Multidrug-resistant tuberculosi

Isoniazid and rifampin are the two most important tuberculosis drugs organisms resistant to both these drugs [multidrug-resistant tuberculosis (MDR-TB)] are much more difficult to treat. 

Multidrug resistant tuberculosis (TB) The presence of at least 1% of Mycobacterium strains in a bacterial population or culture that are resistant to at least isoniazid and rifampin. 

Johnson BJ et al. Differential gene expression in response to adjunctive recombinant human interleukin-2 immunotherapy in multidrug-resistant tuberculosis patients. Infect Immunity 1998 66 2426-2433. 

Wells CD, Cegielski JP, Nelson LJ, Laserson KF, Holtz TH, Finlay A et al. HIV infection and multidrug-resistant tuberculosis the perfect storm. J Infect Dis 2007 196 S86-107. 

After oral administration, it is rapidly absorbed and is distributed in various body tissues including CSF. It is excreted largely unchanged in urine by glomerular filtration. It is used for treatment of multidrug resistant tuberculosis with other primary drugs. It is also used in acute urinary tract infections caused by susceptible microorganisms. 

Fortun J et al Linezolid for the treatment of multidrug-resistant tuberculosis. J Antimicrob Chemother 2005 56 180. [PMID 15911549]... 

In the treatment of tuberculosis, resistant strains of M. tuberculosis (multidrug-resistant tuberculosis, MDRTB) present a growing problem, so that new antituber-culotic agents are required which act according to a different mechanism to that of standard agents such as isoniazid, rifampicin, pyrazinamide, and ethambutol. The more modern fluoroquinolones are of particular interest, and in particular moxifloxacin, which has powerful in vitro and in vivo activity and, in contrast to sparfloxacin and clinafloxacin, is not photo toxic [191]. 

Amaral et al. [3] prepared a review providing cogent evidence that both intracellular multidrug-resistant tuberculosis (MDRTB) and intracellular methicillin-resistant Staphylococcus aureus (MRSA) can be killed by concentrations of thioridazine in the medium that is below that present in the plasma of the patients treated with this agent. Although thioridazine has been claimed to cause arrhythmias and even sudden death, the frequencies of those episodes are rare and, when present, they are related to a patient s underlying cardiac status, as opposed to the direct effect of the agent itself. 

Psychosis occurred in a 32-year-old woman who was taking ciprofloxacin for multidrug resistant tuberculosis the symptoms resolved within 48 hours after the ciprofloxacin was withdrawn (169). 

World Health Organization. (2006b). Drug- and multidrug-resistant tuberculosis (MDR-TB)—Frequently asked questions. Retrieved March 27, 2007 from http //www.who.int/ tb/dots/dotsplus/faq/en/index.html... 

The pharmacokinetics and toxicity of liposomal amikacin have been investigated in a patient treated for advanced pulmonary multidrug-resistant tuberculosis (14). The... 

Whitehead TC, Lovering AM, Cropley IM, Wade P, Davidson RN. Kinetics and toxicity of liposomal and conventional amikacin in a patient with multidrug-resistant tuberculosis. Eur J Clin Microbiol Infect Dis 1998 17(ll) 794-7. 

Treatment problems that can arise are mainly of two types adverse reactions (collateral, toxic, or hypersusceptibility reactions), and initial or acquired resistance of Mycobacterium tuberculosis, Mycobacterium bovis, or non-tuberculous mycobacteria to one or more of the antituberculosis drugs. The latter probably only occurs when the patient has not taken the full combination or the full doses of the drugs all the time. Combination formulations are thus particularly useful. Multidrug-resistant tuberculosis, defined as resistance against at least isoniazid and rifampicin, is the most clinically relevant form of resistance to treatment worldwide. 

Multidrug-resistant tuberculosis generally results from inadequate therapy or lack of compliance with therapy. A strain of mycobacteria is called resistant when it is insensitive to one of the first-line drugs. It is called multiresistant when it is insensitive to both isoniazid and rifampicin. In this case other antituberculosis drugs may also be ineffective (35). In practice, at least two second-line antituberculosis drugs, selected on the basis of individual drug susceptibility, are given in combination with a fluoroquinolone (36). 

Furin JJ, Mitnick CD, Shin SS, Bayona J, Becerra MC, Singler JM, Alcantara F, Castanieda C, Sanchez E, Acha J, Farmer PE, Kim JY. Occurrence of serious adverse effects in patients receiving community-based therapy for multidrug-resistant tuberculosis. Int J Tuberc Lung Dis 2001 5(7) 648-55. 

Tahaoglu K, Torun T, Sevim T, Atac G, Kir A, Karasulu L, Ozmen I, Kapakli N. The treatment of multidrug-resistant tuberculosis in Turkey. N Engl J Med 2001 345(3) 170-4. 

Isemau MD. Treatmeut of multidrug-resistant tuberculosis. N Engl J Med 1993 329(11) 784-91. 

Of 17 individuals with suspected latent multidrug-resistant tuberculosis treated with pyrazinamide and levofloxacin, 11 developed musculoskeletal adverse effects related to therapy, 5 had nervous system effects, and 15 had raised liver enzymes, uric acid, or creatinine kinase (4). 

Papastavros T, Dolovich LR, Holbrook A, Whitehead L, Loeb M. Adverse events associated with pyrazinamide and levofloxacin in the treatment of latent multidrug-resistant tuberculosis. CMAJ 2002 167(2) 131-6. 

Lou HX, Shullo MA, McKaveney TP. Limited tolerability of levofloxacin and pyrazinamide for multidrug-resistant tuberculosis prophylaxis in a solid organ transplant population. Pharmacotherapy 2002 22(6) 701-4. 

Phototoxicity occurred in four of nine patients with multidrug-resistant tuberculosis treated with a combination of sparfloxacin (400 mg/day), ethionamide, and kana-mycin (initially for 3-4 months) (16). It occurred after several months of treatment and was presumably due to... 

In 25 patients taking sparfloxacin for multidrug-resistant tuberculosis, there were five mild phototoxic reactions (12). 

Interferon-y (IFN-y) (Actimmune) activates macrophages to kill M. tuberculosis. Aerosol delivery of IFN-y to the Inngs of patients with multidrug-resistant tuberculosis results in wide pulmonary distribution and enhanced local immune stimulation. 

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