20% and 11%, respectively. CLINICAL TRIALS This study is registered with ClinicalTrials.gov as NCT02279875.
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Affiliation(s)
- Segolene Simeon
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco Schools of Pharmacy and Medicine, San Francisco, California, USA
- UCSF Center for Tuberculosis, University of California, San Francisco, California, USA
| | - Maria Garcia-Cremades
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco Schools of Pharmacy and Medicine, San Francisco, California, USA
- Department of Pharmaceutics and Food Technology, School of Pharmacy, Complutense University of Madrid, Madrid, Spain
- Institute of Industrial Pharmacy, Complutense University of Madrid, Madrid, Spain
| | - Rada Savic
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco Schools of Pharmacy and Medicine, San Francisco, California, USA
- UCSF Center for Tuberculosis, University of California, San Francisco, California, USA
| | - Belén P Solans
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco Schools of Pharmacy and Medicine, San Francisco, California, USA
- UCSF Center for Tuberculosis, University of California, San Francisco, California, USA
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3
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Zhang GXZ, Liu TT, Ren AX, Liang WX, Yin H, Cai Y. Advances in contezolid: novel oxazolidinone antibacterial in Gram-positive treatment. Infection 2024; 52:787-800. [PMID: 38717734 DOI: 10.1007/s15010-024-02287-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 04/25/2024] [Indexed: 06/02/2024]
Abstract
PURPOSE The principal objective of this project was to review and thoroughly examine the chemical characteristics, pharmacological activity, and quantification methods associated with contezolid. METHODS The article was based on published and ongoing preclinical and clinical studies on the application of contezolid. These studies included experiments on the physicochemical properties of contezolid, in vitro antimicrobial research, in vivo antimicrobial research, and clinical trials in various phases. There were no date restrictions on these studies. RESULTS In June 2021, contezolid was approved for treating complicated skin and soft tissue infections. The structural modification of contezolid has resulted in better efficacy compared to linezolid. It inhibits bacterial growth by preventing the production of the functional 70S initiation complex required to translate bacterial proteins. The current evidence has indicated a substantial decline in myelosuppression and monoamine oxidase inhibition without impairing its antibacterial properties. Contezolid was found to have a more significant safety profile and to be metabolised by flavin monooxygenase 5, reducing the risk of harmful effects due to drug-drug interactions. Adjusting doses is unnecessary for patients with mild to moderate renal or hepatic insufficiency. CONCLUSION As an oral oxazolidinone antimicrobial agent, contezolid is effective against multi-drug resistant Gram-positive bacteria. The introduction of contezolid provided a new clinical option.
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Affiliation(s)
- Guan-Xuan-Zi Zhang
- Medical School of Chinese PLA, Graduate School of Chinese, PLA General Hospital, Beijing, 100853, China
- Center of Medicine Clinical Research, Department of Pharmacy, Medical Supplies Center, PLA General Hospital, 28 Fu Xing Road, Beijing, 100853, China
- Department of Health Services, General Hospital of Central Theater Command, Wuhan, 430060, China
| | - Ting-Ting Liu
- Department of Pulmonary and Critical Care Medicine, The Second Medical Center, National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, 100853, China
| | - Ai-Xia Ren
- Medical School of Chinese PLA, Graduate School of Chinese, PLA General Hospital, Beijing, 100853, China
- Department of Neurology, Second Medical Center of PLA General Hospital, Beijing, 100853, China
| | - Wen-Xin Liang
- Center of Medicine Clinical Research, Department of Pharmacy, Medical Supplies Center, PLA General Hospital, 28 Fu Xing Road, Beijing, 100853, China
| | - Hong Yin
- Medical Supplies Center, PLA General Hospital, Beijing, 100853, China
| | - Yun Cai
- Center of Medicine Clinical Research, Department of Pharmacy, Medical Supplies Center, PLA General Hospital, 28 Fu Xing Road, Beijing, 100853, China.
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4
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Boshoff HIM, Young K, Ahn YM, Yadav VD, Crowley BM, Yang L, Su J, Oh S, Arora K, Andrews J, Manikkam M, Sutphin M, Smith AJ, Weiner DM, Piazza MK, Fleegle JD, Gomez F, Dayao EK, Prideaux B, Zimmerman M, Kaya F, Sarathy J, Tan VY, Via LE, Tschirret-Guth R, Lenaerts AJ, Robertson GT, Dartois V, Olsen DB, Barry CE. Mtb-Selective 5-Aminomethyl Oxazolidinone Prodrugs: Robust Potency and Potential Liabilities. ACS Infect Dis 2024; 10:1679-1695. [PMID: 38581700 DOI: 10.1021/acsinfecdis.4c00025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2024]
Abstract
Linezolid is a drug with proven human antitubercular activity whose use is limited to highly drug-resistant patients because of its toxicity. This toxicity is related to its mechanism of action─linezolid inhibits protein synthesis in both bacteria and eukaryotic mitochondria. A highly selective and potent series of oxazolidinones, bearing a 5-aminomethyl moiety (in place of the typical 5-acetamidomethyl moiety of linezolid), was identified. Linezolid-resistant mutants were cross-resistant to these molecules but not vice versa. Resistance to the 5-aminomethyl molecules mapped to an N-acetyl transferase (Rv0133) and these mutants remained fully linezolid susceptible. Purified Rv0133 was shown to catalyze the transformation of the 5-aminomethyl oxazolidinones to their corresponding N-acetylated metabolites, and this transformation was also observed in live cells of Mycobacterium tuberculosis. Mammalian mitochondria, which lack an appropriate N-acetyltransferase to activate these prodrugs, were not susceptible to inhibition with the 5-aminomethyl analogues. Several compounds that were more potent than linezolid were taken into C3HeB/FeJ mice and were shown to be highly efficacious, and one of these (9) was additionally taken into marmosets and found to be highly active. Penetration of these 5-aminomethyl oxazolidinone prodrugs into caseum was excellent. Unfortunately, these compounds were rapidly converted into the corresponding 5-alcohols by mammalian metabolism which retained antimycobacterial activity but resulted in substantial mitotoxicity.
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Affiliation(s)
- Helena I M Boshoff
- Tuberculosis Research Section, Laboratory of Clinical Immunology and Microbiology, National Institutes of Health, Bethesda, Maryland 20892, United States
| | - Katherine Young
- Merck & Co., Inc., West Point, Pennsylvania 19486, United States
| | - Yong-Mo Ahn
- Tuberculosis Research Section, Laboratory of Clinical Immunology and Microbiology, National Institutes of Health, Bethesda, Maryland 20892, United States
| | - Veena D Yadav
- Tuberculosis Research Section, Laboratory of Clinical Immunology and Microbiology, National Institutes of Health, Bethesda, Maryland 20892, United States
| | | | - Lihu Yang
- Merck & Co., Inc., West Point, Pennsylvania 19486, United States
| | - Jing Su
- Merck & Co., Inc., West Point, Pennsylvania 19486, United States
| | - Sangmi Oh
- Tuberculosis Research Section, Laboratory of Clinical Immunology and Microbiology, National Institutes of Health, Bethesda, Maryland 20892, United States
| | - Kriti Arora
- Tuberculosis Research Section, Laboratory of Clinical Immunology and Microbiology, National Institutes of Health, Bethesda, Maryland 20892, United States
| | - Jenna Andrews
- Tuberculosis Research Section, Laboratory of Clinical Immunology and Microbiology, National Institutes of Health, Bethesda, Maryland 20892, United States
| | - Michelle Manikkam
- Tuberculosis Imaging Program, Division of Intramural Research, National Insititute of Allergy and Infectious Disease, National Insititutes of Health, Bethesda, Maryland 20892, United States
| | - Michelle Sutphin
- Tuberculosis Imaging Program, Division of Intramural Research, National Insititute of Allergy and Infectious Disease, National Insititutes of Health, Bethesda, Maryland 20892, United States
| | - Anthony J Smith
- Mycobacterial Research Laboratories, Department of Microbiology, Immunology, and Pathology, Colorado State University, Ft Collins, Colorado 80521, United States
| | - Danielle M Weiner
- Tuberculosis Imaging Program, Division of Intramural Research, National Insititute of Allergy and Infectious Disease, National Insititutes of Health, Bethesda, Maryland 20892, United States
| | - Michaela K Piazza
- Tuberculosis Imaging Program, Division of Intramural Research, National Insititute of Allergy and Infectious Disease, National Insititutes of Health, Bethesda, Maryland 20892, United States
| | - Joel D Fleegle
- Tuberculosis Imaging Program, Division of Intramural Research, National Insititute of Allergy and Infectious Disease, National Insititutes of Health, Bethesda, Maryland 20892, United States
| | - Felipe Gomez
- Tuberculosis Imaging Program, Division of Intramural Research, National Insititute of Allergy and Infectious Disease, National Insititutes of Health, Bethesda, Maryland 20892, United States
| | - Emmannual K Dayao
- Tuberculosis Imaging Program, Division of Intramural Research, National Insititute of Allergy and Infectious Disease, National Insititutes of Health, Bethesda, Maryland 20892, United States
| | - Brendan Prideaux
- Merck & Co., Inc., West Point, Pennsylvania 19486, United States
| | - Matthew Zimmerman
- Hackensack Meridian Health Center for Discovery & Innovation, Nutley, New Jersey 07110, United States
| | - Firat Kaya
- Hackensack Meridian Health Center for Discovery & Innovation, Nutley, New Jersey 07110, United States
| | - Jansy Sarathy
- Hackensack Meridian Health Center for Discovery & Innovation, Nutley, New Jersey 07110, United States
| | - Vee Yang Tan
- Tuberculosis Research Section, Laboratory of Clinical Immunology and Microbiology, National Institutes of Health, Bethesda, Maryland 20892, United States
| | - Laura E Via
- Tuberculosis Imaging Program, Division of Intramural Research, National Insititute of Allergy and Infectious Disease, National Insititutes of Health, Bethesda, Maryland 20892, United States
| | | | - Anne J Lenaerts
- Mycobacterial Research Laboratories, Department of Microbiology, Immunology, and Pathology, Colorado State University, Ft Collins, Colorado 80521, United States
| | - Gregory T Robertson
- Mycobacterial Research Laboratories, Department of Microbiology, Immunology, and Pathology, Colorado State University, Ft Collins, Colorado 80521, United States
| | - Véronique Dartois
- Mycobacterial Research Laboratories, Department of Microbiology, Immunology, and Pathology, Colorado State University, Ft Collins, Colorado 80521, United States
| | - David B Olsen
- Merck & Co., Inc., West Point, Pennsylvania 19486, United States
| | - Clifton E Barry
- Tuberculosis Research Section, Laboratory of Clinical Immunology and Microbiology, National Institutes of Health, Bethesda, Maryland 20892, United States
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5
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Dheda K, Mirzayev F, Cirillo DM, Udwadia Z, Dooley KE, Chang KC, Omar SV, Reuter A, Perumal T, Horsburgh CR, Murray M, Lange C. Multidrug-resistant tuberculosis. Nat Rev Dis Primers 2024; 10:22. [PMID: 38523140 DOI: 10.1038/s41572-024-00504-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/16/2024] [Indexed: 03/26/2024]
Abstract
Tuberculosis (TB) remains the foremost cause of death by an infectious disease globally. Multidrug-resistant or rifampicin-resistant TB (MDR/RR-TB; resistance to rifampicin and isoniazid, or rifampicin alone) is a burgeoning public health challenge in several parts of the world, and especially Eastern Europe, Russia, Asia and sub-Saharan Africa. Pre-extensively drug-resistant TB (pre-XDR-TB) refers to MDR/RR-TB that is also resistant to a fluoroquinolone, and extensively drug-resistant TB (XDR-TB) isolates are additionally resistant to other key drugs such as bedaquiline and/or linezolid. Collectively, these subgroups are referred to as drug-resistant TB (DR-TB). All forms of DR-TB can be as transmissible as rifampicin-susceptible TB; however, it is more difficult to diagnose, is associated with higher mortality and morbidity, and higher rates of post-TB lung damage. The various forms of DR-TB often consume >50% of national TB budgets despite comprising <5-10% of the total TB case-load. The past decade has seen a dramatic change in the DR-TB treatment landscape with the introduction of new diagnostics and therapeutic agents. However, there is limited guidance on understanding and managing various aspects of this complex entity, including the pathogenesis, transmission, diagnosis, management and prevention of MDR-TB and XDR-TB, especially at the primary care physician level.
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Affiliation(s)
- Keertan Dheda
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and UCT Lung Institute & South African MRC/UCT Centre for the Study of Antimicrobial Resistance, University of Cape Town, Cape Town, South Africa.
- Faculty of Infectious and Tropical Diseases, Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, UK.
| | - Fuad Mirzayev
- Global Tuberculosis Programme, WHO, Geneva, Switzerland
| | - Daniela Maria Cirillo
- Emerging Bacterial Pathogens Unit, IRCCS San Raffaele Scientific Institute Milan, Milan, Italy
| | - Zarir Udwadia
- Department of Pulmonology, Hinduja Hospital & Research Center, Mumbai, India
| | - Kelly E Dooley
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kwok-Chiu Chang
- Tuberculosis and Chest Service, Centre for Health Protection, Department of Health, Hong Kong, SAR, China
| | - Shaheed Vally Omar
- Centre for Tuberculosis, National & WHO Supranational TB Reference Laboratory, National Institute for Communicable Diseases, a division of the National Health Laboratory Service, Johannesburg, South Africa
- Department of Molecular Medicine & Haematology, School of Pathology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Anja Reuter
- Sentinel Project on Paediatric Drug-Resistant Tuberculosis, Boston, MA, USA
| | - Tahlia Perumal
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and UCT Lung Institute & South African MRC/UCT Centre for the Study of Antimicrobial Resistance, University of Cape Town, Cape Town, South Africa
- Faculty of Infectious and Tropical Diseases, Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, UK
| | - C Robert Horsburgh
- Department of Epidemiology, Boston University Schools of Public Health and Medicine, Boston, MA, USA
| | - Megan Murray
- Department of Epidemiology, Harvard Medical School, Boston, MA, USA
| | - Christoph Lange
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany
- German Center for Infection Research (DZIF), TTU-TB, Borstel, Germany
- Respiratory Medicine & International Health, University of Lübeck, Lübeck, Germany
- Department of Paediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
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6
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Girase R, Ahmad I, Patel H. Bioisosteric modification of Linezolid identified the potential M. tuberculosis protein synthesis inhibitors to overcome the myelosuppression and serotonergic toxicity associated with Linezolid in the treatment of the multi-drug resistance tuberculosis (MDR-TB). J Biomol Struct Dyn 2024; 42:2111-2126. [PMID: 37097976 DOI: 10.1080/07391102.2023.2203254] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 04/10/2023] [Indexed: 04/26/2023]
Abstract
Linezolid is the first and only oxazolidinone antibacterial drug was approved in the last 35 years. It exhibits bacteriostatic efficacy against M. tuberculosis and is a crucial constituent of the BPaL regimen (Bedaquiline, Pretomanid, and Linezolid), which was authorized by the FDA in 2019 for the treatment of XDR-TB or MDR-TB. Despite its unique mechanism of action, Linezolid carries a considerable risk of toxicity, including myelosuppression and serotonin syndrome (SS), which is caused by inhibition of mitochondrial protein synthesis (MPS) and monoamine oxidase (MAO), respectively. Based on the structure toxicity relationship (STR) of Linezolid, in this work, we used a bioisosteric replacement approach to optimize the structure of Linezolid at the C-ring and/or C-5 position for myelosuppression and serotogenic toxicity. Extensive hierarchical multistep docking, drug likeness prediction, molecular binding interactions analyses, and toxicity assessment identified three promising compounds (3071, 7549 and 9660) as less toxic potential modulators of Mtb EthR protein. Compounds 3071, 7549 and 9660 were having the significant docking score of -12.696 Kcal/mol, -12.681 Kcal/mol and -15.293 Kcal/mol towards the Mtb EthR protein with less MAO-A and B affinity [compound 3071: MAO A (-4.799 Kcal/mol) and MAO B (-6.552 Kcal/mol); compound 7549: MAO A (> -2.00 Kcal/mol) and MAO B (> -2.00 Kcal/mol) and compound 9660: MAO A (> -5.678 Kcal/mol) and MAO B (> -6.537Kcal/mol) and none of them shown the Leukopenia as a side effect due to the Myelosuppression. The MD simulation results and binding free energy estimations correspond well with docking analyses, indicating that the proposed compounds bind and inhibit the EthR protein more effectively than Linezolid. The quantum mechanical and electrical characteristics were evaluated using density functional theory (DFT), which also demonstrated that the proposed compounds are more reactive than Linezolid.Communicated by Ramaswamy H. Sarma.
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Affiliation(s)
- Rukaiyya Girase
- Division of Computer Aided Drug Design, Department of Pharmaceutical Chemistry, R. C. Patel Institute of Pharmaceutical Education and Research, Shirpur, India
| | - Iqrar Ahmad
- Division of Computer Aided Drug Design, Department of Pharmaceutical Chemistry, R. C. Patel Institute of Pharmaceutical Education and Research, Shirpur, India
| | - Harun Patel
- Division of Computer Aided Drug Design, Department of Pharmaceutical Chemistry, R. C. Patel Institute of Pharmaceutical Education and Research, Shirpur, India
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7
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Girase R, Ahmad I, Oh JM, Kim H, Mathew B, Vagolu SK, Tønjum T, Desai NC, Sriram D, Kumari J, Patel HM. Repurposing Azoles to Resolve Serotogenic Toxicity Associated with Linezolid to Combat Multidrug-Resistant Tuberculosis. ACS Med Chem Lett 2023; 14:1754-1759. [PMID: 38116435 PMCID: PMC10726462 DOI: 10.1021/acsmedchemlett.3c00406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/15/2023] [Accepted: 10/25/2023] [Indexed: 12/21/2023] Open
Abstract
Serotogenic toxicity is a major hurdle associated with Linezolid in the treatment of drug-resistant tuberculosis (TB) due to the inhibition of monoamine oxidase (MAO) enzymes. Azole compounds demonstrate structural similarities to the recognized anti-TB drug Linezolid, making them intriguing candidates for repurposing. Therefore, we have repurposed azoles (Posaconazole, Itraconazole, Miconazole, and Clotrimazole) for the treatment of drug-resistant TB with the anticipation of their selectivity in sparing the MAO enzyme. The results of repurposing revealed that Clotrimazole showed equipotent activity against the Mycobacterium tuberculosis (Mtb) H37Rv strain compared to Linezolid, with a minimal inhibitory concentration (MIC) of 2.26 μM. Additionally, Clotrimazole exhibited reasonable MIC50 values of 0.17 μM, 1.72 μM, 1.53 μM, and 5.07 μM against the inhA promoter+, katG+, rpoB+, and MDR clinical Mtb isolates, respectively, compared to Linezolid. Clotrimazole also exhibited 3.90-fold less inhibition of MAO-A and 50.35-fold less inhibition of MAO-B compared to Linezolid, suggesting a reduced serotonergic toxicity burden.
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Affiliation(s)
- Rukaiyya
T. Girase
- Department
of Pharmaceutical Chemistry, R. C. Patel
Institute of Pharmaceutical Education and Research, Shirpur, Maharashtra India, 4254
| | - Iqrar Ahmad
- Department
of Pharmaceutical Chemistry, R. C. Patel
Institute of Pharmaceutical Education and Research, Shirpur, Maharashtra India, 4254
| | - Jong Min Oh
- Department
of Pharmacy, and Research Institute of Life Pharmaceutical Sciences, Sunchon National University, Suncheon 57922, Republic of Korea
| | - Hoon Kim
- Department
of Pharmacy, and Research Institute of Life Pharmaceutical Sciences, Sunchon National University, Suncheon 57922, Republic of Korea
| | - Bijo Mathew
- Department
of Pharmaceutical Chemistry, Amrita School of Pharmacy, Amrita Vishwa Vidyapeetham, Kochi 690525, India
| | - Siva K. Vagolu
- Department
of Microbiology, University of Oslo, N-0316 Oslo, Norway
| | - Tone Tønjum
- Department
of Microbiology, University of Oslo, N-0316 Oslo, Norway
- Department
of Microbiology, Oslo University Hospital, N-0424 Oslo, Norway
| | - Nisheeth C. Desai
- Division
of Medicinal Chemistry, Department of Chemistry (DST-FIST Sponsored), Maharaja Krishnakumarsinhji Bhavnagar University, Mahatma Gandhi Campus, Bhavnagar 364 002, India
| | - Dharmarajan Sriram
- Department
of Pharmacy, Birla Institute of Technology
and Science-Pilani, Hyderabad Campus, Jawahar Nagar, Shameerpet Mandal, R. R. District, Hyderabad 500078, India
| | - Jyothi Kumari
- Department
of Pharmacy, Birla Institute of Technology
and Science-Pilani, Hyderabad Campus, Jawahar Nagar, Shameerpet Mandal, R. R. District, Hyderabad 500078, India
| | - Harun M. Patel
- Department
of Pharmaceutical Chemistry, R. C. Patel
Institute of Pharmaceutical Education and Research, Shirpur, Maharashtra India, 4254
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8
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Georghiou SB, de Vos M, Velen K, Miotto P, Colman RE, Cirillo DM, Ismail N, Rodwell TC, Suresh A, Ruhwald M. Designing molecular diagnostics for current tuberculosis drug regimens. Emerg Microbes Infect 2023; 12:2178243. [PMID: 36752055 PMCID: PMC9980415 DOI: 10.1080/22221751.2023.2178243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Diagnostic development must occur in parallel with drug development to ensure the longevity of new treatment compounds. Despite an increasing number of novel and repurposed anti-tuberculosis compounds and regimens, there remains a large number of drugs for which no rapid and accurate molecular diagnostic option exists. The lack of rapid drug susceptibility testing for linezolid, bedaquiline, clofazimine, the nitroimidazoles (i.e pretomanid and delamanid) and pyrazinamide at any level of the healthcare system compromises the effectiveness of current tuberculosis and drug-resistant tuberculosis treatment regimens. In the context of current WHO tuberculosis treatment guidelines as well as promising new regimens, we identify the key diagnostic gaps for initial and follow-on tests to diagnose emerging drug resistance and aid in regimen selection. Additionally, we comment on potential gene targets for inclusion in rapid molecular drug susceptibility assays and sequencing assays for novel and repurposed drug compounds currently prioritized in current regimens, and evaluate the feasibility of mutation detection given the design of existing technologies. Based on current knowledge, we also propose design priorities for next generation molecular assays to support triage of tuberculosis patients to appropriate and effective treatment regimens. We encourage assay developers to prioritize development of these key molecular assays and support the continued evolution, uptake, and utility of sequencing to build knowledge of tuberculosis resistance mechanisms and further inform rapid treatment decisions in order to curb resistance to critical drugs in current regimens and achieve End TB targets.Trial registration: ClinicalTrials.gov identifier: NCT05117788..
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Affiliation(s)
| | | | | | - Paolo Miotto
- IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Rebecca E. Colman
- FIND, the Global Alliance for Diagnostics, Geneva, Switzerland,Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | | | | | - Timothy C. Rodwell
- FIND, the Global Alliance for Diagnostics, Geneva, Switzerland,Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Anita Suresh
- FIND, the Global Alliance for Diagnostics, Geneva, Switzerland
| | - Morten Ruhwald
- FIND, the Global Alliance for Diagnostics, Geneva, Switzerland, Morten Ruhwald FIND, the Global Alliance for Diagnostics, Campus Biotech, 9 Chemin des Mines, Geneva1202, Switzerland
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9
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Solans BP, Imperial MZ, Olugbosi M, Savic RM. Analysis of Dynamic Efficacy Endpoints of the Nix-TB Trial. Clin Infect Dis 2023; 76:1903-1910. [PMID: 36804834 PMCID: PMC10249992 DOI: 10.1093/cid/ciad051] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND Safer, better, and shorter treatments for multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis (TB) are an urgent global health need. The phase 3 clinical trial Nix-TB (NCT02333799) tested a 6-month treatment of MDR and XDR-TB consisting of high-dose linezolid, bedaquiline, and pretomanid (BPaL). In this study, we investigate the relationship between the pharmacokinetic characteristics of the drugs, patient characteristics and efficacy endpoints from Nix-TB. METHODS Pharmacokinetic data were collected at weeks 2, 8, and 16. Efficacy endpoints including treatment outcomes, time to stable culture conversion, and longitudinal time to positivity in the mycobacterial growth indicator tube assay were each characterized using nonlinear mixed-effects modeling. Relationships between patient, treatment pharmacokinetics, and disease characteristics and efficacy endpoints were evaluated. RESULTS Data from 93 (85% of the total) participants were analyzed. Higher body mass index was associated with a lower incidence of unfavorable treatment outcomes. Median time to stable culture conversion was 3 months in patients with lower baseline burden compared with 4.5 months in patients with high baseline burden. Participants with minimal disease had steeper time to positivity trajectories compared with participants with high-risk phenotypes. No relationship between any drugs' pharmacokinetics (drug concentration or exposure metrics) and any efficacy outcomes was observed. CONCLUSIONS We have successfully described efficacy endpoints of a BPaL regimen from the Nix-TB trial. Participants with high-risk phenotypes significantly delayed time to culture conversion and bacterial clearance. The lack of a relationship between pharmacokinetic exposures and pharmacodynamic biomarkers opens the possibility to use lower, safer doses, particularly for toxicity-prone linezolid. CLINICAL TRIALS REGISTRATION NCT02333799.
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Affiliation(s)
- Belén P Solans
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco Schools of Pharmacy and Medicine, San Francisco, California, USA
- UCSF Center for Tuberculosis, University of California San Francisco, San Francisco, California, USA
| | - Marjorie Z Imperial
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco Schools of Pharmacy and Medicine, San Francisco, California, USA
- UCSF Center for Tuberculosis, University of California San Francisco, San Francisco, California, USA
| | | | - Rada M Savic
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco Schools of Pharmacy and Medicine, San Francisco, California, USA
- UCSF Center for Tuberculosis, University of California San Francisco, San Francisco, California, USA
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10
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Padmapriyadarsini C, Solanki R, Jeyakumar SM, Bhatnagar A, Muthuvijaylaksmi M, Jeyadeepa B, Reddy D, Shah P, Sridhar R, Vohra V, Bhui NK. Linezolid Pharmacokinetics and Its Association with Adverse Drug Reactions in Patients with Drug-Resistant Pulmonary Tuberculosis. Antibiotics (Basel) 2023; 12:antibiotics12040714. [PMID: 37107075 PMCID: PMC10135341 DOI: 10.3390/antibiotics12040714] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 03/30/2023] [Accepted: 03/31/2023] [Indexed: 04/29/2023] Open
Abstract
We evaluated the relationship between the pharmacokinetic parameters of linezolid (LZD) and development of adverse drug reactions (ADRs) in patients with pulmonary drug-resistant tuberculosis. A prospective cohort of adults with pulmonary multidrug-resistant tuberculosis with additional resistance to fluoroquinolone (MDR-TBFQ+) received treatment with bedaquiline, delamanid, clofazimine, and LZD. Blood samples were collected during weeks 8 and 16 at eight time points over 24 h. The pharmacokinetic parameters of LZD were measured using high-performance liquid chromatography and associated with ADRs. Of the 165 MDR-TBFQ+ patients on treatment, 78 patients developed LZD-associated anemia and 69 developed peripheral neuropathy. Twenty-three patients underwent intense pharmacokinetic testing. Plasma median trough concentration was 2.08 µg/mL and 3.41 µg/mL, (normal <2 µg/mL) and AUC0-24 was 184.5 µg/h/mL and 240.5 µg/h/mL at weeks 8 and 16, respectively, showing a linear relationship between duration of intake and plasma levels. Nineteen patients showed LZD-associated ADRs-nine at week 8, twelve at week 16, and two at both weeks 8 and 16. Thirteen of the nineteen had high plasma trough and peak concentrations of LZD. A strong association between LZD-associated ADRs and plasma LZD levels was noted. Trough concentration alone or combinations of trough with peak levels are potential targets for therapeutic drug monitoring.
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Affiliation(s)
| | - Rajesh Solanki
- B.J. Medical College and Hospital, Ahmedabad 380016, India
| | - S M Jeyakumar
- ICMR-National Institute for Research in Tuberculosis, Chennai 600031, India
| | - Anuj Bhatnagar
- Rajan Babu Institute of Pulmonary Medicine and Tuberculosis, New Delhi 110009, India
| | - M Muthuvijaylaksmi
- ICMR-National Institute for Research in Tuberculosis, Chennai 600031, India
| | - Bharathi Jeyadeepa
- ICMR-National Institute for Research in Tuberculosis, Chennai 600031, India
| | - Devarajulu Reddy
- ICMR-National Institute for Research in Tuberculosis, Chennai 600031, India
| | - Prashanth Shah
- B.J. Medical College and Hospital, Ahmedabad 380016, India
| | | | - Vikram Vohra
- National Institute for Tuberculosis and Respiratory Diseases, New Delhi 110030, India
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11
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Marriott DJE, Cattaneo D. Why Product Information Should not be Set in Stone: Lessons from a Decade of Linezolid Therapeutic Drug Monitoring: An Opinion Paper. Ther Drug Monit 2023; 45:209-216. [PMID: 36920503 DOI: 10.1097/ftd.0000000000001088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Affiliation(s)
- Deborah J E Marriott
- Department of Clinical Microbiology and Infectious Diseases, St Vincent's Hospital, Sydney, Australia; and
| | - Dario Cattaneo
- Unit of Clinical Pharmacology, ASST Fatebenefratelli Sacco University Hospital, Milan, Italy
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12
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Efficacy of Replacing Linezolid with OTB-658 in Anti-Tuberculosis Regimens in Murine Models. Antimicrob Agents Chemother 2023; 67:e0139922. [PMID: 36622240 PMCID: PMC9933650 DOI: 10.1128/aac.01399-22] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Linezolid (LZD) was the first oxazolidinone approved for treating drug-resistant tuberculosis. A newly approved regimen combining LZD with bedaquiline (BDQ) and pretomanid (PMD) (BPaL regimen) is the first 6-month oral regimen that is effective against multidrug- and extensively drug-resistant tuberculosis. However, LZD toxicity, primarily due to mitochondrial protein synthesis inhibition, may undermine the efficacy of LZD regimens, and oxazolidinones with higher efficacy and lower toxicity during prolonged administration are needed. OTB-658 is an oxazolidinone anti-TB candidate derived from LZD that could replace LZD in TB treatment. We previously found that OTB-658 had better anti-TB activity and safety than LZD in vitro and in vivo. In the present work, two murine TB models were used to evaluate replacing LZD with OTB-658 in LZD-containing regimens. In the C3HeB/FeJ murine model, replacing 100 mg/kg LZD with 50 mg/kg OTB-658 in the BDQ + PMD backbone significantly reduced lung and spleen CFU counts (P < 0.05), and there were few relapses at 8 weeks of treatment. Replacing 100 mg/kg LZD with 50 or 100 mg/kg OTB-658 in the pyrifazimine (previously called TBI-166) + BDQ backbone did not change the anti-TB efficacy and relapse rate. In BALB/c mice, replacing 100 mg/kg LZD with 100 mg/kg OTB-658 in the TBI-166 + BDQ backbone resulted in no culture-positive lungs at 4 and 8 weeks of treatment, and there were no significant differences in relapses rate between the groups. In conclusion, OTB-658 is a promising clinical candidate that could replace LZD in the BPaL or TBI-166 + BDQ + LZD regimens and should be studied further in clinical trials.
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13
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Zhang H, He Y, Davies Forsman L, Paues J, Werngren J, Niward K, Schön T, Bruchfeld J, Alffenaar JW, Hu Y. Population pharmacokinetics and dose evaluations of linezolid in the treatment of multidrug-resistant tuberculosis. Front Pharmacol 2023; 13:1032674. [PMID: 36699070 PMCID: PMC9868619 DOI: 10.3389/fphar.2022.1032674] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 12/15/2022] [Indexed: 01/11/2023] Open
Abstract
Background: The pharmacokinetic/pharmacodynamics (PK/PD) target derived from the hollow-fiber system model for linezolid for treatment of the multidrug-resistant tuberculosis (MDR-TB) requires clinical validation. Therefore, this study aimed to develop a population PK model for linezolid when administered as part of a standardized treatment regimen, to identify the PK/PD threshold associated with successful treatment outcomes and to evaluate currently recommended linezolid doses. Method: This prospective multi-center cohort study of participants with laboratory-confirmed MDR-TB was conducted in five TB designated hospitals. The population PK model for linezolid was built using nonlinear mixed-effects modeling using data from 168 participants. Boosted classification and regression tree analyses (CART) were used to identify the ratio of 0- to 24-h area under the concentration-time curve (AUC0-24h) to the minimal inhibitory concentration (MIC) threshold using the BACTEC MGIT 960 method associated with successful treatment outcome and validated in multivariate analysis using data from a different and prospective cohort of 159 participants with MDR-TB. Furthermore, based on the identified thresholds, the recommended doses were evaluated by the probability of target attainment (PTA) analysis. Result: Linezolid plasma concentrations (1008 samples) from 168 subjects treated with linezolid, were best described by a 2-compartment model with first-order absorption and elimination. An AUC0-24h/MIC > 125 was identified as a threshold for successful treatment outcome. Median time to sputum culture conversion between the group with AUC0-24h/MIC above and below 125 was 2 versus 24 months; adjusted hazard ratio (aHR), 21.7; 95% confidence interval (CI), (6.4, 72.8). The boosted CART-derived threshold and its relevance to the final treatment outcome was comparable to the previously suggested target of AUC0-24h/MIC (119) using MGIT MICs in a hollow fiber infection model. Based on the threshold from the present study, at a standard linezolid dose of 600 mg daily, PTA was simulated to achieve 100% at MGIT MICs of ≤ .25 mg which included the majority (81.1%) of isolates in the study. Conclusion: We validated an AUC0-24h/MIC threshold which may serve as a target for dose adjustment to improve efficacy of linezolid in a bedaquiline-containing treatment. Linezolid exposures with the WHO-recommended dose (600 mg daily) was sufficient for all the M. tb isolates with MIC ≤ .25 mg/L.
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Affiliation(s)
- Haoyue Zhang
- Department of Epidemiology, School of Public Health and Key Laboratory of Public Health Safety, Fudan University, Shanghai, China
| | - Yuying He
- Institute of Tuberculosis Control, Guizhou Provincial Center for Disease Control and Prevention, Guiyang, China
| | - Lina Davies Forsman
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden,Department of Medicine, Division of Infectious Diseases, Karolinska Institute, Stockholm, Sweden
| | - Jakob Paues
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden,Department of Infectious Diseases, Linköping University Hospital, Linköping, Sweden
| | - Jim Werngren
- Department of Microbiology, The Public Health Agency of Sweden, Stockholm, Sweden
| | - Katarina Niward
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden,Department of Infectious Diseases, Linköping University Hospital, Linköping, Sweden
| | - Thomas Schön
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden,Department of Infectious Diseases, Linköping University Hospital, Linköping, Sweden,Department of Infectious Diseases, Kalmar County Hospital, Linköping University, Kalmar, Sweden
| | - Judith Bruchfeld
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden,Department of Medicine, Division of Infectious Diseases, Karolinska Institute, Stockholm, Sweden
| | - Jan-Willem Alffenaar
- University of Sydney, Faculty of Medicine and Health, School of Pharmacy, Sydney, NSW, Australia,Westmead Hospital, Sydney, NSW, Australia,Sydney Institute for Infectious Diseases, University of Sydney, Sydney, NSW, Australia
| | - Yi Hu
- Department of Epidemiology, School of Public Health and Key Laboratory of Public Health Safety, Fudan University, Shanghai, China,*Correspondence: Yi Hu,
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14
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Resendiz-Galvan JE, Arora PR, Abdelwahab MT, Udwadia ZF, Rodrigues C, Gupta A, Denti P, Ashavaid TF, Tornheim JA. Pharmacokinetic analysis of linezolid for multidrug resistant tuberculosis at a tertiary care centre in Mumbai, India. Front Pharmacol 2023; 13:1081123. [PMID: 36686664 PMCID: PMC9846493 DOI: 10.3389/fphar.2022.1081123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 12/12/2022] [Indexed: 01/06/2023] Open
Abstract
Linezolid is an oxazolidinone used to treat multidrug-resistant tuberculosis (MDR-TB), including in the recently-endorsed shorter 6-month treatment regimens. Due to its narrow therapeutic index, linezolid is often either dose-adjusted or discontinued due to intolerance or toxicity during treatment, and the optimal balance between linezolid efficacy and toxicity remains unclear. India carries a significant burden of MDR-TB cases in the world, but limited information on the pharmacokinetics of linezolid and minimum inhibitory concentration (MIC) distribution is available from Indian MDR-TB patients. We enrolled participants from a tertiary care centre in Mumbai, India, treated for MDR-TB and receiving linezolid daily doses of 600 or 300 mg. Pharmacokinetic visits were scheduled between 1 and 15 months after treatment initiation to undergo intensive or sparse blood sampling. Linezolid concentration versus time data were analysed using non-linear mixed-effects modelling, with simulations to evaluate doses for different scenarios. We enrolled 183 participants (121 females), with a median age of 26 years (interquartile range [IQR] 21-35), weight 55.0 kg (IQR 45.6-65.8), and fat-free mass 38.7 kg (IQR 32.7-46.0). Linezolid pharmacokinetics was best described by a one-compartment model with first-order elimination allometrically scaled by fat-free mass and transit compartment absorption. The typical clearance value was 3.81 L/h. Simulations predicted that treatment with 300 mg daily achieves a high probability of target attainment (PTA) when linezolid MIC was ≤0.25 mg/L (61.5% of participant samples tested), while 600 mg daily would be required if MIC were 0.5 mg/L (29% of samples). While linezolid 300 mg daily is predicted to achieve effective targets for the majority of adults with MDR-TB, it failed to achieve the therapeutic target for 21% participants. A dose of 600 mg had a PTA >90% for all susceptible samples, but with a higher likelihood of exceeding toxicity thresholds (31% vs 9.6%). These data suggest potential benefit to individualized dosing taking host and microbial characteristics into account to improve the likelihood of treatment efficacy while minimizing risk of toxicity from linezolid for the treatment of MDR-TB. Further prospective evaluation in different clinical settings is urgently needed to inform safety and efficacy of these lower doses.
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Affiliation(s)
| | - Prerna R Arora
- Research Laboratories, P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, India
| | - Mahmoud Tareq Abdelwahab
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Zarir F Udwadia
- Division of Respiratory Medicine, P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, India
| | - Camilla Rodrigues
- Research Laboratories, P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, India
| | - Amita Gupta
- Center for Infectious Diseases in India, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Center for Tuberculosis Research, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Paolo Denti
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Tester F Ashavaid
- Research Laboratories, P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, India
| | - Jeffrey A Tornheim
- Center for Infectious Diseases in India, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Center for Tuberculosis Research, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
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15
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Bossù G, Autore G, Bernardi L, Buonsenso D, Migliori GB, Esposito S. Treatment options for children with multi-drug resistant tuberculosis. Expert Rev Clin Pharmacol 2023; 16:5-15. [PMID: 36378271 DOI: 10.1080/17512433.2023.2148653] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION According to the latest report from the World Health Organization (WHO), approximately 10.0 million people fell ill with tuberculosis (TB) in 2020, 12% of which were children aged under 15 years. There is very few experience on treatment of multi-drug resistant (MDR)-TB in pediatrics. AREAS COVERED The aim of this review is to analyze and summarize therapeutic options available for children experiencing MDR-TB. We also focused on management of MDR-TB prophylaxis. EXPERT OPINION The therapeutic management of children with MDR-TB or MDR-TB contacts is complicated by a lack of knowledge, and the fact that many potentially useful drugs are not registered for pediatric use and there are no formulations suitable for children in the first years of life. Furthermore, most of the available drugs are burdened by major adverse events that need to be taken into account, particularly in the case of prolonged therapy. A close follow-up with a standardized timeline and a comprehensive assessment of clinical, laboratory, microbiologic and radiologic data is extremely important in these patients. Due to the complexity of their management, pediatric patients with confirmed or suspected MDR-TB should always be referred to a specialized center.
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Affiliation(s)
- Gianluca Bossù
- Pediatric Clinic, Pietro Barilla Children's Hospital, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Giovanni Autore
- Pediatric Clinic, Pietro Barilla Children's Hospital, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Luca Bernardi
- Pediatric Clinic, Pietro Barilla Children's Hospital, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giovanni Battista Migliori
- Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri - IRCCS, Tradate, Italia
| | - Susanna Esposito
- Pediatric Clinic, Pietro Barilla Children's Hospital, Department of Medicine and Surgery, University of Parma, Parma, Italy
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16
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Kelebekli L. Synthesis and hydrolysis of monocarbamate from allylic 1,4-dicarbamate: Bis-homodichloroinositol. Carbohydr Res 2022; 522:108681. [PMID: 36166876 DOI: 10.1016/j.carres.2022.108681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 09/01/2022] [Accepted: 09/16/2022] [Indexed: 11/27/2022]
Abstract
The synthesis of novel bis-homodichloroinositol with a configuration similar to that of conduritol-D is reported for the first time. The photooxygenation of cis-dichloro-diene obtained using cyclooctatetraene as the starting molecule afforted the tricyclic endoperoxide. The reduction of the endoperoxide with thiourea gave the corresponding allylic cis-diol. Formation of the bis-carbamate groups with p-TsNCO of allylic cis-diol followed by the [(dba)3Pd2CHCl3] in the presence of trimethylsilyl azide, gave a new monocarbamate as well as oxazolidinone derivative. Oxidation of the double bond in the monocarbamate with osmium tetraoxide followed by acetylation furnished the desired monocarbamate triacetate. Eventually, the desired halogenated bicyclo[4.2.0] inositol (bis-homodichloroinositol) were obtained in high yield by hydrolysis of the acetate groups and monocarbanate group by potassium carbonate in methanol. Characterization of all the synthesized compounds were performed by FT-IR, 1H NMR, 13C NMR, COSY (2D-NMR), HRMS, and Elemental Analysis techniques.
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Affiliation(s)
- Latif Kelebekli
- Department of Chemistry, Faculty of Sciences and Arts, Ordu University, 52200, Ordu, Turkey.
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17
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Conradie F, Bagdasaryan TR, Borisov S, Howell P, Mikiashvili L, Ngubane N, Samoilova A, Skornykova S, Tudor E, Variava E, Yablonskiy P, Everitt D, Wills GH, Sun E, Olugbosi M, Egizi E, Li M, Holsta A, Timm J, Bateson A, Crook AM, Fabiane SM, Hunt R, McHugh TD, Tweed CD, Foraida S, Mendel CM, Spigelman M. Bedaquiline-Pretomanid-Linezolid Regimens for Drug-Resistant Tuberculosis. N Engl J Med 2022; 387:810-823. [PMID: 36053506 PMCID: PMC9490302 DOI: 10.1056/nejmoa2119430] [Citation(s) in RCA: 155] [Impact Index Per Article: 77.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND The bedaquiline-pretomanid-linezolid regimen has been reported to have 90% efficacy against highly drug-resistant tuberculosis, but the incidence of adverse events with 1200 mg of linezolid daily has been high. The appropriate dose of linezolid and duration of treatment with this agent to minimize toxic effects while maintaining efficacy against highly drug-resistant tuberculosis are unclear. METHODS We enrolled participants with extensively drug-resistant (XDR) tuberculosis (i.e., resistant to rifampin, a fluoroquinolone, and an aminoglycoside), pre-XDR tuberculosis (i.e., resistant to rifampin and to either a fluoroquinolone or an aminoglycoside), or rifampin-resistant tuberculosis that was not responsive to treatment or for which a second-line regimen had been discontinued because of side effects. We randomly assigned the participants to receive bedaquiline for 26 weeks (200 mg daily for 8 weeks, then 100 mg daily for 18 weeks), pretomanid (200 mg daily for 26 weeks), and daily linezolid at a dose of 1200 mg for 26 weeks or 9 weeks or 600 mg for 26 weeks or 9 weeks. The primary end point in the modified intention-to-treat population was the incidence of an unfavorable outcome, defined as treatment failure or disease relapse (clinical or bacteriologic) at 26 weeks after completion of treatment. Safety was also evaluated. RESULTS A total of 181 participants were enrolled, 88% of whom had XDR or pre-XDR tuberculosis. Among participants who received bedaquiline-pretomanid-linezolid with linezolid at a dose of 1200 mg for 26 weeks or 9 weeks or 600 mg for 26 weeks or 9 weeks, 93%, 89%, 91%, and 84%, respectively, had a favorable outcome; peripheral neuropathy occurred in 38%, 24%, 24%, and 13%, respectively; myelosuppression occurred in 22%, 15%, 2%, and 7%, respectively; and the linezolid dose was modified (i.e., interrupted, reduced, or discontinued) in 51%, 30%, 13%, and 13%, respectively. Optic neuropathy developed in 4 participants (9%) who had received linezolid at a dose of 1200 mg for 26 weeks; all the cases resolved. Six of the seven unfavorable microbiologic outcomes through 78 weeks of follow-up occurred in participants assigned to the 9-week linezolid groups. CONCLUSIONS A total of 84 to 93% of the participants across all four bedaquiline-pretomanid-linezolid treatment groups had a favorable outcome. The overall risk-benefit ratio favored the group that received the three-drug regimen with linezolid at a dose of 600 mg for 26 weeks, with a lower incidence of adverse events reported and fewer linezolid dose modifications. (Funded by the TB Alliance and others; ZeNix ClinicalTrials.gov number, NCT03086486.).
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Affiliation(s)
- Francesca Conradie
- From the Clinical HIV Research Unit (F.C., P.H.) and Klerksdorp-Tshepong Hospital Complex, Department of Internal Medicine (E.V.), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, the Clinical HIV Research Unit, King DinuZulu Hospital, Durban (N.N.), and the TB Alliance, Pretoria (M.O.) - all in South Africa; the Central TB Research Institute of the Federal Agency of Scientific Organizations Moscow (T.R.B.), Moscow City Research and Practice Tuberculosis Treatment Center (S.B.), and National Medical Research Center of Phthisiopulmonology and Infectious Diseases (A.S.), Moscow, Ural Research Institute of Phthisiopulmonology, Yekaterinburg (S.S.), and St. Petersburg Research Institute of Phthisiopulmonology, St. Petersburg (P.Y.) - all in Russia; the National Center for Tuberculosis and Lung Disease, Tbilisi, Georgia (L.M.); the Chiril Draganiuc Institute of Phthisiopneumology, Chisinau, Moldova (E.T.); the TB Alliance, New York (D.E., E.S., E.E., M.L., A.H., J.T., S.F., C.M.M., M.S.); and the Medical Research Council Clinical Trials Unit at University College London (G.H.W., A.M.C., S.M.F., C.D.T.) and the University College London Centre for Clinical Microbiology (A.B., R.H., T.D.M.), University College London, London
| | - Tatevik R Bagdasaryan
- From the Clinical HIV Research Unit (F.C., P.H.) and Klerksdorp-Tshepong Hospital Complex, Department of Internal Medicine (E.V.), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, the Clinical HIV Research Unit, King DinuZulu Hospital, Durban (N.N.), and the TB Alliance, Pretoria (M.O.) - all in South Africa; the Central TB Research Institute of the Federal Agency of Scientific Organizations Moscow (T.R.B.), Moscow City Research and Practice Tuberculosis Treatment Center (S.B.), and National Medical Research Center of Phthisiopulmonology and Infectious Diseases (A.S.), Moscow, Ural Research Institute of Phthisiopulmonology, Yekaterinburg (S.S.), and St. Petersburg Research Institute of Phthisiopulmonology, St. Petersburg (P.Y.) - all in Russia; the National Center for Tuberculosis and Lung Disease, Tbilisi, Georgia (L.M.); the Chiril Draganiuc Institute of Phthisiopneumology, Chisinau, Moldova (E.T.); the TB Alliance, New York (D.E., E.S., E.E., M.L., A.H., J.T., S.F., C.M.M., M.S.); and the Medical Research Council Clinical Trials Unit at University College London (G.H.W., A.M.C., S.M.F., C.D.T.) and the University College London Centre for Clinical Microbiology (A.B., R.H., T.D.M.), University College London, London
| | - Sergey Borisov
- From the Clinical HIV Research Unit (F.C., P.H.) and Klerksdorp-Tshepong Hospital Complex, Department of Internal Medicine (E.V.), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, the Clinical HIV Research Unit, King DinuZulu Hospital, Durban (N.N.), and the TB Alliance, Pretoria (M.O.) - all in South Africa; the Central TB Research Institute of the Federal Agency of Scientific Organizations Moscow (T.R.B.), Moscow City Research and Practice Tuberculosis Treatment Center (S.B.), and National Medical Research Center of Phthisiopulmonology and Infectious Diseases (A.S.), Moscow, Ural Research Institute of Phthisiopulmonology, Yekaterinburg (S.S.), and St. Petersburg Research Institute of Phthisiopulmonology, St. Petersburg (P.Y.) - all in Russia; the National Center for Tuberculosis and Lung Disease, Tbilisi, Georgia (L.M.); the Chiril Draganiuc Institute of Phthisiopneumology, Chisinau, Moldova (E.T.); the TB Alliance, New York (D.E., E.S., E.E., M.L., A.H., J.T., S.F., C.M.M., M.S.); and the Medical Research Council Clinical Trials Unit at University College London (G.H.W., A.M.C., S.M.F., C.D.T.) and the University College London Centre for Clinical Microbiology (A.B., R.H., T.D.M.), University College London, London
| | - Pauline Howell
- From the Clinical HIV Research Unit (F.C., P.H.) and Klerksdorp-Tshepong Hospital Complex, Department of Internal Medicine (E.V.), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, the Clinical HIV Research Unit, King DinuZulu Hospital, Durban (N.N.), and the TB Alliance, Pretoria (M.O.) - all in South Africa; the Central TB Research Institute of the Federal Agency of Scientific Organizations Moscow (T.R.B.), Moscow City Research and Practice Tuberculosis Treatment Center (S.B.), and National Medical Research Center of Phthisiopulmonology and Infectious Diseases (A.S.), Moscow, Ural Research Institute of Phthisiopulmonology, Yekaterinburg (S.S.), and St. Petersburg Research Institute of Phthisiopulmonology, St. Petersburg (P.Y.) - all in Russia; the National Center for Tuberculosis and Lung Disease, Tbilisi, Georgia (L.M.); the Chiril Draganiuc Institute of Phthisiopneumology, Chisinau, Moldova (E.T.); the TB Alliance, New York (D.E., E.S., E.E., M.L., A.H., J.T., S.F., C.M.M., M.S.); and the Medical Research Council Clinical Trials Unit at University College London (G.H.W., A.M.C., S.M.F., C.D.T.) and the University College London Centre for Clinical Microbiology (A.B., R.H., T.D.M.), University College London, London
| | - Lali Mikiashvili
- From the Clinical HIV Research Unit (F.C., P.H.) and Klerksdorp-Tshepong Hospital Complex, Department of Internal Medicine (E.V.), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, the Clinical HIV Research Unit, King DinuZulu Hospital, Durban (N.N.), and the TB Alliance, Pretoria (M.O.) - all in South Africa; the Central TB Research Institute of the Federal Agency of Scientific Organizations Moscow (T.R.B.), Moscow City Research and Practice Tuberculosis Treatment Center (S.B.), and National Medical Research Center of Phthisiopulmonology and Infectious Diseases (A.S.), Moscow, Ural Research Institute of Phthisiopulmonology, Yekaterinburg (S.S.), and St. Petersburg Research Institute of Phthisiopulmonology, St. Petersburg (P.Y.) - all in Russia; the National Center for Tuberculosis and Lung Disease, Tbilisi, Georgia (L.M.); the Chiril Draganiuc Institute of Phthisiopneumology, Chisinau, Moldova (E.T.); the TB Alliance, New York (D.E., E.S., E.E., M.L., A.H., J.T., S.F., C.M.M., M.S.); and the Medical Research Council Clinical Trials Unit at University College London (G.H.W., A.M.C., S.M.F., C.D.T.) and the University College London Centre for Clinical Microbiology (A.B., R.H., T.D.M.), University College London, London
| | - Nosipho Ngubane
- From the Clinical HIV Research Unit (F.C., P.H.) and Klerksdorp-Tshepong Hospital Complex, Department of Internal Medicine (E.V.), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, the Clinical HIV Research Unit, King DinuZulu Hospital, Durban (N.N.), and the TB Alliance, Pretoria (M.O.) - all in South Africa; the Central TB Research Institute of the Federal Agency of Scientific Organizations Moscow (T.R.B.), Moscow City Research and Practice Tuberculosis Treatment Center (S.B.), and National Medical Research Center of Phthisiopulmonology and Infectious Diseases (A.S.), Moscow, Ural Research Institute of Phthisiopulmonology, Yekaterinburg (S.S.), and St. Petersburg Research Institute of Phthisiopulmonology, St. Petersburg (P.Y.) - all in Russia; the National Center for Tuberculosis and Lung Disease, Tbilisi, Georgia (L.M.); the Chiril Draganiuc Institute of Phthisiopneumology, Chisinau, Moldova (E.T.); the TB Alliance, New York (D.E., E.S., E.E., M.L., A.H., J.T., S.F., C.M.M., M.S.); and the Medical Research Council Clinical Trials Unit at University College London (G.H.W., A.M.C., S.M.F., C.D.T.) and the University College London Centre for Clinical Microbiology (A.B., R.H., T.D.M.), University College London, London
| | - Anastasia Samoilova
- From the Clinical HIV Research Unit (F.C., P.H.) and Klerksdorp-Tshepong Hospital Complex, Department of Internal Medicine (E.V.), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, the Clinical HIV Research Unit, King DinuZulu Hospital, Durban (N.N.), and the TB Alliance, Pretoria (M.O.) - all in South Africa; the Central TB Research Institute of the Federal Agency of Scientific Organizations Moscow (T.R.B.), Moscow City Research and Practice Tuberculosis Treatment Center (S.B.), and National Medical Research Center of Phthisiopulmonology and Infectious Diseases (A.S.), Moscow, Ural Research Institute of Phthisiopulmonology, Yekaterinburg (S.S.), and St. Petersburg Research Institute of Phthisiopulmonology, St. Petersburg (P.Y.) - all in Russia; the National Center for Tuberculosis and Lung Disease, Tbilisi, Georgia (L.M.); the Chiril Draganiuc Institute of Phthisiopneumology, Chisinau, Moldova (E.T.); the TB Alliance, New York (D.E., E.S., E.E., M.L., A.H., J.T., S.F., C.M.M., M.S.); and the Medical Research Council Clinical Trials Unit at University College London (G.H.W., A.M.C., S.M.F., C.D.T.) and the University College London Centre for Clinical Microbiology (A.B., R.H., T.D.M.), University College London, London
| | - Sergey Skornykova
- From the Clinical HIV Research Unit (F.C., P.H.) and Klerksdorp-Tshepong Hospital Complex, Department of Internal Medicine (E.V.), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, the Clinical HIV Research Unit, King DinuZulu Hospital, Durban (N.N.), and the TB Alliance, Pretoria (M.O.) - all in South Africa; the Central TB Research Institute of the Federal Agency of Scientific Organizations Moscow (T.R.B.), Moscow City Research and Practice Tuberculosis Treatment Center (S.B.), and National Medical Research Center of Phthisiopulmonology and Infectious Diseases (A.S.), Moscow, Ural Research Institute of Phthisiopulmonology, Yekaterinburg (S.S.), and St. Petersburg Research Institute of Phthisiopulmonology, St. Petersburg (P.Y.) - all in Russia; the National Center for Tuberculosis and Lung Disease, Tbilisi, Georgia (L.M.); the Chiril Draganiuc Institute of Phthisiopneumology, Chisinau, Moldova (E.T.); the TB Alliance, New York (D.E., E.S., E.E., M.L., A.H., J.T., S.F., C.M.M., M.S.); and the Medical Research Council Clinical Trials Unit at University College London (G.H.W., A.M.C., S.M.F., C.D.T.) and the University College London Centre for Clinical Microbiology (A.B., R.H., T.D.M.), University College London, London
| | - Elena Tudor
- From the Clinical HIV Research Unit (F.C., P.H.) and Klerksdorp-Tshepong Hospital Complex, Department of Internal Medicine (E.V.), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, the Clinical HIV Research Unit, King DinuZulu Hospital, Durban (N.N.), and the TB Alliance, Pretoria (M.O.) - all in South Africa; the Central TB Research Institute of the Federal Agency of Scientific Organizations Moscow (T.R.B.), Moscow City Research and Practice Tuberculosis Treatment Center (S.B.), and National Medical Research Center of Phthisiopulmonology and Infectious Diseases (A.S.), Moscow, Ural Research Institute of Phthisiopulmonology, Yekaterinburg (S.S.), and St. Petersburg Research Institute of Phthisiopulmonology, St. Petersburg (P.Y.) - all in Russia; the National Center for Tuberculosis and Lung Disease, Tbilisi, Georgia (L.M.); the Chiril Draganiuc Institute of Phthisiopneumology, Chisinau, Moldova (E.T.); the TB Alliance, New York (D.E., E.S., E.E., M.L., A.H., J.T., S.F., C.M.M., M.S.); and the Medical Research Council Clinical Trials Unit at University College London (G.H.W., A.M.C., S.M.F., C.D.T.) and the University College London Centre for Clinical Microbiology (A.B., R.H., T.D.M.), University College London, London
| | - Ebrahim Variava
- From the Clinical HIV Research Unit (F.C., P.H.) and Klerksdorp-Tshepong Hospital Complex, Department of Internal Medicine (E.V.), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, the Clinical HIV Research Unit, King DinuZulu Hospital, Durban (N.N.), and the TB Alliance, Pretoria (M.O.) - all in South Africa; the Central TB Research Institute of the Federal Agency of Scientific Organizations Moscow (T.R.B.), Moscow City Research and Practice Tuberculosis Treatment Center (S.B.), and National Medical Research Center of Phthisiopulmonology and Infectious Diseases (A.S.), Moscow, Ural Research Institute of Phthisiopulmonology, Yekaterinburg (S.S.), and St. Petersburg Research Institute of Phthisiopulmonology, St. Petersburg (P.Y.) - all in Russia; the National Center for Tuberculosis and Lung Disease, Tbilisi, Georgia (L.M.); the Chiril Draganiuc Institute of Phthisiopneumology, Chisinau, Moldova (E.T.); the TB Alliance, New York (D.E., E.S., E.E., M.L., A.H., J.T., S.F., C.M.M., M.S.); and the Medical Research Council Clinical Trials Unit at University College London (G.H.W., A.M.C., S.M.F., C.D.T.) and the University College London Centre for Clinical Microbiology (A.B., R.H., T.D.M.), University College London, London
| | - Petr Yablonskiy
- From the Clinical HIV Research Unit (F.C., P.H.) and Klerksdorp-Tshepong Hospital Complex, Department of Internal Medicine (E.V.), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, the Clinical HIV Research Unit, King DinuZulu Hospital, Durban (N.N.), and the TB Alliance, Pretoria (M.O.) - all in South Africa; the Central TB Research Institute of the Federal Agency of Scientific Organizations Moscow (T.R.B.), Moscow City Research and Practice Tuberculosis Treatment Center (S.B.), and National Medical Research Center of Phthisiopulmonology and Infectious Diseases (A.S.), Moscow, Ural Research Institute of Phthisiopulmonology, Yekaterinburg (S.S.), and St. Petersburg Research Institute of Phthisiopulmonology, St. Petersburg (P.Y.) - all in Russia; the National Center for Tuberculosis and Lung Disease, Tbilisi, Georgia (L.M.); the Chiril Draganiuc Institute of Phthisiopneumology, Chisinau, Moldova (E.T.); the TB Alliance, New York (D.E., E.S., E.E., M.L., A.H., J.T., S.F., C.M.M., M.S.); and the Medical Research Council Clinical Trials Unit at University College London (G.H.W., A.M.C., S.M.F., C.D.T.) and the University College London Centre for Clinical Microbiology (A.B., R.H., T.D.M.), University College London, London
| | - Daniel Everitt
- From the Clinical HIV Research Unit (F.C., P.H.) and Klerksdorp-Tshepong Hospital Complex, Department of Internal Medicine (E.V.), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, the Clinical HIV Research Unit, King DinuZulu Hospital, Durban (N.N.), and the TB Alliance, Pretoria (M.O.) - all in South Africa; the Central TB Research Institute of the Federal Agency of Scientific Organizations Moscow (T.R.B.), Moscow City Research and Practice Tuberculosis Treatment Center (S.B.), and National Medical Research Center of Phthisiopulmonology and Infectious Diseases (A.S.), Moscow, Ural Research Institute of Phthisiopulmonology, Yekaterinburg (S.S.), and St. Petersburg Research Institute of Phthisiopulmonology, St. Petersburg (P.Y.) - all in Russia; the National Center for Tuberculosis and Lung Disease, Tbilisi, Georgia (L.M.); the Chiril Draganiuc Institute of Phthisiopneumology, Chisinau, Moldova (E.T.); the TB Alliance, New York (D.E., E.S., E.E., M.L., A.H., J.T., S.F., C.M.M., M.S.); and the Medical Research Council Clinical Trials Unit at University College London (G.H.W., A.M.C., S.M.F., C.D.T.) and the University College London Centre for Clinical Microbiology (A.B., R.H., T.D.M.), University College London, London
| | - Genevieve H Wills
- From the Clinical HIV Research Unit (F.C., P.H.) and Klerksdorp-Tshepong Hospital Complex, Department of Internal Medicine (E.V.), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, the Clinical HIV Research Unit, King DinuZulu Hospital, Durban (N.N.), and the TB Alliance, Pretoria (M.O.) - all in South Africa; the Central TB Research Institute of the Federal Agency of Scientific Organizations Moscow (T.R.B.), Moscow City Research and Practice Tuberculosis Treatment Center (S.B.), and National Medical Research Center of Phthisiopulmonology and Infectious Diseases (A.S.), Moscow, Ural Research Institute of Phthisiopulmonology, Yekaterinburg (S.S.), and St. Petersburg Research Institute of Phthisiopulmonology, St. Petersburg (P.Y.) - all in Russia; the National Center for Tuberculosis and Lung Disease, Tbilisi, Georgia (L.M.); the Chiril Draganiuc Institute of Phthisiopneumology, Chisinau, Moldova (E.T.); the TB Alliance, New York (D.E., E.S., E.E., M.L., A.H., J.T., S.F., C.M.M., M.S.); and the Medical Research Council Clinical Trials Unit at University College London (G.H.W., A.M.C., S.M.F., C.D.T.) and the University College London Centre for Clinical Microbiology (A.B., R.H., T.D.M.), University College London, London
| | - Eugene Sun
- From the Clinical HIV Research Unit (F.C., P.H.) and Klerksdorp-Tshepong Hospital Complex, Department of Internal Medicine (E.V.), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, the Clinical HIV Research Unit, King DinuZulu Hospital, Durban (N.N.), and the TB Alliance, Pretoria (M.O.) - all in South Africa; the Central TB Research Institute of the Federal Agency of Scientific Organizations Moscow (T.R.B.), Moscow City Research and Practice Tuberculosis Treatment Center (S.B.), and National Medical Research Center of Phthisiopulmonology and Infectious Diseases (A.S.), Moscow, Ural Research Institute of Phthisiopulmonology, Yekaterinburg (S.S.), and St. Petersburg Research Institute of Phthisiopulmonology, St. Petersburg (P.Y.) - all in Russia; the National Center for Tuberculosis and Lung Disease, Tbilisi, Georgia (L.M.); the Chiril Draganiuc Institute of Phthisiopneumology, Chisinau, Moldova (E.T.); the TB Alliance, New York (D.E., E.S., E.E., M.L., A.H., J.T., S.F., C.M.M., M.S.); and the Medical Research Council Clinical Trials Unit at University College London (G.H.W., A.M.C., S.M.F., C.D.T.) and the University College London Centre for Clinical Microbiology (A.B., R.H., T.D.M.), University College London, London
| | - Morounfolu Olugbosi
- From the Clinical HIV Research Unit (F.C., P.H.) and Klerksdorp-Tshepong Hospital Complex, Department of Internal Medicine (E.V.), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, the Clinical HIV Research Unit, King DinuZulu Hospital, Durban (N.N.), and the TB Alliance, Pretoria (M.O.) - all in South Africa; the Central TB Research Institute of the Federal Agency of Scientific Organizations Moscow (T.R.B.), Moscow City Research and Practice Tuberculosis Treatment Center (S.B.), and National Medical Research Center of Phthisiopulmonology and Infectious Diseases (A.S.), Moscow, Ural Research Institute of Phthisiopulmonology, Yekaterinburg (S.S.), and St. Petersburg Research Institute of Phthisiopulmonology, St. Petersburg (P.Y.) - all in Russia; the National Center for Tuberculosis and Lung Disease, Tbilisi, Georgia (L.M.); the Chiril Draganiuc Institute of Phthisiopneumology, Chisinau, Moldova (E.T.); the TB Alliance, New York (D.E., E.S., E.E., M.L., A.H., J.T., S.F., C.M.M., M.S.); and the Medical Research Council Clinical Trials Unit at University College London (G.H.W., A.M.C., S.M.F., C.D.T.) and the University College London Centre for Clinical Microbiology (A.B., R.H., T.D.M.), University College London, London
| | - Erica Egizi
- From the Clinical HIV Research Unit (F.C., P.H.) and Klerksdorp-Tshepong Hospital Complex, Department of Internal Medicine (E.V.), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, the Clinical HIV Research Unit, King DinuZulu Hospital, Durban (N.N.), and the TB Alliance, Pretoria (M.O.) - all in South Africa; the Central TB Research Institute of the Federal Agency of Scientific Organizations Moscow (T.R.B.), Moscow City Research and Practice Tuberculosis Treatment Center (S.B.), and National Medical Research Center of Phthisiopulmonology and Infectious Diseases (A.S.), Moscow, Ural Research Institute of Phthisiopulmonology, Yekaterinburg (S.S.), and St. Petersburg Research Institute of Phthisiopulmonology, St. Petersburg (P.Y.) - all in Russia; the National Center for Tuberculosis and Lung Disease, Tbilisi, Georgia (L.M.); the Chiril Draganiuc Institute of Phthisiopneumology, Chisinau, Moldova (E.T.); the TB Alliance, New York (D.E., E.S., E.E., M.L., A.H., J.T., S.F., C.M.M., M.S.); and the Medical Research Council Clinical Trials Unit at University College London (G.H.W., A.M.C., S.M.F., C.D.T.) and the University College London Centre for Clinical Microbiology (A.B., R.H., T.D.M.), University College London, London
| | - Mengchun Li
- From the Clinical HIV Research Unit (F.C., P.H.) and Klerksdorp-Tshepong Hospital Complex, Department of Internal Medicine (E.V.), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, the Clinical HIV Research Unit, King DinuZulu Hospital, Durban (N.N.), and the TB Alliance, Pretoria (M.O.) - all in South Africa; the Central TB Research Institute of the Federal Agency of Scientific Organizations Moscow (T.R.B.), Moscow City Research and Practice Tuberculosis Treatment Center (S.B.), and National Medical Research Center of Phthisiopulmonology and Infectious Diseases (A.S.), Moscow, Ural Research Institute of Phthisiopulmonology, Yekaterinburg (S.S.), and St. Petersburg Research Institute of Phthisiopulmonology, St. Petersburg (P.Y.) - all in Russia; the National Center for Tuberculosis and Lung Disease, Tbilisi, Georgia (L.M.); the Chiril Draganiuc Institute of Phthisiopneumology, Chisinau, Moldova (E.T.); the TB Alliance, New York (D.E., E.S., E.E., M.L., A.H., J.T., S.F., C.M.M., M.S.); and the Medical Research Council Clinical Trials Unit at University College London (G.H.W., A.M.C., S.M.F., C.D.T.) and the University College London Centre for Clinical Microbiology (A.B., R.H., T.D.M.), University College London, London
| | - Alda Holsta
- From the Clinical HIV Research Unit (F.C., P.H.) and Klerksdorp-Tshepong Hospital Complex, Department of Internal Medicine (E.V.), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, the Clinical HIV Research Unit, King DinuZulu Hospital, Durban (N.N.), and the TB Alliance, Pretoria (M.O.) - all in South Africa; the Central TB Research Institute of the Federal Agency of Scientific Organizations Moscow (T.R.B.), Moscow City Research and Practice Tuberculosis Treatment Center (S.B.), and National Medical Research Center of Phthisiopulmonology and Infectious Diseases (A.S.), Moscow, Ural Research Institute of Phthisiopulmonology, Yekaterinburg (S.S.), and St. Petersburg Research Institute of Phthisiopulmonology, St. Petersburg (P.Y.) - all in Russia; the National Center for Tuberculosis and Lung Disease, Tbilisi, Georgia (L.M.); the Chiril Draganiuc Institute of Phthisiopneumology, Chisinau, Moldova (E.T.); the TB Alliance, New York (D.E., E.S., E.E., M.L., A.H., J.T., S.F., C.M.M., M.S.); and the Medical Research Council Clinical Trials Unit at University College London (G.H.W., A.M.C., S.M.F., C.D.T.) and the University College London Centre for Clinical Microbiology (A.B., R.H., T.D.M.), University College London, London
| | - Juliano Timm
- From the Clinical HIV Research Unit (F.C., P.H.) and Klerksdorp-Tshepong Hospital Complex, Department of Internal Medicine (E.V.), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, the Clinical HIV Research Unit, King DinuZulu Hospital, Durban (N.N.), and the TB Alliance, Pretoria (M.O.) - all in South Africa; the Central TB Research Institute of the Federal Agency of Scientific Organizations Moscow (T.R.B.), Moscow City Research and Practice Tuberculosis Treatment Center (S.B.), and National Medical Research Center of Phthisiopulmonology and Infectious Diseases (A.S.), Moscow, Ural Research Institute of Phthisiopulmonology, Yekaterinburg (S.S.), and St. Petersburg Research Institute of Phthisiopulmonology, St. Petersburg (P.Y.) - all in Russia; the National Center for Tuberculosis and Lung Disease, Tbilisi, Georgia (L.M.); the Chiril Draganiuc Institute of Phthisiopneumology, Chisinau, Moldova (E.T.); the TB Alliance, New York (D.E., E.S., E.E., M.L., A.H., J.T., S.F., C.M.M., M.S.); and the Medical Research Council Clinical Trials Unit at University College London (G.H.W., A.M.C., S.M.F., C.D.T.) and the University College London Centre for Clinical Microbiology (A.B., R.H., T.D.M.), University College London, London
| | - Anna Bateson
- From the Clinical HIV Research Unit (F.C., P.H.) and Klerksdorp-Tshepong Hospital Complex, Department of Internal Medicine (E.V.), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, the Clinical HIV Research Unit, King DinuZulu Hospital, Durban (N.N.), and the TB Alliance, Pretoria (M.O.) - all in South Africa; the Central TB Research Institute of the Federal Agency of Scientific Organizations Moscow (T.R.B.), Moscow City Research and Practice Tuberculosis Treatment Center (S.B.), and National Medical Research Center of Phthisiopulmonology and Infectious Diseases (A.S.), Moscow, Ural Research Institute of Phthisiopulmonology, Yekaterinburg (S.S.), and St. Petersburg Research Institute of Phthisiopulmonology, St. Petersburg (P.Y.) - all in Russia; the National Center for Tuberculosis and Lung Disease, Tbilisi, Georgia (L.M.); the Chiril Draganiuc Institute of Phthisiopneumology, Chisinau, Moldova (E.T.); the TB Alliance, New York (D.E., E.S., E.E., M.L., A.H., J.T., S.F., C.M.M., M.S.); and the Medical Research Council Clinical Trials Unit at University College London (G.H.W., A.M.C., S.M.F., C.D.T.) and the University College London Centre for Clinical Microbiology (A.B., R.H., T.D.M.), University College London, London
| | - Angela M Crook
- From the Clinical HIV Research Unit (F.C., P.H.) and Klerksdorp-Tshepong Hospital Complex, Department of Internal Medicine (E.V.), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, the Clinical HIV Research Unit, King DinuZulu Hospital, Durban (N.N.), and the TB Alliance, Pretoria (M.O.) - all in South Africa; the Central TB Research Institute of the Federal Agency of Scientific Organizations Moscow (T.R.B.), Moscow City Research and Practice Tuberculosis Treatment Center (S.B.), and National Medical Research Center of Phthisiopulmonology and Infectious Diseases (A.S.), Moscow, Ural Research Institute of Phthisiopulmonology, Yekaterinburg (S.S.), and St. Petersburg Research Institute of Phthisiopulmonology, St. Petersburg (P.Y.) - all in Russia; the National Center for Tuberculosis and Lung Disease, Tbilisi, Georgia (L.M.); the Chiril Draganiuc Institute of Phthisiopneumology, Chisinau, Moldova (E.T.); the TB Alliance, New York (D.E., E.S., E.E., M.L., A.H., J.T., S.F., C.M.M., M.S.); and the Medical Research Council Clinical Trials Unit at University College London (G.H.W., A.M.C., S.M.F., C.D.T.) and the University College London Centre for Clinical Microbiology (A.B., R.H., T.D.M.), University College London, London
| | - Stella M Fabiane
- From the Clinical HIV Research Unit (F.C., P.H.) and Klerksdorp-Tshepong Hospital Complex, Department of Internal Medicine (E.V.), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, the Clinical HIV Research Unit, King DinuZulu Hospital, Durban (N.N.), and the TB Alliance, Pretoria (M.O.) - all in South Africa; the Central TB Research Institute of the Federal Agency of Scientific Organizations Moscow (T.R.B.), Moscow City Research and Practice Tuberculosis Treatment Center (S.B.), and National Medical Research Center of Phthisiopulmonology and Infectious Diseases (A.S.), Moscow, Ural Research Institute of Phthisiopulmonology, Yekaterinburg (S.S.), and St. Petersburg Research Institute of Phthisiopulmonology, St. Petersburg (P.Y.) - all in Russia; the National Center for Tuberculosis and Lung Disease, Tbilisi, Georgia (L.M.); the Chiril Draganiuc Institute of Phthisiopneumology, Chisinau, Moldova (E.T.); the TB Alliance, New York (D.E., E.S., E.E., M.L., A.H., J.T., S.F., C.M.M., M.S.); and the Medical Research Council Clinical Trials Unit at University College London (G.H.W., A.M.C., S.M.F., C.D.T.) and the University College London Centre for Clinical Microbiology (A.B., R.H., T.D.M.), University College London, London
| | - Robert Hunt
- From the Clinical HIV Research Unit (F.C., P.H.) and Klerksdorp-Tshepong Hospital Complex, Department of Internal Medicine (E.V.), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, the Clinical HIV Research Unit, King DinuZulu Hospital, Durban (N.N.), and the TB Alliance, Pretoria (M.O.) - all in South Africa; the Central TB Research Institute of the Federal Agency of Scientific Organizations Moscow (T.R.B.), Moscow City Research and Practice Tuberculosis Treatment Center (S.B.), and National Medical Research Center of Phthisiopulmonology and Infectious Diseases (A.S.), Moscow, Ural Research Institute of Phthisiopulmonology, Yekaterinburg (S.S.), and St. Petersburg Research Institute of Phthisiopulmonology, St. Petersburg (P.Y.) - all in Russia; the National Center for Tuberculosis and Lung Disease, Tbilisi, Georgia (L.M.); the Chiril Draganiuc Institute of Phthisiopneumology, Chisinau, Moldova (E.T.); the TB Alliance, New York (D.E., E.S., E.E., M.L., A.H., J.T., S.F., C.M.M., M.S.); and the Medical Research Council Clinical Trials Unit at University College London (G.H.W., A.M.C., S.M.F., C.D.T.) and the University College London Centre for Clinical Microbiology (A.B., R.H., T.D.M.), University College London, London
| | - Timothy D McHugh
- From the Clinical HIV Research Unit (F.C., P.H.) and Klerksdorp-Tshepong Hospital Complex, Department of Internal Medicine (E.V.), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, the Clinical HIV Research Unit, King DinuZulu Hospital, Durban (N.N.), and the TB Alliance, Pretoria (M.O.) - all in South Africa; the Central TB Research Institute of the Federal Agency of Scientific Organizations Moscow (T.R.B.), Moscow City Research and Practice Tuberculosis Treatment Center (S.B.), and National Medical Research Center of Phthisiopulmonology and Infectious Diseases (A.S.), Moscow, Ural Research Institute of Phthisiopulmonology, Yekaterinburg (S.S.), and St. Petersburg Research Institute of Phthisiopulmonology, St. Petersburg (P.Y.) - all in Russia; the National Center for Tuberculosis and Lung Disease, Tbilisi, Georgia (L.M.); the Chiril Draganiuc Institute of Phthisiopneumology, Chisinau, Moldova (E.T.); the TB Alliance, New York (D.E., E.S., E.E., M.L., A.H., J.T., S.F., C.M.M., M.S.); and the Medical Research Council Clinical Trials Unit at University College London (G.H.W., A.M.C., S.M.F., C.D.T.) and the University College London Centre for Clinical Microbiology (A.B., R.H., T.D.M.), University College London, London
| | - Conor D Tweed
- From the Clinical HIV Research Unit (F.C., P.H.) and Klerksdorp-Tshepong Hospital Complex, Department of Internal Medicine (E.V.), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, the Clinical HIV Research Unit, King DinuZulu Hospital, Durban (N.N.), and the TB Alliance, Pretoria (M.O.) - all in South Africa; the Central TB Research Institute of the Federal Agency of Scientific Organizations Moscow (T.R.B.), Moscow City Research and Practice Tuberculosis Treatment Center (S.B.), and National Medical Research Center of Phthisiopulmonology and Infectious Diseases (A.S.), Moscow, Ural Research Institute of Phthisiopulmonology, Yekaterinburg (S.S.), and St. Petersburg Research Institute of Phthisiopulmonology, St. Petersburg (P.Y.) - all in Russia; the National Center for Tuberculosis and Lung Disease, Tbilisi, Georgia (L.M.); the Chiril Draganiuc Institute of Phthisiopneumology, Chisinau, Moldova (E.T.); the TB Alliance, New York (D.E., E.S., E.E., M.L., A.H., J.T., S.F., C.M.M., M.S.); and the Medical Research Council Clinical Trials Unit at University College London (G.H.W., A.M.C., S.M.F., C.D.T.) and the University College London Centre for Clinical Microbiology (A.B., R.H., T.D.M.), University College London, London
| | - Salah Foraida
- From the Clinical HIV Research Unit (F.C., P.H.) and Klerksdorp-Tshepong Hospital Complex, Department of Internal Medicine (E.V.), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, the Clinical HIV Research Unit, King DinuZulu Hospital, Durban (N.N.), and the TB Alliance, Pretoria (M.O.) - all in South Africa; the Central TB Research Institute of the Federal Agency of Scientific Organizations Moscow (T.R.B.), Moscow City Research and Practice Tuberculosis Treatment Center (S.B.), and National Medical Research Center of Phthisiopulmonology and Infectious Diseases (A.S.), Moscow, Ural Research Institute of Phthisiopulmonology, Yekaterinburg (S.S.), and St. Petersburg Research Institute of Phthisiopulmonology, St. Petersburg (P.Y.) - all in Russia; the National Center for Tuberculosis and Lung Disease, Tbilisi, Georgia (L.M.); the Chiril Draganiuc Institute of Phthisiopneumology, Chisinau, Moldova (E.T.); the TB Alliance, New York (D.E., E.S., E.E., M.L., A.H., J.T., S.F., C.M.M., M.S.); and the Medical Research Council Clinical Trials Unit at University College London (G.H.W., A.M.C., S.M.F., C.D.T.) and the University College London Centre for Clinical Microbiology (A.B., R.H., T.D.M.), University College London, London
| | - Carl M Mendel
- From the Clinical HIV Research Unit (F.C., P.H.) and Klerksdorp-Tshepong Hospital Complex, Department of Internal Medicine (E.V.), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, the Clinical HIV Research Unit, King DinuZulu Hospital, Durban (N.N.), and the TB Alliance, Pretoria (M.O.) - all in South Africa; the Central TB Research Institute of the Federal Agency of Scientific Organizations Moscow (T.R.B.), Moscow City Research and Practice Tuberculosis Treatment Center (S.B.), and National Medical Research Center of Phthisiopulmonology and Infectious Diseases (A.S.), Moscow, Ural Research Institute of Phthisiopulmonology, Yekaterinburg (S.S.), and St. Petersburg Research Institute of Phthisiopulmonology, St. Petersburg (P.Y.) - all in Russia; the National Center for Tuberculosis and Lung Disease, Tbilisi, Georgia (L.M.); the Chiril Draganiuc Institute of Phthisiopneumology, Chisinau, Moldova (E.T.); the TB Alliance, New York (D.E., E.S., E.E., M.L., A.H., J.T., S.F., C.M.M., M.S.); and the Medical Research Council Clinical Trials Unit at University College London (G.H.W., A.M.C., S.M.F., C.D.T.) and the University College London Centre for Clinical Microbiology (A.B., R.H., T.D.M.), University College London, London
| | - Melvin Spigelman
- From the Clinical HIV Research Unit (F.C., P.H.) and Klerksdorp-Tshepong Hospital Complex, Department of Internal Medicine (E.V.), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, the Clinical HIV Research Unit, King DinuZulu Hospital, Durban (N.N.), and the TB Alliance, Pretoria (M.O.) - all in South Africa; the Central TB Research Institute of the Federal Agency of Scientific Organizations Moscow (T.R.B.), Moscow City Research and Practice Tuberculosis Treatment Center (S.B.), and National Medical Research Center of Phthisiopulmonology and Infectious Diseases (A.S.), Moscow, Ural Research Institute of Phthisiopulmonology, Yekaterinburg (S.S.), and St. Petersburg Research Institute of Phthisiopulmonology, St. Petersburg (P.Y.) - all in Russia; the National Center for Tuberculosis and Lung Disease, Tbilisi, Georgia (L.M.); the Chiril Draganiuc Institute of Phthisiopneumology, Chisinau, Moldova (E.T.); the TB Alliance, New York (D.E., E.S., E.E., M.L., A.H., J.T., S.F., C.M.M., M.S.); and the Medical Research Council Clinical Trials Unit at University College London (G.H.W., A.M.C., S.M.F., C.D.T.) and the University College London Centre for Clinical Microbiology (A.B., R.H., T.D.M.), University College London, London
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Verma N, Arora V, Awasthi R, Chan Y, Jha NK, Thapa K, Jawaid T, Kamal M, Gupta G, Liu G, Paudel KR, Hansbro PM, George Oliver BG, Singh SK, Chellappan DK, Dureja H, Dua K. Recent developments, challenges and future prospects in advanced drug delivery systems in the management of tuberculosis. J Drug Deliv Sci Technol 2022. [DOI: 10.1016/j.jddst.2022.103690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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19
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Huang T, Zeng M, Fu H, Zhao K, Song T, Guo Y, Zhou J, Zhai L, Liu C, Prithiviraj B, Wang X, Chu Y. A novel antibiotic combination of linezolid and polymyxin B octapeptide PBOP against clinical Pseudomonas aeruginosa strains. Ann Clin Microbiol Antimicrob 2022; 21:38. [PMID: 36038932 PMCID: PMC9422153 DOI: 10.1186/s12941-022-00531-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 08/17/2022] [Indexed: 11/25/2022] Open
Abstract
Background Antibiotic-resistant Gram-negative bacteria are becoming a major public health threat such as the important opportunistic pathogen Pseudomonas aeruginosa (P. aeruginosa). The present study investigated enhancement of the linezolid spectrum, which is normally used to treat Gram-positive bacteria, at inhibiting P. aeruginosa growth. Methods The checkerboard test or time-kill assay were carried out to determine the antibacterial effects of linezolid in cooperation with polymyxin B octapeptide PBOP (LP) against P. aeruginosa based on in vitro model. The protective effect of LP against P. aeruginosa infection was assessed based on a Caenorhabditis elegans (C. elegans) model. Results The synergistic activity and antibacterial effects were significantly increased against P. aeruginosa by LP treatment, while linezolid and PBOP as monotherapies exhibited no remarkably bactericidal activity against the clinical strains. Additionally, LP treatment modified biofilm production, morphology, swimming motility of P. aeruginosa, and protected C. elegans from P. aeruginosa infection. Conclusions This research demonstrates that LP combination has significant synergistic activity against P. aeruginosa, and PBOP is potential to be an activity enhancer. Notably, this strategy improved the antibacterial activity spectrum of linezolid and other anti-Gram-positive agents and represents an effective choice to surmount the antibiotic resistance of bacteria in the long term. Supplementary Information The online version contains supplementary material available at 10.1186/s12941-022-00531-5.
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Affiliation(s)
- Ting Huang
- Antibiotics Research and Re-Evaluation Key Laboratory of Sichuan Province, School of Pharmacy, Chengdu University, Chengdu, 610052, Sichuan, China
| | - Mao Zeng
- Antibiotics Research and Re-Evaluation Key Laboratory of Sichuan Province, School of Pharmacy, Chengdu University, Chengdu, 610052, Sichuan, China
| | - Huiyao Fu
- Antibiotics Research and Re-Evaluation Key Laboratory of Sichuan Province, School of Pharmacy, Chengdu University, Chengdu, 610052, Sichuan, China
| | - Kelei Zhao
- Antibiotics Research and Re-Evaluation Key Laboratory of Sichuan Province, School of Pharmacy, Chengdu University, Chengdu, 610052, Sichuan, China
| | - Tao Song
- Antibiotics Research and Re-Evaluation Key Laboratory of Sichuan Province, School of Pharmacy, Chengdu University, Chengdu, 610052, Sichuan, China
| | - Yidong Guo
- Antibiotics Research and Re-Evaluation Key Laboratory of Sichuan Province, School of Pharmacy, Chengdu University, Chengdu, 610052, Sichuan, China
| | - Jingyu Zhou
- Department of Chemistry and Biochemistry, University of California, San Diego, La Jolla, CA, 92093, USA
| | - Longfei Zhai
- Antibiotics Research and Re-Evaluation Key Laboratory of Sichuan Province, School of Pharmacy, Chengdu University, Chengdu, 610052, Sichuan, China
| | - Chaolan Liu
- Antibiotics Research and Re-Evaluation Key Laboratory of Sichuan Province, School of Pharmacy, Chengdu University, Chengdu, 610052, Sichuan, China
| | - Balakrishnan Prithiviraj
- Marine Bio-Products Research Laboratory, Department of Plant, Food and Environmental Sciences, Dalhousie University, Truro, NS, B2N 5E3, Canada
| | - Xinrong Wang
- Antibiotics Research and Re-Evaluation Key Laboratory of Sichuan Province, School of Pharmacy, Chengdu University, Chengdu, 610052, Sichuan, China.
| | - Yiwen Chu
- Antibiotics Research and Re-Evaluation Key Laboratory of Sichuan Province, School of Pharmacy, Chengdu University, Chengdu, 610052, Sichuan, China.
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20
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Recent advances in oxazolidinones as antituberculosis agents. Future Med Chem 2022; 14:1149-1165. [PMID: 35866418 DOI: 10.4155/fmc-2022-0079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Tuberculosis (TB) is an infectious and fatal disease caused by Mycobacterium tuberculosis (Mtb) and remains a serious public health threat; therefore, the development of new antitubercular agents is a priority for the World Health Organization's End TB strategy and the United Nations' Sustainable Development Goals to eradicate TB. Oxazolidinones are a class of synthetic antibacterial agents with a distinct mode of action developed for the treatment of Gram-positive bacterial infections. Many oxazolidinones exhibit good activity against Mtb, and some are currently in clinical trials for multidrug-resistant TB and extensively drug-resistant TB therapy. In this review, the mechanism of action, activity and toxicity of oxazolidinones and recent progress in the research and development of oxazolidinones as anti-TB agents are summarized.
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El-Gaml RM, El-Khodary NM, Abozahra RR, El-Tayar AA, El-Masry SM. Applying pharmacokinetic/pharmacodynamic measurements for linezolid in critically ill patients: optimizing efficacy and reducing resistance occurrence. Eur J Clin Pharmacol 2022; 78:1301-1310. [PMID: 35610318 PMCID: PMC9283351 DOI: 10.1007/s00228-022-03340-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 05/17/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Linezolid (LZD) levels are frequently insufficient in intensive care unit (ICU) patients receiving standard dose, which is predictive of a poor prognosis. Alternative dosing regimens are suggested to address these insufficient levels, which are substantial factors contributing to the emergence of multidrug-resistant bacteria, resulting in increased morbidity and mortality among people who are critically ill. METHODS Forty-eight patients admitted to the intensive care unit were enrolled in an open-label, prospective, randomized study and assigned to one of three LZD administration modes: intermittent groupI (GpI) (600 mg/12 h), continuous infusion groupII (GpII) (1200 mg/24 h) or continuous infusion with loading dose groupIII (GpIII) (on Day 1, 300 mg intravenously plus 900 mg continuous infusion, followed by 1200 mg/24 h on Day 2). We evaluated serum levels of LZD using a validated ultra-performance liquid chromatography (UPLC) technique. RESULTS Time spent with a drug concentration more than 85% over the minimum inhibitory concentration (T > MIC) was substantially more common in GpII and III than in GpI (P < 0.01). AUC/MIC values greater than 80 were obtained more frequently with continuous infusion GpIII and GpII than with intermittent infusion GpI, at 62.5%, 37.5% and 25%, respectively (P < 0.01). In GpI, the mortality rate was significantly higher than in the other groups. CONCLUSION In critically ill patients, continuous infusion with a loading dose (GpIII) is obviously superior to continuous infusion without a loading dose (GpII) or intermittent infusion (GpI) for infection therapy. Additionally, it might limit fluctuations in plasma concentrations, which may help overcome LZD resistance.
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Affiliation(s)
- Rasha M El-Gaml
- Department of Clinical Pharmacy & Pharmacy Practice, Faculty of Pharmacy, Damanhour University, Damanhour City, Egypt
| | - Noha M El-Khodary
- Department of Clinical Pharmacy, Faculty of Pharmacy, Kafrelsheikh University, Kafrelsheikh City, Egypt.
| | - Rania R Abozahra
- Department of Microbiology and Immunology, Faculty of Pharmacy, Damanhour University, Damanhour City, Egypt
| | - Ayman A El-Tayar
- Intensive Care Unit, Damanhour National Medical Instititue, Damanhour City, Egypt
| | - Soha M El-Masry
- Department of Pharmaceutics, Faculty of Pharmacy, Damanhour University, Damanhour City, Egypt
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22
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Huang T, Lv Z, Lin J, Zhao K, Zhai L, Wang X, Chu Y. A Potent Antibiotic Combination of Linezolid and Polymycin B Nonapeptide Against Klebsiella pneumoniae Infection In Vitro and In Vivo. Front Pharmacol 2022; 13:887941. [PMID: 35559242 PMCID: PMC9086963 DOI: 10.3389/fphar.2022.887941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 03/30/2022] [Indexed: 11/30/2022] Open
Abstract
The emergence of antibiotic resistant Gram-negative bacteria such as Klebsiella pneumoniae (KP) is becoming a major public health threat and imposing a financial burden worldwide. A serious lack of new drugs under development is undermining efforts to fight them. In this study, we report a potent combination of linezolid and polymyxin B nonapeptide PBNP (LP) against KP infection in vitro and in vivo. The checkerboard test and the time-kill assay were performed to detect the antibacterial activity of LP against KP in vitro. And the Caenorhabditis elegans (C. elegans) was used as infection model to evaluate the protective effect of LP against KP infection in vivo. The LP combination showed significantly synergistic activity and antibacterial effects against KP, while linezolid and PBNP as monotherapies revealed no dramatically antibacterial activity against the KP strains. Additionally, we found that the LP treatment altered the biofilm production and morphology of KP. Furthermore, the LP treatments significantly protected C. elegans from KP infection. In conclusion, this study indicated that the LP combination exhibited significantly synergistic activity against KP and PBNP can be used as a potential activity enhancer. More importantly, this strategy provided the improvement of antibacterial activity spectrum of agents like linezolid and represented a potent alternative to overcome antibiotic resistance in the future.
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Affiliation(s)
- Ting Huang
- Antibiotics Research and Re-Evaluation Key Laboratory of Sichuan Province, School of Pharmacy, Chengdu University, Chengdu, China
| | - Zheng Lv
- Antibiotics Research and Re-Evaluation Key Laboratory of Sichuan Province, School of Pharmacy, Chengdu University, Chengdu, China
| | - Jiafu Lin
- Antibiotics Research and Re-Evaluation Key Laboratory of Sichuan Province, School of Pharmacy, Chengdu University, Chengdu, China
| | - Kelei Zhao
- Antibiotics Research and Re-Evaluation Key Laboratory of Sichuan Province, School of Pharmacy, Chengdu University, Chengdu, China
| | - Longfei Zhai
- Antibiotics Research and Re-Evaluation Key Laboratory of Sichuan Province, School of Pharmacy, Chengdu University, Chengdu, China
| | - Xinrong Wang
- Antibiotics Research and Re-Evaluation Key Laboratory of Sichuan Province, School of Pharmacy, Chengdu University, Chengdu, China
| | - Yiwen Chu
- Antibiotics Research and Re-Evaluation Key Laboratory of Sichuan Province, School of Pharmacy, Chengdu University, Chengdu, China
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Dohál M, Dvořáková V, Šperková M, Pinková M, Spitaleri A, Norman A, Cabibbe AM, Rasmussen EM, Porvazník I, Škereňová M, Solovič I, Cirillo DM, Mokrý J. Whole genome sequencing of multidrug-resistant Mycobacterium tuberculosis isolates collected in the Czech Republic, 2005-2020. Sci Rep 2022; 12:7149. [PMID: 35505072 PMCID: PMC9062869 DOI: 10.1038/s41598-022-11287-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 04/21/2022] [Indexed: 01/11/2023] Open
Abstract
The emergence and spread of resistant tuberculosis (TB) pose a threat to public health, so it is necessary to diagnose the drug-resistant forms in a clinically short time frame and closely monitor their transmission. In this study, we carried out a first whole genome sequencing (WGS)-based analysis of multidrug resistant (MDR) M. tuberculosis strains to explore the phylogenetic lineages diversity, drug resistance mechanisms, and ongoing transmission chains within the country. In total, 65 isolates phenotypically resistant to at least rifampicin and isoniazid collected in the Czech Republic in 2005-2020 were enrolled for further analysis. The agreement of the results obtained by WGS with phenotypic drug susceptibility testing (pDST) in the determination of resistance to isoniazid, rifampicin, pyrazinamide, streptomycin, second-line injectables and fluoroquinolones was more than 80%. Phylogenetic analysis of WGS data revealed that the majority of MDR M. tuberculosis isolates were the Beijing lineage 2.2.1 (n = 46/65; 70.8%), while the remaining strains belonged to Euro-American lineage. Cluster analysis with a predefined cut-off distance of less than 12 single nucleotide polymorphisms between isolates showed 19 isolates in 6 clusters (clustering rate 29.2%), located mainly in the region of the capital city of Prague. This study highlights the utility of WGS as a high-resolution approach in the diagnosis, characterization of resistance patterns, and molecular-epidemiological analysis of resistant TB in the country.
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Affiliation(s)
- Matúš Dohál
- Department of Pharmacology and Biomedical Centre Martin, Jessenius Faculty of Medicine in Martin, Comenius University, Bratislava, Slovakia.
| | - Věra Dvořáková
- National Reference Laboratory for Mycobacteria, National Institute of Public Health, Praha, Czech Republic
| | - Miluše Šperková
- National Reference Laboratory for Mycobacteria, National Institute of Public Health, Praha, Czech Republic
| | - Martina Pinková
- National Reference Laboratory for Mycobacteria, National Institute of Public Health, Praha, Czech Republic
| | - Andrea Spitaleri
- Emerging Bacterial Pathogens Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Anders Norman
- International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark
| | | | - Erik Michael Rasmussen
- International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark
| | - Igor Porvazník
- National Institute of Tuberculosis, Lung Diseases and Thoracic Surgery, Vyšné Hágy, Slovakia
- Faculty of Health, Catholic University, Ružomberok, Slovakia
| | - Mária Škereňová
- Department of Molecular Medicine and Biomedical Centre Martin, Jessenius Faculty of Medicine in Martin, Comenius University, Bratislava, Slovakia
- Department of Clinical Biochemistry, Jessenius Faculty of Medicine in Martin, Comenius University, Bratislava, Slovakia
| | - Ivan Solovič
- National Institute of Tuberculosis, Lung Diseases and Thoracic Surgery, Vyšné Hágy, Slovakia
- Faculty of Health, Catholic University, Ružomberok, Slovakia
| | - Daniela Maria Cirillo
- Emerging Bacterial Pathogens Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Juraj Mokrý
- Department of Pharmacology and Biomedical Centre Martin, Jessenius Faculty of Medicine in Martin, Comenius University, Bratislava, Slovakia
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Linezolid Pharmacokinetics/Pharmacodynamics-Based Optimal Dosing for Multidrug-Resistant Tuberculosis. Int J Antimicrob Agents 2022; 59:106589. [DOI: 10.1016/j.ijantimicag.2022.106589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 02/03/2022] [Accepted: 04/03/2022] [Indexed: 11/05/2022]
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Wasserman S, Brust JCM, Abdelwahab MT, Little F, Denti P, Wiesner L, Gandhi NR, Meintjes G, Maartens G. Linezolid toxicity in patients with drug-resistant tuberculosis: a prospective cohort study. J Antimicrob Chemother 2022; 77:1146-1154. [PMID: 35134182 PMCID: PMC7612559 DOI: 10.1093/jac/dkac019] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 12/28/2021] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Linezolid is recommended for treating drug-resistant TB. Adverse events are a concern to prescribers but have not been systematically studied at the standard dose, and the relationship between linezolid exposure and clinical toxicity is not completely elucidated. PATIENTS AND METHODS We conducted an observational cohort study to describe the incidence and determinants of linezolid toxicity, and to determine a drug exposure threshold for toxicity, among patients with rifampicin-resistant TB in South Africa. Linezolid exposures were estimated from a population pharmacokinetic model. Mixed-effects modelling was used to analyse toxicity outcomes. RESULTS One hundred and fifty-one participants, 63% HIV positive, were enrolled and followed for a median of 86 weeks. Linezolid was permanently discontinued for toxicity in 32 (21%) participants. Grade 3 or 4 linezolid-associated adverse events occurred in 21 (14%) participants. Mean haemoglobin concentrations increased with time on treatment (0.03 g/dL per week; 95% CI 0.02-0.03). Linezolid trough concentration, male sex and age (but not HIV positivity) were independently associated with a decrease in haemoglobin >2 g/dL. Trough linezolid concentration of 2.5 mg/L or higher resulted in optimal model performance to describe changing haemoglobin and treatment-emergent anaemia (adjusted OR 2.9; 95% CI 1.3-6.8). SNPs 2706A > G and 3010G > A in mitochondrial DNA were not associated with linezolid toxicity. CONCLUSIONS Permanent discontinuation of linezolid was common, but linezolid-containing therapy was associated with average improvement in toxicity measures. HIV co-infection was not independently associated with linezolid toxicity. Linezolid trough concentration of 2.5 mg/L should be evaluated as a target for therapeutic drug monitoring.
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Affiliation(s)
- Sean Wasserman
- Wellcome Centre for Infectious Diseases Research in Africa, Institute for Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Division of Infectious Diseases and HIV Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - James C. M. Brust
- Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine & Montefiore Medical Center, Bronx, NY, USA
| | | | - Francesca Little
- Department of Statistical Sciences, University of Cape Town, Cape Town, South Africa
| | - Paolo Denti
- Division of Clinical Pharmacology, University of Cape Town, Cape Town, South Africa
| | - Lubbe Wiesner
- Division of Clinical Pharmacology, University of Cape Town, Cape Town, South Africa
| | - Neel R. Gandhi
- Departments of Epidemiology & Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Division of Infectious Diseases, Department of Medicine, Emory School of Medicine, Emory University, Atlanta, GA, USA
| | - Graeme Meintjes
- Wellcome Centre for Infectious Diseases Research in Africa, Institute for Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Gary Maartens
- Wellcome Centre for Infectious Diseases Research in Africa, Institute for Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Division of Clinical Pharmacology, University of Cape Town, Cape Town, South Africa
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Linezolid Population Pharmacokinetics in South African Adults with Drug-Resistant Tuberculosis. Antimicrob Agents Chemother 2021; 65:e0138121. [PMID: 34543098 DOI: 10.1128/aac.01381-21] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Linezolid is widely used for drug-resistant tuberculosis (DR-TB) but has a narrow therapeutic index. To inform dose optimization, we aimed to characterize the population pharmacokinetics of linezolid in South African participants with DR-TB and explore the effect of covariates, including HIV coinfection, on drug exposure. Data were obtained from pharmacokinetic substudies in a randomized controlled trial and an observational cohort study, both of which enrolled adults with drug-resistant pulmonary tuberculosis. Participants underwent intensive and sparse plasma sampling. We analyzed linezolid concentration data using nonlinear mixed-effects modeling and performed simulations to estimate attainment of putative efficacy and toxicity targets. A total of 124 participants provided 444 plasma samples; 116 were on the standard daily dose of 600 mg, while 19 had dose reduction to 300 mg due to adverse events. Sixty-one participants were female, 71 were HIV-positive, and their median weight was 56 kg (interquartile range [IQR], 50 to 63). In the final model, typical values for clearance and central volume were 3.57 liters/h and 40.2 liters, respectively. HIV coinfection had no significant effect on linezolid exposure. Simulations showed that 600-mg dosing achieved the efficacy target (area under the concentration-time curve for the free, unbound fraction of the drug [[Formula: see text] at a MIC level of 0.5 mg/liter) with 96% probability but had 56% probability of exceeding safety target ([Formula: see text]. The 300-mg dose did not achieve adequate efficacy exposures. Our model characterized population pharmacokinetics of linezolid in South African patients with DR-TB and supports the 600-mg daily dose with safety monitoring.
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Imperial MZ, Nedelman JR, Conradie F, Savic RM. Proposed linezolid dosing strategies to minimize adverse events for treatment of extensively drug-resistant tuberculosis. Clin Infect Dis 2021; 74:1736-1747. [PMID: 34604901 PMCID: PMC9155613 DOI: 10.1093/cid/ciab699] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND We evaluated clinical trial data (Nix-TB, NCT02333799) to provide data-driven dosing recommendations to potentially minimize linezolid toxicity in patients with extensively drug-resistant tuberculosis. METHODS Based on 104 participants, a pharmacokinetic model and toxicodynamic models for peripheral neuropathy, hemoglobin, and platelets were developed. Simulations compared safety outcomes for daily linezolid of 1200 and 600 mg, with and without dose adjustments for toxicity. Severe neuropathy was based on symptom scores from the Brief Peripheral Neuropathy Screen. Severe anemia and thrombocytopenia were defined as ≥grade 3 adverse events according to the Division of Microbiology and Infectious Disease Adult Toxicity table. RESULTS Predicted individual concentration-time profiles were a major predictor in all three toxicodynamic models. Simulations showed higher percentages of patients with severe neuropathy (median: 19% (90%CI: 17-22%) vs 5% (4-7%)) and severe anemia (15% (12-17%) vs 1% (0-2%)) between 1200 and 600 mg daily linezolid. No differences in severe thrombocytopenia were observed (median: <1% for both daily doses). Generally, neuropathy occurred after 3 to 6 months of treatment and, with protocol-specified management, reversed within 15 months after onset. Simulations indicated that a >10% decrease from pretreatment in hemoglobin level after 4 weeks of treatment would have maximum sensitivity (82%) and specificity (84%) for predicting severe anemia. Reducing dose from 1200 to 600 mg triggered by this marker may prevent 60% (90%CI: 45-72) of severe anemia. CONCLUSIONS Simple neuropathy symptom and hemoglobin monitoring may guide linezolid dosing to avoid toxicities, but prospective testing is needed to confirm benefit-to-risk ratio.
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Affiliation(s)
- Marjorie Z Imperial
- Department of Bioengineering and Therapeutic Sciences, Schools of Pharmacy, University of California, San Francisco, CA, USA
| | | | - Francesca Conradie
- Clinical HIV Research Unit, University of Witwatersrand, Johannesburg, South Africa
| | - Rada M Savic
- Department of Bioengineering and Therapeutic Sciences, Schools of Pharmacy, University of California, San Francisco, CA, USA
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Perletti G, Trinchieri A, Stamatiou K, Magri V. Safety considerations with new antibacterial approaches for chronic bacterial prostatitis. Expert Opin Drug Saf 2021; 21:171-182. [PMID: 34260337 DOI: 10.1080/14740338.2021.1956459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Introduction: Chronic bacterial prostatitis (CBP) is a difficult-to-eradicate infection. Antibacterial therapy with currently licensed agents is hindered due to the increasing emergence of pathogen resistance worldwide and to frequent infection relapse. With limited treatment options, physicians are investigating new agents, which, however, may raise safety concerns.Areas covered: Antibacterial agents currently licensed for CBP were not considered. Available reports about the safety and efficacy of antibacterial agents that have been clinically tested or tentatively used to treat CBP in single cases were evaluated. This review also focused on agents targeting Gram-positive pathogens, whose prevalence as causative agents of CBP is increasing.Expert opinion: (i) Most antibacterial agents considered in this review have been administered off-label in the interest of patients, and their use requires particular caution. (ii) Reports describing the usage of many of the drugs reviewed here are still scant, and readers should be warned of the limited published evidence supporting therapy for CBP with these agents. (iii) As treatment must extend over several weeks, medium-term adverse events may occur and therapy should be individualized, taking into account the dosage and the potential toxicity of each specific antibiotic. Regarding dangerous drug-drug interactions, particular attention should be paid to the risk of ECG-QT-interval elongation.
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Affiliation(s)
- Gianpaolo Perletti
- Department of Biotechnology and Life Sciences, Section of Medical and Surgical Sciences, University of Insubria, Varese, Italy.,Department of Human Function and Repair, Faculty of Medicine and Medical Sciences, Ghent University, Ghent, Belgium
| | - Alberto Trinchieri
- Department of Urology, IRCCS Ca' Granda Ospedale Maggiore Policlinico - University of Milan, Milan, Italy
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Ghimire S, Karki S, Maharjan B, Kosterink JGW, Touw DJ, van der Werf TS, Shrestha B, Alffenaar JW. Treatment outcomes of patients with MDR-TB in Nepal on a current programmatic standardised regimen: retrospective single-centre study. BMJ Open Respir Res 2021; 7:7/1/e000606. [PMID: 32796020 PMCID: PMC7430340 DOI: 10.1136/bmjresp-2020-000606] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 07/16/2020] [Accepted: 07/16/2020] [Indexed: 01/20/2023] Open
Abstract
Objectives The objectives of this study were to evaluate treatment in patients on current programmatic multidrug-resistant tuberculosis (MDR-TB) regimen and verify eligibility for the 9-month regimen and therapeutic drug monitoring (TDM). Methods We performed a retrospective chart review of patients with MDR-TB receiving standardised regimen at the German Nepal TB Project Clinic, Nepal, between 2014 and 2016. Eligibility for the 9-month regimen and indications for TDM were evaluated. Results Out of 107 available patients’ medical records, 98 were included. In this centre, the MDR-TB treatment success rates were 69.0% in 2015, 86.6% in 2016 and 86.5% in 2017. The median time to sputum smear conversion was 60 days (60–90 IQR) and culture conversion was 60 days (60–90 IQR). Observed side effects did not impact treatment outcomes. No difference in treatment success rates was observed between patients with predisposing risk factors and those without. Only 49% (36/74) of patients were eligible for the 9-month regimen and 23 patients for TDM according to American Thoracic Society guideline criteria. Conclusions Nepalese patients with MDR-TB on ambulatory care had good treatment outcome after programmatic treatment. Implementation of the new WHO oral MDR-TB treatment regimen may further improve treatment results. The 9-month regimen and TDM should be considered as part of programmatic care.
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Affiliation(s)
- Samiksha Ghimire
- Clinical Pharmacy and Pharmacology, University of Groningen Faculty of Medical Sciences, Groningen, The Netherlands
| | - Samriddhi Karki
- Tuberculosis Unit, Nepal Anti-Tuberculosis Association/German Nepal TB Project, Kathmandu, Nepal
| | - Bhagwan Maharjan
- Tuberculosis Unit, Nepal Anti-Tuberculosis Association/German Nepal TB Project, Kathmandu, Nepal
| | - Jos G W Kosterink
- Clinical Pharmacy and Pharmacology, University of Groningen Faculty of Medical Sciences, Groningen, The Netherlands
| | - Daan J Touw
- Clinical Pharmacy and Pharmacology, University of Groningen Faculty of Medical Sciences, Groningen, The Netherlands.,Groningen Research Institute of Pharmacy, Department of Pharmaceutical Analysis, University of Groningen, Groningen, Groningen, the Netherlands
| | - Tjip S van der Werf
- Infectious Diseases Service and Tuberculosis Unit, University of Groningen Faculty of Medical Sciences, Groningen, The Netherlands
| | - Bhabana Shrestha
- Tuberculosis Unit, Nepal Anti-Tuberculosis Association/German Nepal TB Project, Kathmandu, Nepal
| | - Jan-Willem Alffenaar
- Clinical Pharmacy and Pharmacology, University of Groningen Faculty of Medical Sciences, Groningen, The Netherlands.,Faculty of Medicine and Health, School of Pharmacy and Westmead hospital, University of Sydney, Sydney, New South Wales, Australia
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30
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Fatima S, Bhaskar A, Dwivedi VP. Repurposing Immunomodulatory Drugs to Combat Tuberculosis. Front Immunol 2021; 12:645485. [PMID: 33927718 PMCID: PMC8076598 DOI: 10.3389/fimmu.2021.645485] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 03/22/2021] [Indexed: 12/24/2022] Open
Abstract
Tuberculosis (TB) is an infectious disease caused by an obligate intracellular pathogen, Mycobacterium tuberculosis (M.tb) and is responsible for the maximum number of deaths due to a single infectious agent. Current therapy for TB, Directly Observed Treatment Short-course (DOTS) comprises multiple antibiotics administered in combination for 6 months, which eliminates the bacteria and prevents the emergence of drug-resistance in patients if followed as prescribed. However, due to various limitations viz., severe toxicity, low efficacy and long duration; patients struggle to comply with the prescribed therapy, which leads to the development of drug resistance (DR). The emergence of resistance to various front-line anti-TB drugs urgently require the introduction of new TB drugs, to cure DR patients and to shorten the treatment course for both drug-susceptible and resistant populations of bacteria. However, the development of a novel drug regimen involving 2-3 new and effective drugs will require approximately 20-30 years and huge expenditure, as seen during the discovery of bedaquiline and delamanid. These limitations make the field of drug-repurposing indispensable and repurposing of pre-existing drugs licensed for other diseases has tremendous scope in anti-DR-TB therapy. These repurposed drugs target multiple pathways, thus reducing the risk of development of drug resistance. In this review, we have discussed some of the repurposed drugs that have shown very promising results against TB. The list includes sulfonamides, sulfanilamide, sulfadiazine, clofazimine, linezolid, amoxicillin/clavulanic acid, carbapenems, metformin, verapamil, fluoroquinolones, statins and NSAIDs and their mechanism of action with special emphasis on their immunomodulatory effects on the host to attain both host-directed and pathogen-targeted therapy. We have also focused on the studies involving the synergistic effect of these drugs with existing TB drugs in order to translate their potential as adjunct therapies against TB.
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Affiliation(s)
- Samreen Fatima
- Immunobiology Group, International Centre for Genetic Engineering and Biotechnology, New Delhi, India
| | - Ashima Bhaskar
- Signal Transduction Laboratory-1, National Institute of Immunology, New Delhi, India
| | - Ved Prakash Dwivedi
- Immunobiology Group, International Centre for Genetic Engineering and Biotechnology, New Delhi, India
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Kushwaha B, Kushwaha ND, Parish T, Guzman J, Kajee A, Shaikh MS, Kehinde I, Obakachi VA, Pathan TK, Shinde SR, Karpoormath R. A New Class of Linezolid‐Based Molecules as Potential Antimicrobial and Antitubercular Agents: A Rational Approach. ChemistrySelect 2021. [DOI: 10.1002/slct.202100493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Babita Kushwaha
- Department of Pharmaceutical Chemistry Discipline of Pharmaceutical Sciences College of Health Sciences University of KwaZulu-Natal, Westville Campus Durban South Africa
| | - Narva Deshwar Kushwaha
- Department of Pharmaceutical Chemistry Discipline of Pharmaceutical Sciences College of Health Sciences University of KwaZulu-Natal, Westville Campus Durban South Africa
| | - Tanya Parish
- Infectious Disease Research Institute Seattle Washington United States of America
- Center for Global Infectious Disease Research, Seattle Children's Research Institute Seattle Washington USA
| | - Junitta Guzman
- Infectious Disease Research Institute Seattle Washington United States of America
| | - Afsana Kajee
- Department of Pharmaceutical Chemistry Discipline of Pharmaceutical Sciences College of Health Sciences University of KwaZulu-Natal, Westville Campus Durban South Africa
- Department of Microbiology National Health Laboratory Services (NHLS) Inkosi Albert Luthuli Central Hospital Durban South Africa
| | - Mahamadhanif S. Shaikh
- Department of Pharmaceutical Chemistry Discipline of Pharmaceutical Sciences College of Health Sciences University of KwaZulu-Natal, Westville Campus Durban South Africa
| | - Idowu Kehinde
- KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP)/Genomics Unit School of Laboratory Medicine and Medical Sciences College of Health Sciences Nelson R Mandela School of Medicine University of KwaZulu-Natal Medical Campus Durban 4001 South Africa
| | - Vincent A. Obakachi
- Department of Pharmaceutical Chemistry Discipline of Pharmaceutical Sciences College of Health Sciences University of KwaZulu-Natal, Westville Campus Durban South Africa
| | - Tabasum Khan Pathan
- Department of Pharmaceutical Chemistry Discipline of Pharmaceutical Sciences College of Health Sciences University of KwaZulu-Natal, Westville Campus Durban South Africa
| | - Suraj Raosaheb Shinde
- Department of Pharmaceutical Chemistry Discipline of Pharmaceutical Sciences College of Health Sciences University of KwaZulu-Natal, Westville Campus Durban South Africa
| | - Rajshekhar Karpoormath
- Department of Pharmaceutical Chemistry Discipline of Pharmaceutical Sciences College of Health Sciences University of KwaZulu-Natal, Westville Campus Durban South Africa
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A Review of Clinical Pharmacokinetic and Pharmacodynamic Relationships and Clinical Implications for Drugs Used to Treat Multi-drug Resistant Tuberculosis. Eur J Drug Metab Pharmacokinet 2021; 45:305-313. [PMID: 31925745 DOI: 10.1007/s13318-019-00604-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Multidrug-resistant tuberculosis (MDR-TB) is becoming a global health crisis. The World Health Organization has released new guidelines for the use of tuberculosis-active drugs for the treatment of patients with MDR-TB. Despite documented activity against tuberculosis isolates, doses and exposure targets are yet to be optimized. Our objective was therefore to review the clinical pharmacokinetic and pharmacodynamic literature pertaining to drugs recommended to treat MDR-TB and to identify target areas for future research. To date, published research is limited but studies were identified that evaluated the pharmacokinetics and pharmacodynamics of these drugs. Exposure targets were assessed and summarized for each drug. Exposure-based targets (e.g., area under the concentration curve/minimum inhibitory concentration) appear to be most commonly associated with predicting drug efficacy. Dose variation studies based on these targets were largely inconclusive. Future research should focus on determining the risks and benefits of dose optimization to meet exposure targets and improve patient outcomes. The role of therapeutic drug monitoring also remains yet to be confirmed, both from a clinical perspective as well as a resource allocation perspective in regions where MDR-TB is active.
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Sharma A, De Rosa M, Singla N, Singh G, Barnwal RP, Pandey A. Tuberculosis: An Overview of the Immunogenic Response, Disease Progression, and Medicinal Chemistry Efforts in the Last Decade toward the Development of Potential Drugs for Extensively Drug-Resistant Tuberculosis Strains. J Med Chem 2021; 64:4359-4395. [PMID: 33826327 DOI: 10.1021/acs.jmedchem.0c01833] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Tuberculosis (TB) is a slow growing, potentially debilitating disease that has plagued humanity for centuries and has claimed numerous lives across the globe. Concerted efforts by researchers have culminated in the development of various strategies to combat this malady. This review aims to raise awareness of the rapidly increasing incidences of multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis, highlighting the significant modifications that were introduced in the TB treatment regimen over the past decade. A description of the role of pathogen-host immune mechanisms together with strategies for prevention of the disease is discussed. The struggle to develop novel drug therapies has continued in an effort to reduce the treatment duration, improve patient compliance and outcomes, and circumvent TB resistance mechanisms. Herein, we give an overview of the extensive medicinal chemistry efforts made during the past decade toward the discovery of new chemotypes, which are potentially active against TB-resistant strains.
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Affiliation(s)
- Akanksha Sharma
- Department of Biophysics, Panjab University, Chandigarh 160014, India.,UIPS, Panjab University, Chandigarh 160014, India
| | - Maria De Rosa
- Drug Discovery Unit, Ri.MED Foundation, Palermo 90133, Italy
| | - Neha Singla
- Department of Biophysics, Panjab University, Chandigarh 160014, India
| | - Gurpal Singh
- UIPS, Panjab University, Chandigarh 160014, India
| | - Ravi P Barnwal
- Department of Biophysics, Panjab University, Chandigarh 160014, India
| | - Ankur Pandey
- Department of Chemistry, Panjab University, Chandigarh 160014, India
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Chauhan A, Kumar M, Kumar A, Kanchan K. Comprehensive review on mechanism of action, resistance and evolution of antimycobacterial drugs. Life Sci 2021; 274:119301. [PMID: 33675895 DOI: 10.1016/j.lfs.2021.119301] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/14/2021] [Accepted: 02/24/2021] [Indexed: 01/04/2023]
Abstract
Tuberculosis is one of the deadliest infectious diseases existing in the world since ancient times and still possesses serious threat across the globe. Each year the number of cases increases due to high drug resistance shown by Mycobacterium tuberculosis (Mtb). Available antimycobacterial drugs have been classified as First line, Second line and Third line antibiotics depending on the time of their discoveries and their effectiveness in the treatment. These antibiotics have a broad range of targets ranging from cell wall to metabolic processes and their non-judicious and uncontrolled usage in the treatment for years has created a significant problem called multi-drug resistant (MDR) tuberculosis. In this review, we have summarized the mechanism of action of all the classified antibiotics currently in use along with the resistance mechanisms acquired by Mtb. We have focused on the new drug candidates/repurposed drugs, and drug in combinations, which are in clinical trials for either treating the MDR tuberculosis more effectively or involved in reducing the time required for the chemotherapy of drug sensitive TB. This information is not discussed very adequately on a single platform. Additionally, we have discussed the recent technologies that are being used to discover novel resistance mechanisms acquired by Mtb and for exploring novel drugs. The story of intrinsic resistance mechanisms and evolution in Mtb is far from complete. Therefore, we have also discussed intrinsic resistance mechanisms of Mtb and their evolution with time, emphasizing the hope for the development of novel antimycobacterial drugs for effective therapy of tuberculosis.
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Affiliation(s)
- Aditi Chauhan
- Amity Institute of Molecular Medicine and Stem Cell Research, Amity University Uttar Pradesh, Noida 201313, India
| | - Manoj Kumar
- Amity Food and Agriculture Foundation, Amity University Uttar Pradesh, Noida 201313, India
| | - Awanish Kumar
- Department of Bio Technology, National Institute of Technology, Raipur, India
| | - Kajal Kanchan
- Amity Institute of Molecular Medicine and Stem Cell Research, Amity University Uttar Pradesh, Noida 201313, India.
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Linezolid use for the treatment of multidrug-resistant tuberculosis, TB centers of excellence, United States, 2013-2018. J Clin Tuberc Other Mycobact Dis 2020; 22:100201. [PMID: 33336084 PMCID: PMC7732868 DOI: 10.1016/j.jctube.2020.100201] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background In 2019, the World Health Organization released guidelines reflecting major changes in multidrug-resistant tuberculosis (MDR-TB) management-prioritizing fluoroquinolones, bedaquiline, and linezolid (LZD) while de-emphasizing previously favored injectable agents. In some cases, linezolid use is associated with gastrointestinal intolerance, mitochondrial toxicity, and significant drug interactions. CDC's Division of Tuberculosis Elimination supports a network of regional TB Centers of Excellence, which provide medical consultation to healthcare providers. Consultations are documented in a medical consultation database (MCD) enabling evaluation of management questions and recommendations. We describe the scope of clinical inquiries and responses specific to linezolid use for MDR-TB in the US. Research Question What are the major themes of provider and patient challenges regarding the use of linezolid for the treatment of MDR-TB in the US? Methods We queried MCD consults categorized as "MDR/XDR-TB" from 1/1/2013 to 12/31/2018. Only linezolid-specific consultations were included; incomplete and duplicate entries were excluded as were those citing linezolid historically or theoretically. Subgroup characteristics were assessed (e.g., Center, year, provider type). A descriptive coding scheme was developed through inductive thematic analysis. Results In 2013-2018 of the 1889 consults regarding MDR/XDR-TB, 934 MDR-TB consults referenced linezolid; 137 met inclusion criteria, representing between 4 and 10% of MDR-TB consults annually. Four main themes emerged: adverse effects (71.5%); concerns about linezolid use due to co-morbidities or concurrent medication use (15.3%); dosing adjustments (8.8%); and monitoring and maintenance logistics (4.4%). Interpretations Linezolid consults consistently exceeded 4% of all consults annually over the 6-year period, suggesting a need for access to expert opinion for providers using linezolid to manage MDR-TB. While only a snapshot of MDR-TB in the US, this evaluation summarizes major provider concerns regarding particular adverse effects, and highlights a need for evidence-based guidance regarding linezolid dosing and toxicity management.
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Key Words
- CITC, Curry International Tuberculosis Center
- COE, Center of Excellence
- Drug resistance
- GTBI, Global Tuberculosis Institute
- HNTC, Heartland National Tuberculosis Center
- LZD, Linezolid
- Linezolid
- MCCT, Mayo Clinic Center for Tuberculosis
- MCD, Medical Consultation Database
- MDR-TB, Multidrug-Resistant Tuberculosis, a form of infection caused by the bacterium M. tuberculosis that is resistant to both isoniazid and rifampin SNTC, Southeastern National Tuberculosis Center
- Multi-drug resistance
- SSRI, Selective serotonin reuptake inhibitor
- TB, Tuberculosis
- TDM, Therapeutic drug monitoring
- Tuberculosis
- XDR-TB, Extensively Drug-Resistant Tuberculosis, a form of infection caused by the bacterium M. tuberculosis that is resistant to isoniazid and rifampin plus a fluoroquinolone and at least 1 of the following injectable medications: amikacin, kanamycin, or capreomycin
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Märtson AG, Burch G, Ghimire S, Alffenaar JWC, Peloquin CA. Therapeutic drug monitoring in patients with tuberculosis and concurrent medical problems. Expert Opin Drug Metab Toxicol 2020; 17:23-39. [PMID: 33040625 DOI: 10.1080/17425255.2021.1836158] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Therapeutic drug monitoring (TDM) has been recommended for treatment optimization in tuberculosis (TB) but is only is used in certain countries e.g. USA, Germany, the Netherlands, Sweden and Tanzania. Recently, new drugs have emerged and PK studies in TB are continuing, which contributes further evidence for TDM in TB. The aim of this review is to provide an update on drugs used in TB, treatment strategies for these drugs, and TDM to support broader implementation. AREAS COVERED This review describes the different drug classes used for TB, multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB), along with their pharmacokinetics, dosing strategies, TDM and sampling strategies. Moreover, the review discusses TDM for patient TB and renal or liver impairment, patients co-infected with HIV or hepatitis, and special patient populations - children and pregnant women. EXPERT OPINION TB treatment has a long history of using 'one size fits all.' This has contributed to treatment failures, treatment relapses, and the selection of drug-resistant isolates. While challenging in resource-limited circumstances, TDM offers the clinician the opportunity to individualize and optimize treatment early in treatment. This approach may help to refine treatment and thereby reduce adverse effects and poor treatment outcomes. Funding, training, and randomized controlled trials are needed to advance the use of TDM for patients with TB.
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Affiliation(s)
- Anne-Grete Märtson
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen , Groningen, The Netherlands
| | - Gena Burch
- Infectious Disease Pharmacokinetics Laboratory, College of Pharmacy and Emerging Pathogens Institute, University of Florida , Gainesville, FL, USA
| | - Samiksha Ghimire
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen , Groningen, The Netherlands
| | - Jan-Willem C Alffenaar
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen , Groningen, The Netherlands.,Department of Pharmacy, Westmead Hospital , Sydney, Australia.,Sydney Pharmacy School, The University of Sydney , Sydney, New South Wales, Australia.,Marie Bashir Institute of Infectious Diseases and Biosecurity, University of Sydney , Sydney, Australia
| | - Charles A Peloquin
- Infectious Disease Pharmacokinetics Laboratory, College of Pharmacy and Emerging Pathogens Institute, University of Florida , Gainesville, FL, USA
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Bigelow KM, Tasneen R, Chang YS, Dooley KE, Nuermberger EL. Preserved Efficacy and Reduced Toxicity with Intermittent Linezolid Dosing in Combination with Bedaquiline and Pretomanid in a Murine Tuberculosis Model. Antimicrob Agents Chemother 2020; 64:e01178-20. [PMID: 32690647 PMCID: PMC7508620 DOI: 10.1128/aac.01178-20] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 07/15/2020] [Indexed: 11/20/2022] Open
Abstract
The novel regimen of bedaquiline, pretomanid, and linezolid (BPaL) is highly effective against drug-resistant tuberculosis, but linezolid toxicities are frequent. We hypothesized that, for a similar total weekly cumulative dose, thrice-weekly administration of linezolid would preserve efficacy while reducing toxicity compared with daily dosing, in the context of the BPaL regimen. Using C3HeB/FeJ and BALB/c mouse models of tuberculosis disease, thrice-weekly linezolid dosing was compared with daily dosing, with intermittent dosing introduced (i) from treatment initiation or (ii) after an initial period of daily dosing. In all animals, BPa was dosed daily throughout treatment. Blood counts were used to assess hematologic toxicity. After unexpected findings of apparent antagonism, we conducted additional experiments to investigate strain-to-strain differences in the contribution of linezolid to regimen efficacy by comparing each 1- and 2-drug component to the BPaL regimen in BALB/c mice infected with Mycobacterium tuberculosis H37Rv or HN878. Giving linezolid daily for 1 to 2 months achieved the greatest efficacy but, after that, results were similar if the drug was stopped, dosed thrice-weekly, or continued daily. Erythrocyte counts were lower with daily than thrice-weekly dosing. Linezolid had additive effects with BPa against M. tuberculosis H37Rv but antagonistic effects with BPa against M. tuberculosis HN878. However, the overall efficacy of BPaL was high and similar against both strains. Dosing linezolid daily for the first 2 months and then less frequently thereafter may optimize its therapeutic margin. Linezolid's contribution to BPaL regimens may depend on the M. tuberculosis strain.
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Affiliation(s)
- Kristina M Bigelow
- Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rokeya Tasneen
- Center for Tuberculosis Research, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Yong S Chang
- Center for Tuberculosis Research, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kelly E Dooley
- Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Center for Tuberculosis Research, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Eric L Nuermberger
- Center for Tuberculosis Research, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Wasserman S, Louw G, Ramangoaela L, Barber G, Hayes C, Omar SV, Maartens G, Barry C, Song T, Meintjes G. Linezolid resistance in patients with drug-resistant TB and treatment failure in South Africa. J Antimicrob Chemother 2020; 74:2377-2384. [PMID: 31081017 PMCID: PMC6640298 DOI: 10.1093/jac/dkz206] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 04/08/2019] [Accepted: 04/09/2019] [Indexed: 11/13/2022] Open
Abstract
Objectives Limited data exist on clinical associations and genotypic correlates of linezolid resistance in Mycobacterium tuberculosis. We aimed to describe mutations and clinical factors associated with phenotypic linezolid resistance from patients with drug-resistant TB at two public sector facilities in South Africa. Methods Adults and adolescents with treatment failure (culture positivity ≥4 months) on a linezolid-containing regimen were retrospectively identified. Phenotypic resistance, as defined by a linezolid MIC >1 mg/L, was assessed for retrieved isolates using broth microdilution. Targeted sequencing of rrl and rplC was performed, irrespective of growth on subculture. Results Thirty-nine patients with linezolid-based treatment failure were identified, 13 (33%) of whom had phenotypic or genotypic linezolid resistance after a median duration of 22 months (range = 7–32) of linezolid therapy. Paired MIC testing and genotyping was performed on 55 unique isolates. All isolates with phenotypic resistance (n = 16) were associated with known resistance mutations, most frequently due to the T460C substitution in rplC (n = 10); rrl mutations included G2814T, G2270C/T and A2810C. No mutations were detected in isolates with MICs at or below the critical concentration. Conclusions Linezolid resistance occurred in a third of patients with drug-resistant TB and treatment failure. Resistance occurred late and was predicted by a limited number of mutations in rrl and rplC. Screening for genotypic resistance should be considered for patients with a positive culture after 4 months of linezolid therapy in order to optimize treatment and avoid the toxicity of ineffective linezolid therapy.
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Affiliation(s)
- Sean Wasserman
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.,Division of Infectious Diseases and HIV Medicine, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Gail Louw
- Institute of Infectious Disease and Molecular Medicine, Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - Limpho Ramangoaela
- Jose Pearson Hospital, Eastern Province Department of Health, Port Elizabeth, South Africa
| | - Garrick Barber
- Jose Pearson Hospital, Eastern Province Department of Health, Port Elizabeth, South Africa
| | - Cindy Hayes
- National Health Laboratory Service, TB Laboratory, Port Elizabeth, South Africa
| | - Shaheed Vally Omar
- Centre for Tuberculosis, WHO Supranational TB Reference Network, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Gary Maartens
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.,Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Clifton Barry
- Institute of Infectious Disease and Molecular Medicine, Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - Taeksun Song
- Institute of Infectious Disease and Molecular Medicine, Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - Graeme Meintjes
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.,Division of Infectious Diseases and HIV Medicine, Department of Medicine, University of Cape Town, Cape Town, South Africa
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Zhao H, Wang B, Fu L, Li G, Lu H, Liu Y, Sheng L, Li Y, Zhang B, Lu Y, Ma C, Huang H, Zhang D, Lu Y. Discovery of a Conformationally Constrained Oxazolidinone with Improved Safety and Efficacy Profiles for the Treatment of Multidrug-Resistant Tuberculosis. J Med Chem 2020; 63:9316-9339. [PMID: 32666789 DOI: 10.1021/acs.jmedchem.0c00500] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Tuberculosis (TB) remains a serious public health challenge, and the research and development of new anti-TB drugs is an essential component of the global strategy to eradicate TB. In this work, we discovered a conformationally constrained oxazolidinone 19c with improved anti-TB activity and safety profile through a focused lead optimization effort. Compound 19c displayed superior in vivo efficacy in a mouse TB infection model compared to linezolid and sutezolid. The druggability of compound 19c was demonstrated in a panel of assays including microsomal stability, cytotoxicity, cytochrome P450 enzyme inhibition, and pharmacokinetics in animals. Compound 19c demonstrated an excellent safety profile in a battery of safety assays, including mitochondrial protein synthesis, hERG K+, hCav1.2, and Nav1.5 channels, monoamine oxidase, and genotoxicity. In a 4 week repeated dose toxicology study in rats, 19c appeared to have less bone marrow suppression than linezolid, which has been a major liability of the oxazolidinone class.
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Affiliation(s)
- Hongyi Zhao
- Beijing Key Laboratory of Active Substance Discovery and Druggability Evaluation, Chinese Academy of Medical Sciences Key Laboratory of Anti-DR TB Innovative Drug Research, Institute of Materia Medica, Peking Union Medical College and Chinese Academy of Medical Sciences, 1 Xian Nong Tan Street, Beijing 100050, P. R. China
| | - Bin Wang
- Beijing Key Laboratory of Drug Resistance Tuberculosis Research, Department of Pharmacology, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Chest Hospital, Capital Medical University, 97 Ma Chang Street, Beijing 101149, P. R. China
| | - Lei Fu
- Beijing Key Laboratory of Drug Resistance Tuberculosis Research, Department of Pharmacology, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Chest Hospital, Capital Medical University, 97 Ma Chang Street, Beijing 101149, P. R. China
| | - Gang Li
- Beijing Key Laboratory of Active Substance Discovery and Druggability Evaluation, Chinese Academy of Medical Sciences Key Laboratory of Anti-DR TB Innovative Drug Research, Institute of Materia Medica, Peking Union Medical College and Chinese Academy of Medical Sciences, 1 Xian Nong Tan Street, Beijing 100050, P. R. China
| | - Haijia Lu
- Beijing Key Laboratory of Active Substance Discovery and Druggability Evaluation, Chinese Academy of Medical Sciences Key Laboratory of Anti-DR TB Innovative Drug Research, Institute of Materia Medica, Peking Union Medical College and Chinese Academy of Medical Sciences, 1 Xian Nong Tan Street, Beijing 100050, P. R. China
| | - Yuke Liu
- Beijing Key Laboratory of Non-Clinical Drug Metabolism and PK/PD Study, Chinese Academy of Medical Sciences Key Laboratory of Anti-DR TB Innovative Drug Research, Institute of Materia Medica, Peking Union Medical College and Chinese Academy of Medical Sciences, 1 Xian Nong Tan Street, Beijing 100050, P. R. China
| | - Li Sheng
- Beijing Key Laboratory of Non-Clinical Drug Metabolism and PK/PD Study, Chinese Academy of Medical Sciences Key Laboratory of Anti-DR TB Innovative Drug Research, Institute of Materia Medica, Peking Union Medical College and Chinese Academy of Medical Sciences, 1 Xian Nong Tan Street, Beijing 100050, P. R. China
| | - Yan Li
- Beijing Key Laboratory of Non-Clinical Drug Metabolism and PK/PD Study, Chinese Academy of Medical Sciences Key Laboratory of Anti-DR TB Innovative Drug Research, Institute of Materia Medica, Peking Union Medical College and Chinese Academy of Medical Sciences, 1 Xian Nong Tan Street, Beijing 100050, P. R. China
| | - Baoxi Zhang
- Beijing Key Laboratory of Polymorphic Drugs, Institute of Materia Medica, Peking Union Medical College and Chinese Academy of Medical Sciences, 1 Xian Nong Tan Street, Beijing 100050, P. R. China
| | - Yang Lu
- Beijing Key Laboratory of Polymorphic Drugs, Institute of Materia Medica, Peking Union Medical College and Chinese Academy of Medical Sciences, 1 Xian Nong Tan Street, Beijing 100050, P. R. China
| | - Chen Ma
- Beijing Key Laboratory of Polymorphic Drugs, Chinese Academy of Medical Sciences Key Laboratory of Anti-DR TB Innovative Drug Research, Institute of Materia Medica, Peking Union Medical College and Chinese Academy of Medical Sciences, 1 Xian Nong Tan Street, Beijing 100050, P. R. China
| | - Haihong Huang
- Beijing Key Laboratory of Active Substance Discovery and Druggability Evaluation, Chinese Academy of Medical Sciences Key Laboratory of Anti-DR TB Innovative Drug Research, Institute of Materia Medica, Peking Union Medical College and Chinese Academy of Medical Sciences, 1 Xian Nong Tan Street, Beijing 100050, P. R. China
| | - Dongfeng Zhang
- Beijing Key Laboratory of Active Substance Discovery and Druggability Evaluation, Chinese Academy of Medical Sciences Key Laboratory of Anti-DR TB Innovative Drug Research, Institute of Materia Medica, Peking Union Medical College and Chinese Academy of Medical Sciences, 1 Xian Nong Tan Street, Beijing 100050, P. R. China
| | - Yu Lu
- Beijing Key Laboratory of Drug Resistance Tuberculosis Research, Department of Pharmacology, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Chest Hospital, Capital Medical University, 97 Ma Chang Street, Beijing 101149, P. R. China
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Huang HL, Lu PL, Lee CH, Chong IW. Treatment of pulmonary disease caused by Mycobacterium kansasii. J Formos Med Assoc 2020; 119 Suppl 1:S51-S57. [PMID: 32505588 DOI: 10.1016/j.jfma.2020.05.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/15/2020] [Accepted: 05/15/2020] [Indexed: 01/10/2023] Open
Abstract
As a cause of lung disease (LD), Mycobacterium kansasii is regarded as a highly virulent species among nontuberculous mycobacteria (NTM). Both the frequency of M. kansasii isolates and global prevalence of M. kansasii-LD have increased gradually over recent decades. Treatment of M. kansasii-LD is recommended because of the disease's poor prognosis and fatal outcome. The decision on the optimal time point for treatment initiation should be based on both the benefits and risks posed by multiple antimicrobial agents. For treatment-naïve patients with M. kansasii-LD, rifampin-containing multiple antimicrobial regimens for ≥12 months after culture negative conversion are effective. However, some challenges remain, such as determining the precise length of treatment duration as well as addressing intolerable adverse effects, the uncertain effectiveness of isoniazid and ethambutol in treatment, the uncertain correlation between in vitro drug susceptibility testing and clinical outcomes, and the increasing prevalence of clarithromycin-resistant M. kansasii isolates. Short-course and effective therapies must be developed. New candidate drugs, such as tedizoid and clofazimine, exhibit excellent antimycobacterial activity against M. kansasii in vitro, but in vivo studies of their clinical applications are lacking. This paper reviews the treatment, outcomes and future directions in patients with M. kansasii-LD.
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Affiliation(s)
- Hung-Ling Huang
- Division of Pulmonary and Critical Care Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Po-Liang Lu
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Laboratory Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chen-Hsiang Lee
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; College of Medicine, Chang Gung University, Kaohsiung, Taiwan
| | - Inn-Wen Chong
- Division of Pulmonary and Critical Care Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Respiratory Therapy, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
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Bigelow KM, Deitchman AN, Li SY, Barnes-Boyle K, Tyagi S, Soni H, Dooley KE, Savic RM, Nuermberger EL. Pharmacodynamic Correlates of Linezolid Activity and Toxicity in Murine Models of Tuberculosis. J Infect Dis 2020; 223:1855-1864. [PMID: 31993638 PMCID: PMC8176636 DOI: 10.1093/infdis/jiaa016] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 01/24/2020] [Indexed: 01/21/2023] Open
Abstract
Background Linezolid (LZD) is bactericidal against Mycobacterium tuberculosis, but it has treatment-limiting toxicities. A better understanding of exposure-response relationships governing LZD efficacy and toxicity will inform dosing strategies. Because in vitro monotherapy studies yielded conflicting results, we explored LZD pharmacokinetic/pharmacodynamic (PK/PD) relationships in vivo against actively and nonactively multiplying bacteria, including in combination with pretomanid. Methods Linezolid multidose pharmacokinetics were modeled in mice. Dose-fractionation studies were performed in acute (net bacterial growth) and chronic (no net growth) infection models. In acute models, LZD was administered alone or with bacteriostatic or bactericidal pretomanid doses. Correlations between PK/PD parameters and lung colony-forming units (CFUs) and complete blood counts were assessed. Results Overall, time above minimum inhibitory concentration (T>MIC) correlated best with CFU decline. However, in growth-constrained models (ie, chronic infection, coadministration with pretomanid 50 mg/kg per day), area under the concentration-time curve over MIC (AUC/MIC) had similar explanatory power. Red blood cell counts correlated strongly with LZD minimum concentration (Cmin). Conclusions Although T>MIC was the most consistent correlate of efficacy, AUC/MIC was equally predictive when bacterial multiplication was constrained by host immunity or pretomanid. In effective combination regimens, administering the same total LZD dose less frequently may be equally effective and cause less Cmin-dependent toxicity.
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Affiliation(s)
- Kristina M Bigelow
- Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Center for Tuberculosis Research, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Amelia N Deitchman
- University of California San Francisco, Department of Bioengineering and Therapeutic Sciences, San Francisco, California, USA
| | - Si-Yang Li
- Center for Tuberculosis Research, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kala Barnes-Boyle
- Center for Tuberculosis Research, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sandeep Tyagi
- Center for Tuberculosis Research, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Heena Soni
- Center for Tuberculosis Research, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kelly E Dooley
- Center for Tuberculosis Research, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rada M Savic
- University of California San Francisco, Department of Bioengineering and Therapeutic Sciences, San Francisco, California, USA
| | - Eric L Nuermberger
- Center for Tuberculosis Research, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Correspondence: Eric Nuermberger, MD, Center for Tuberculosis Research, Department of Medicine/Division of Infectious Diseases, Johns Hopkins University School of Medicine, 1550 Orleans Street, Room 105, Baltimore, Maryland 21231 ()
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Cerrone M, Bracchi M, Wasserman S, Pozniak A, Meintjes G, Cohen K, Wilkinson RJ. Safety implications of combined antiretroviral and anti-tuberculosis drugs. Expert Opin Drug Saf 2020; 19:23-41. [PMID: 31809218 PMCID: PMC6938542 DOI: 10.1080/14740338.2020.1694901] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 11/15/2019] [Indexed: 01/01/2023]
Abstract
Introduction: Antiretroviral and anti-tuberculosis (TB) drugs are often co-administered in people living with HIV (PLWH). Early initiation of antiretroviral therapy (ART) during TB treatment improves survival in patients with advanced HIV disease. However, safety concerns related to clinically significant changes in drug exposure resulting from drug-drug interactions, development of overlapping toxicities and specific challenges related to co-administration during pregnancy represent barriers to successful combined treatment for HIV and TB.Areas covered: Pharmacokinetic interactions of different classes of ART when combined with anti-TB drugs used for sensitive-, drug-resistant (DR) and latent TB are discussed. Overlapping drug toxicities, implications of immune reconstitution inflammatory syndrome (IRIS), safety in pregnancy and research gaps are also explored.Expert opinion: New antiretroviral and anti-tuberculosis drugs have been recently introduced and international guidelines updated. A number of effective molecules and clinical data are now available to build treatment regimens for PLWH with latent or active TB. Adopting a systematic approach that also takes into account the need for individualized variations based on the available evidence is the key to successfully integrate ART and TB treatment and improve treatment outcomes.
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Affiliation(s)
- Maddalena Cerrone
- Department of Medicine, Imperial College London, W2 1PG, UK
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine and Department of Medicine, University of Cape Town, Observatory 7925, South Africa
- Department of HIV, Chelsea and Westminster Hospital NHS Trust, London, UK
- Francis Crick Institute, London, NW1 1AT, UK
| | - Margherita Bracchi
- Department of HIV, Chelsea and Westminster Hospital NHS Trust, London, UK
| | - Sean Wasserman
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine and Department of Medicine, University of Cape Town, Observatory 7925, South Africa
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Anton Pozniak
- Department of HIV, Chelsea and Westminster Hospital NHS Trust, London, UK
- The London School of Hygiene & Tropical Medicine
| | - Graeme Meintjes
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine and Department of Medicine, University of Cape Town, Observatory 7925, South Africa
| | - Karen Cohen
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, South Africa
| | - Robert J Wilkinson
- Department of Medicine, Imperial College London, W2 1PG, UK
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine and Department of Medicine, University of Cape Town, Observatory 7925, South Africa
- Francis Crick Institute, London, NW1 1AT, UK
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Bolhuis MS, Akkerman OW, Sturkenboom MGG, Ghimire S, Srivastava S, Gumbo T, Alffenaar JWC. Linezolid-based Regimens for Multidrug-resistant Tuberculosis (TB): A Systematic Review to Establish or Revise the Current Recommended Dose for TB Treatment. Clin Infect Dis 2019; 67:S327-S335. [PMID: 30496467 DOI: 10.1093/cid/ciy625] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Linezolid has been successfully used for treatment of multidrug-resistant tuberculosis (MDR-TB). However, dose- and duration-related toxicity limit its use. Here, our aim was to search relevant pharmacokinetics (PK)/pharmacodynamics (PD) literature to identify the effective PK/PD index and to define the optimal daily dose and dosing frequency of linezolid in MDR-TB regimens. The systematic search resulted in 8 studies that met inclusion criteria. A significant PK variability was observed. Efficacy of linezolid seems to be driven by area under the concentration-time curve (AUC)/minimum inhibitory concentration (MIC). Literature is inconclusive about the preferred administration of a daily dose of 600 mg. To prevent development of drug resistance, an AUC/MIC ratio of 100 in the presence of a companion drug at relevant exposure is required. A daily dose of 600 mg seems appropriate to balance between efficacy and toxicity. Being a drug with a very narrow therapeutic window, linezolid treatment may benefit from a more personalized approach, that is, measuring actual MIC values and therapeutic drug monitoring.
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Affiliation(s)
- Mathieu S Bolhuis
- Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen
| | - Onno W Akkerman
- Pulmonary Diseases and Tuberculosis, University Medical Center Groningen, University of Groningen.,Tuberculosis Center Beatrixoord, University Medical Center Groningen, University of Groningen, Haren, The Netherlands
| | - Marieke G G Sturkenboom
- Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen
| | - Samiksha Ghimire
- Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen
| | - Shashikant Srivastava
- Center for Infectious Diseases Research and Experimental Therapeutics, Baylor Research Institute, Baylor University Medical Center, Dallas, Texas
| | - Tawanda Gumbo
- Center for Infectious Diseases Research and Experimental Therapeutics, Baylor Research Institute, Baylor University Medical Center, Dallas, Texas
| | - Jan-Willem C Alffenaar
- Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen
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Zhang Z, Cheng Z, Liu Q, Shang T, Jiang L, Fu Z, Zhu K, Wang X, Chen J, Xu H. Safety of longer linezolid regimen in children with drug-resistant tuberculosis and extensive tuberculosis in Southwest China. J Glob Antimicrob Resist 2019; 21:375-379. [PMID: 31593796 DOI: 10.1016/j.jgar.2019.09.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 09/12/2019] [Accepted: 09/27/2019] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVES Linezolid (LNZ) has recently been listed by the World Health Organization (WHO) as a Group A agent for the treatment of multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) in longer regimens (18-20 months). However, little is known about the safety of LNZ in longer TB treatment regimens in children. METHODS Here we report 31 children who received LNZ treatment for drug-resistant tuberculosis (DR-TB) and extensive tuberculosis in the Children's Hospital of Chongqing Medical University, China, during September 2016 to March 2019. The mean duration of LNZ treatment was 8.56 months (range, 1-24 months). RESULTS Of the 31 patients, 13 (42%) had suspected or confirmed adverse events (AEs) related to LNZ treatment, including digestive symptoms, haematological toxicity, neuropathy and lactic acidosis. Haematological toxicity was the most frequent AE, presenting as leukopenia (9/13) and anaemia (5/13). No hepatotoxicity or nephrotoxicity was observed. Two patients suffered from life-threatening lactic acidosis when the LNZ dose was increased to 1.2 g daily, however they recovered following LNZ withdrawal. CONCLUSION A high rate of AEs of LNZ treatment was observed in children receiving a longer regimen, which might relate to the treatment course and dose. Haematological toxicity was the most frequent AE in children. It is necessary to regularly monitor the blood chemistry and lactic acid concentration during LNZ treatment.
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Affiliation(s)
- ZhenZhen Zhang
- Department of Infectious Diseases, Children's Hospital of Chongqing Medical University, Chongqing, China; Ministry of Education Key Laboratory of Child Development and Disorders, Key Laboratory of Pediatrics in Chongqing, Chongqing, China
| | - ZhenLi Cheng
- Department of Cardiology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - QuanBo Liu
- Department of Infectious Diseases, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - TingTing Shang
- Department of Infectious Diseases, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Li Jiang
- Department of Infectious Diseases, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Zhou Fu
- Department of Respiratory Diseases, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Kun Zhu
- Department of Radiology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Xiao Wang
- Department of Infectious Diseases, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Juan Chen
- Department of Infectious Diseases, Children's Hospital of Chongqing Medical University, Chongqing, China; The Key Laboratory of Molecular Biology of Infectious Diseases Designated by the Chinese Ministry of Education, Chongqing, China
| | - HongMei Xu
- Department of Infectious Diseases, Children's Hospital of Chongqing Medical University, Chongqing, China; Ministry of Education Key Laboratory of Child Development and Disorders, Key Laboratory of Pediatrics in Chongqing, Chongqing, China.
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Abstract
PURPOSE OF REVIEW This review aims to describe the key principles in treatment of drug-resistant tuberculosis (TB) in people living with HIV, including early access to timely diagnostics, linkage into care, TB treatment strategies including the use of new and repurposed drugs, co-management of HIV disease, and treatment complications and programmatic support to optimize treatment outcomes. These are necessary strategies to decrease the likelihood of poor treatment outcomes including lower treatment completion rates and higher mortality. RECENT FINDINGS Diagnosis of drug-resistant TB is the gateway into care; yet understanding the utility and the limitations of genotypic methods in this population is necessary. The principles of TB treatment in HIV-infected individuals are similar to those without HIV co-infection, with few exceptions. However, adverse effects with potential significant morbidity may emerge during treatment, and timely antiretroviral therapy is essential to improve mortality in this patient population. Emerging data on the use of new and repurposed drugs and short course multidrug-resistant TB regimens and adherence strategies benefiting this population are reviewed. SUMMARY The clinical complexity of co-managing drug-resistant TB and HIV, and the higher rate of poor treatment outcomes in this population demand careful clinical management strategies, and multidisciplinary and comprehensive programmatic interventions to optimize treatment success in this vulnerable group.
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46
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Wasserman S, Davis A, Wilkinson RJ, Meintjes G. Key considerations in the pharmacotherapy of tuberculous meningitis. Expert Opin Pharmacother 2019; 20:1791-1795. [PMID: 31305179 DOI: 10.1080/14656566.2019.1638912] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Sean Wasserman
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town , Cape Town , South Africa.,Division of Infectious Diseases and HIV Medicine, Department of Medicine, University of Cape Town , Cape Town , South Africa
| | - Angharad Davis
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town , Cape Town , South Africa.,Faculty of Life Sciences, University College London , London , UK.,The Francis Crick Institute , London , UK
| | - Robert J Wilkinson
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town , Cape Town , South Africa.,The Francis Crick Institute , London , UK.,Department of Medicine, Imperial College London , London , UK
| | - Graeme Meintjes
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town , Cape Town , South Africa.,Division of Infectious Diseases and HIV Medicine, Department of Medicine, University of Cape Town , Cape Town , South Africa
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47
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Yew WW, Chan DP, Chang KC. Does linezolid have a role in shortening treatment of tuberculosis? Clin Microbiol Infect 2019; 25:1060-1062. [PMID: 31238119 DOI: 10.1016/j.cmi.2019.06.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 06/16/2019] [Accepted: 06/17/2019] [Indexed: 10/26/2022]
Affiliation(s)
- W-W Yew
- Stanley Ho Centre for Emerging Infectious Diseases, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - D P Chan
- Stanley Ho Centre for Emerging Infectious Diseases, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - K-C Chang
- Tuberculosis and Chest Service, Centre for Health Protection, Department of Health, Hong Kong SAR, China.
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Linezolid Pharmacokinetics in South African Patients with Drug-Resistant Tuberculosis and a High Prevalence of HIV Coinfection. Antimicrob Agents Chemother 2019; 63:AAC.02164-18. [PMID: 30617089 DOI: 10.1128/aac.02164-18] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 12/14/2018] [Indexed: 12/24/2022] Open
Abstract
The World Health Organization (WHO) recently recommended that linezolid be prioritized in treatment regimens for drug-resistant tuberculosis (TB), but there are limited data on its pharmacokinetics (PK) in patients with this disease. We conducted an observational study to explore covariate effects on linezolid PK and to estimate the probability of PK/pharmacodynamic target attainment in South African patients with drug-resistant TB. Consecutive adults on linezolid-based regimens were recruited in Cape Town and underwent intensive PK sampling at steady state. Noncompartmental analysis was performed. Thirty participants were included: 15 HIV positive, 26 on the initial dose of 600 mg daily, and 4 participants on 300 mg daily after dose reduction for linezolid-related toxicity. There was a negative correlation between body weight and exposure, with 17.4% (95% confidence interval [CI], 0.1 to 31.7) decrease in area under the concentration-time curve from 0 to 24 h (AUC0-24) per 10-kg weight increment after adjustment for other covariates. Age was an independent predictor of trough concentration, with an estimated 43.4% (95% CI, 5.9 to 94.2) increase per 10-year increment in age. The standard 600-mg dose achieved the efficacy target of free AUC/MIC of >119 at wild-type MIC values (≤0.5 mg/liter), but the probability of target attainment dropped to 61.5% (95% CI, 40.6 to 79.8) at the critical concentration of 1 mg/liter. When dosed at 600 mg daily, trough concentrations were above the toxicity threshold of 2 mg/liter in 57.7% (95% CI, 36.9 to 76.6). This confirms the narrow therapeutic index of linezolid, and alternative dosing strategies should be explored.
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Hashemian SMR, Farhadi T, Ganjparvar M. Linezolid: a review of its properties, function, and use in critical care. DRUG DESIGN DEVELOPMENT AND THERAPY 2018; 12:1759-1767. [PMID: 29950810 PMCID: PMC6014438 DOI: 10.2147/dddt.s164515] [Citation(s) in RCA: 198] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Linezolid can be considered as the first member of the class of oxazolidinone antibiotics. The compound is a synthetic antibiotic that inhibits bacterial protein synthesis through binding to rRNA. It also inhibits the creation of the initiation complex during protein synthesis which can reduce the length of the developed peptide chains, and decrease the rate of reaction of translation elongation. Linezolid has been approved for the treatment of infections caused by vancomycin-resistant Enterococcus faecium, hospital-acquired pneumonia caused by Staphylococcus aureus, complicated skin and skin structure infections (SSSIs), uncomplicated SSSIs caused by methicillin-susceptible S. aureus or Streptococcus pyogenes, and community-acquired pneumonia caused by Streptococcus pneumoniae. Analysis of high-resolution structures of linezolid has demonstrated that it binds a deep cleft of the 50S ribosomal subunit that is surrounded by 23S rRNA nucleotides. Mutation of 23S rRNA was shown to be a linezolid resistance mechanism. Besides, mutations in specific regions of ribosomal proteins uL3 and uL4 are increasingly associated with linezolid resistance. However, these proteins are located further away from the bound drug. The methicillin-resistant S. aureus and vancomycin-resistant enterococci are considered the most common Gram-positive bacteria found in intensive care units (ICUs), and linezolid, as an antimicrobial drug, is commonly utilized to treat infected ICU patients. The drug has favorable in vitro and in vivo activity against the mentioned organisms and is considered as a useful antibiotic to treat infections in the ICU.
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Affiliation(s)
- Seyed Mohammad Reza Hashemian
- Chronic Respiratory Disease Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Tayebeh Farhadi
- Chronic Respiratory Disease Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mojdeh Ganjparvar
- Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran
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Wu X, Tang Y, Zhang X, Wu C, Kong L. Pharmacokinetics and pharmacodynamics of linezolid in plasma/cerebrospinal fluid in patients with cerebral hemorrhage after lateral ventricular drainage by Monte Carlo simulation. DRUG DESIGN DEVELOPMENT AND THERAPY 2018; 12:1679-1684. [PMID: 29928111 PMCID: PMC6001839 DOI: 10.2147/dddt.s168757] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Objective We investigated the pharmacokinetic (PK) and pharmacodynamic (PD) parameters of linezolid in patients who had suffered cerebral hemorrhage after lateral ventricular drainage. Materials and methods Ten patients with cerebral hemorrhage after lateral ventricular drainage with stroke-associated pneumonia who were given linezolid were enrolled. Plasma and cerebrospinal fluid (CSF) samples were taken at appropriate intervals after the first administration of linezolid and assayed by high-performance liquid chromatography (HPLC). Then, PK parameters were estimated, and a Monte Carlo simulation was used to calculate the probability of target attainments (PTAs) for linezolid achieving the PK/PD index at different minimal inhibitory concentrations (MICs). Results The maximum concentration of linezolid in plasma and CSF was reached at 1.00 h and 3.10 h, respectively. The average penetration of linezolid in CSF was 56.81%. If the area under the plasma concentration vs time curve from zero to the final sampling time (AUC0-24 h)/MIC ≥ 59.1 was applied as a parameter, the PTA of linezolid in plasma could provide good coverage (PTA ≥ 90%) only for pathogens with a MIC of ≤2 μg/mL, whereas it could be achieved in CSF with a MIC of ≤1 μg/mL. If %T > MIC ≥ 40% was applied as a parameter, the PTA of linezolid in plasma/CSF could provide good coverage if the MIC was ≤4 μg/mL. Conclusions For patients with infection of the central nervous system and who are sensitive to the drug, the usual dosing regimens of linezolid can achieve a good therapeutic effect. However, for critically ill or drug-resistant patients, an increase in dose, the frequency of administration, or longer infusion may be needed to improve the curative effect.
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Affiliation(s)
- Xiaofei Wu
- Department of Emergency Internal Medicine, the First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, People's Republic of China
| | - Yan Tang
- Department of Emergency Internal Medicine, the First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, People's Republic of China
| | - Xiaohua Zhang
- Department of Emergency Internal Medicine, the First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, People's Republic of China
| | - Chenchen Wu
- Department of Endocrinology, the First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, People's Republic of China
| | - Lingti Kong
- Department of Pharmacy, the First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, People's Republic of China
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