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Rao PS, Reed K, Modi N, Handler D, de Guex KP, Yu S, Kagan L, Reiss R, Narayanan N, Peloquin CA, Lardizabal A, Vinnard C, Thomas TA, Xie YL, Heysell SK. Isoniazid urine spectrophotometry for prediction of serum pharmacokinetics in adults with TB. IJTLD Open 2024; 1:90-95. [PMID: 38655375 PMCID: PMC11037464 DOI: 10.5588/ijtldopen.23.0361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
BACKGROUND Isoniazid (INH) is an important drug in many TB regimens, and unfavorable treatment outcomes can be caused by suboptimal pharmacokinetics. Dose adjustment can be personalized by measuring peak serum concentrations; however, the process involves cold-chain preservation and laboratory techniques such as liquid chromatography (LC)/mass spectrometry (MS), which are unavailable in many high-burden settings. Urine spectrophotometry could provide a low-cost alternative with simple sampling and quantification methods. METHODS We enrolled 56 adult patients on treatment for active TB. Serum was collected at 0, 1, 2, 4, 6, and 8 h for measurement of INH concentrations using validated LC-MS/MS methods. Urine was collected at 0-4, 4-8, and 8-24 h intervals, with INH concentrations measured using colorimetric methods. RESULTS The median peak serum concentration and total serum exposure over 24 h were 4.8 mg/L and 16.4 mg*hour/L, respectively. Area under the receiver operator characteristic curves for urine values predicting a subtherapeutic serum concentration (peak <3.0 mg/L) were as follows: 0-4 h interval (AUC 0.85, 95% CI 0.7-0.96), 0-8 h interval (AUC 0.85, 95% CI 0.71-0.96), and 0-24 h urine collection interval (AUC 0.84, 95% CI 0.68-0.96). CONCLUSION Urine spectrophotometry may improve feasibility of personalized dosing in high TB burden regions but requires further study of target attainment following dose adjustment based on a urine threshold.
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Affiliation(s)
- P S Rao
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA
| | - K Reed
- School of Arts and Sciences, University of Virginia, Charlottesville, VA
| | - N Modi
- Public Health Research Institute and Global Tuberculosis Institute, Rutgers New Jersey Medical School, Newark, NJ
| | - D Handler
- Public Health Research Institute and Global Tuberculosis Institute, Rutgers New Jersey Medical School, Newark, NJ
| | - K Petros de Guex
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA
| | - S Yu
- Department of Pharmaceutics and Center of Excellence for Pharmaceutical Translational Research and Education, Ernest Mario School of Pharmacy, Rutgers State University of New Jersey, Newark, NJ
| | - L Kagan
- Department of Pharmaceutics and Center of Excellence for Pharmaceutical Translational Research and Education, Ernest Mario School of Pharmacy, Rutgers State University of New Jersey, Newark, NJ
| | - R Reiss
- Public Health Research Institute and Global Tuberculosis Institute, Rutgers New Jersey Medical School, Newark, NJ
| | - N Narayanan
- Department of Pharmaceutics and Center of Excellence for Pharmaceutical Translational Research and Education, Ernest Mario School of Pharmacy, Rutgers State University of New Jersey, Newark, NJ
| | - C A Peloquin
- College of Pharmacy and Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
| | - A Lardizabal
- Public Health Research Institute and Global Tuberculosis Institute, Rutgers New Jersey Medical School, Newark, NJ
| | - C Vinnard
- Public Health Research Institute and Global Tuberculosis Institute, Rutgers New Jersey Medical School, Newark, NJ
| | - T A Thomas
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA
| | - Y L Xie
- Public Health Research Institute and Global Tuberculosis Institute, Rutgers New Jersey Medical School, Newark, NJ
| | - S K Heysell
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA
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Gobaud AN, Haley CA, Wilson JW, Bhavaraju R, Lardizabal A, Seaworth BJ, Goswami ND. Multidrug-resistant tuberculosis care in the United States. Int J Tuberc Lung Dis 2020; 24:409-413. [PMID: 32317065 DOI: 10.5588/ijtld.19.0515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: To examine the utilization of the Tuberculosis (TB) Centers of Excellence (COE) medical consultation service and evaluate how these services were being employed for patients in relation to multidrug-resistant TB (MDR-TB).METHODS: Medical consults are documented in a secure database. The database was queried for MDR-TB consultations over the period 1 January 2013-31 December 2017. All were analyzed to assess provider type, center, setting, year of call, and type of patient (pediatric vs. adult). A subgroup was randomly selected for thematic analysis.RESULTS: The centers received 1560 MDR-TB consultation requests over this period. Providers requesting consults were primarily physicians (55%). The majority of requests were from public health departments (64%) and for adult patients (80%). Four major topic areas emerged: 1) initial management of MDR-TB, 2) MDR-TB longitudinal treatment and complications, 3) management of persons exposed to MDR-TB, and 4) MDR-TB treatment completion.CONCLUSIONS: Analysis of these consultations provides insight into the type of expert advice about MDR-TB that was provided. These findings highlight topics where increased medical training and education may help to improve MDR-TB-related practices.
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Affiliation(s)
- A N Gobaud
- Rollins School of Public Health, Emory University, Atlanta, GA
| | - C A Haley
- Southeastern National TB Center at University of Gainesville, Gainesville, FL
| | - J W Wilson
- Mayo Clinic Center for Tuberculosis, Rochester, MN
| | - R Bhavaraju
- Global TB Institute at Rutgers, The State University of New Jersey, Newark, NJ
| | - A Lardizabal
- Global TB Institute at Rutgers, The State University of New Jersey, Newark, NJ
| | - B J Seaworth
- Heartland National Tuberculosis Center and University of Texas Health Science Center, Tyler, TX
| | - N D Goswami
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
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