Multi-drug-resistant tuberculosis medical therapy: Difference between revisions
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==Overview== | ==Overview== | ||
==Medical Therapy== | ==Medical Therapy== | ||
{{ | ===Drugs Used in Drug-Resistant Tuberculosis=== | ||
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# | ! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Groups}} | ||
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Drugs}} | |||
# | |- | ||
# | | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | Group 1: <br> First-line oral drugs | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | |||
* [[Pyrazinamide]] | |||
* [[Ethambutol]] | |||
* [[Rifabutin]] | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | Group 2: <br> Injectable drugs | |||
| style="padding: 5px 5px; background: #F5F5F5;" | | |||
*[[Kanamycin]] | |||
*[[Amikacin]] | |||
*[[Capreomycin]] | |||
*[[Streptomycin]] | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | Group 3: Fluoroquinolones | |||
| style="padding: 5px 5px; background: #F5F5F5;" | | |||
*[[Levofloxacin]] | |||
*[[Moxifloxacin]] | |||
*[[Ofloxacin]] | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | Group 4: <br> Oral bacteriostatic second-line drugs | |||
| style="padding: 5px 5px; background: #F5F5F5;" | | |||
*Para-[[aminosalicylic acid]] | |||
*[[Cycloserine]] | |||
*[[Terizidone]] | |||
*[[Ethionamide]] | |||
*[[Protionamide]] | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | Group 5: <br> Agents with unclear role in treatment of drug resistant-TB | |||
| style="padding: 5px 5px; background: #F5F5F5;" | | |||
*[[Clofazimine]] | |||
*[[Linezolid]] | |||
*[[Amoxicillin]]/[[clavulanate]] | |||
*[[Thioacetazone]] | |||
*[[Imipenem]]/[[cilastatin]] | |||
*High-dose [[isoniazid]] | |||
*[[Clarithromycin]] | |||
|- | |||
| style="padding: 5px 5px; background: #F5F5F5;" colspan=2| <small>Adapted from WHO 2013 Treatment of Tuberculosis: Guidelines – 4th ed.<ref name="WHO 2013"> {{cite web| url=http://www.who.int/tb/publications/tb_treatmentguidelines/en/| title=2013 WHO Treatment of Tuberculosis: Guidelines for National Programmes (4th Edition) }}</ref></small> | |||
|} | |||
Treatment | ==MDR Tuberculosis Regimen<small><small><small> Adapted from WHO 2013 Treatment of Tuberculosis: Guidelines – 4th ed. <ref name="WHO 2013"> {{cite web| url=http://www.who.int/tb/publications/tb_treatmentguidelines/en/| title=2013 WHO Treatment of Tuberculosis: Guidelines for National Programmes (4th Edition) }}</ref></small></small></small>== | ||
*MDR-TB is defined as resistance to [[isoniazid]] and [[rifampicin]], with or without resistance to other first-line drugs. | |||
*Medical treatment for MDR-TB consists of at least 4 drugs that have shown effectiveness against MDR. Within these 4 drugs must be included at least one drug from each group. | |||
*Treatment duration will depend on the culture results. The duration of therapy should be > 18 months after culture is negative. | |||
*Chronic cases with severe pulmonary disease may require more than 24 months of therapy. | |||
*Empirical treatment should start immediately and the regimen should be modified according to the [[DST]] ([[Drug susceptibility testing]]) results. | |||
*Drugs in each group must be used, in order of preference, as shown below.<ref name="CamineroSotgiu2010">{{cite journal|last1=Caminero|first1=José A|last2=Sotgiu|first2=Giovanni|last3=Zumla|first3=Alimuddin|last4=Migliori|first4=Giovanni Battista|title=Best drug treatment for multidrug-resistant and extensively drug-resistant tuberculosis|journal=The Lancet Infectious Diseases|volume=10|issue=9|year=2010|pages=621–629|issn=14733099|doi=10.1016/S1473-3099(10)70139-0}}</ref> | |||
*The following treatment regimens show daily dosing for each drug. | |||
<SMALL><font color="#FF4C4C">'''▸ Click on the following categories to expand treatment regimens.'''</font></SMALL> | |||
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<font color="#FFF"> | |||
'''MDR Tuberculosis''' | |||
</font> | |||
</div> | |||
<div class="mw-customtoggle-table01" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;"> | |||
<font color="#FFF"> | |||
▸ '''Adults''' | |||
</font> | |||
</div> | |||
<div class="mw-customtoggle-table02" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;"> | |||
<font color="#FFF"> | |||
▸ '''Children''' | |||
</font> | |||
</div> | |||
| valign=top | | |||
--><ref name=" | {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table01" style="background: #FFFFFF;" | ||
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{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;" | |||
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|MDR-TB Adults}} | |||
|- | |||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Standard Regimen''''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | '''<u>Group 1: First-line oral drugs</u>''' <br> | |||
| | ▸ ''' [[Pyrazinamide]] 20–30 mg/kg''' <br> OR <br> ▸ '''[[Ethambutol]] 15–25 mg/kg''' <br> OR <br> ▸ '''[[Rifabutin]] 5 mg/kg''' | ||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | '''<u>Group 2: Injectable drugs</u>''' <br> | |||
▸ '''[[Capreomycin]] 15 mg/kg'''<br> OR <br> ▸ '''[[Kanamycin]] 15 mg/kg'''<br> OR <br> ▸ '''[[Amikacin]] 7.5-10 mg/kg'''<br> OR <br> ▸ '''[[Streptomycin]] 12–18 mg/kg''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | '''<u>Group 3: Fluoroquinolones</u>''' <br> | |||
▸ '''[[Levofloxacin]] 500-1000 mg'''<br> OR <br> ▸ '''[[Moxifloxacin]] 400 mg'''<br> OR <br> ▸ '''[[Ofloxacin]] 400 mg''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | '''<u>Group 4:Oral bacteriostatic second-line drugs</u>''' <br> | |||
▸ '''[[Ethionamide]] 15-20 mg/kg'''<br> OR <br> ▸ '''[[Protionamide]] 15-20 mg/kg''' <br> OR <br> ▸ '''[[Cycloserine]] 10-15 mg/kg'''<br> OR <br> ▸ '''[[Terizidone]] 10-20 mg/kg '''<br> OR <br>▸ '''[[Aminosalicylic acid|Para-aminosalicylic acid]] 8-12 g/d divided q8-12h''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5;" align=left |<small>Table adapted from WHO 2013 Treatment of Tuberculosis: Guidelines – 4th ed.<ref name="WHO 2013"> {{cite web| url=http://www.who.int/tb/publications/tb_treatmentguidelines/en/| title=2013 WHO Treatment of Tuberculosis: Guidelines for National Programmes (4th Edition) }}</ref></small> | |||
|} | |||
|} | |||
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table02" style="background: #FFFFFF;" | |||
| valign=top | | |||
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;" | |||
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|MDR-TB Children}} | |||
|- | |||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Standard Regimen''''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | '''<u>Group 1: First-line oral drugs</u>''' <br> | |||
▸ ''' [[Pyrazinamide]] 20-30 mg/kg (Max: 600 mg)''' <br> OR <br> ▸ '''[[Ethambutol]] 15-20 mg/kg''' <br> OR <br> ▸ '''[[Rifabutin]] 5 mg/kg''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | '''<u>Group 2: Injectable drugs</u>''' <br> | |||
▸ '''[[Capreomycin]] 15-30 mg/kg (Max: 1000 mg)'''<br> OR <br> ▸ '''[[Kanamycin]] 15-30 mg/kg (Max: 1000 mg)'''<br> OR <br> ▸ '''[[Amikacin]] 15-22.5 mg/kg (Max: 1000 mg)'''<br> OR <br> ▸ '''[[Streptomycin]] 12-18 mg/kg''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | '''<u>Group 3: Fluoroquinolones</u>''' <br> | |||
▸ '''[[Levofloxacin]] 7.5-10 mg/kg'''<br> OR <br> ▸ '''[[Moxifloxacin]] 7.5-10 mg/kg'''<br> OR <br> ▸ '''[[Ofloxacin]] 15-20 mg/kg divided q12h (Max:800 mg)''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | '''<u>Group 4:Oral bacteriostatic second-line drugs</u>''' <br> | |||
▸ '''[[Ethionamide]] 15-20 mg/kg divided q12h (Max: 1000 mg)'''<br> OR <br> ▸ '''[[Protionamide]] 15-20 mg/kg divided q12h (Max: 1000 mg)''' <br> OR <br> ▸ '''[[Cycloserine]] 10-20 mg/kg (Max: 1000 mg)'''<br> OR <br> ▸ '''[[Terizidone]] 10-20 mg/kg (Max: 1000 mg)'''<br> OR <br> ▸ '''[[Aminosalicylic acid|Para-aminosalicylic acid]] 150 mg/kg divided q8-12h(Max: 12 000 mg)''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5;" align=left |<small>Table adapted from WHO 2013 Treatment of tuberculosis: guidelines – 4th ed.<ref name="WHO 2013"> {{cite web| url=http://www.who.int/tb/publications/tb_treatmentguidelines/en/| title=2013 WHO Treatment of Tuberculosis: Guidelines for National Programmes (4th Edition) }}</ref> and Guidance for national tuberculosis programmes on the management of tuberculosis in children <ref name="WHO TB Children"> {{cite web |url=http://apps.who.int/iris/bitstream/10665/112360/1/9789241548748_eng.pdf| title=WHO Guidance for national tuberculosis programmes on the management of tuberculosis in children, 2014}} </ref></small> | |||
|} | |||
|} | |||
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==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} |
Revision as of 12:28, 25 September 2014
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Medical Therapy
Drugs Used in Drug-Resistant Tuberculosis
Groups | Drugs |
---|---|
Group 1: First-line oral drugs |
|
Group 2: Injectable drugs |
|
Group 3: Fluoroquinolones | |
Group 4: Oral bacteriostatic second-line drugs |
|
Group 5: Agents with unclear role in treatment of drug resistant-TB |
|
Adapted from WHO 2013 Treatment of Tuberculosis: Guidelines – 4th ed.[1] |
MDR Tuberculosis Regimen Adapted from WHO 2013 Treatment of Tuberculosis: Guidelines – 4th ed. [1]
- MDR-TB is defined as resistance to isoniazid and rifampicin, with or without resistance to other first-line drugs.
- Medical treatment for MDR-TB consists of at least 4 drugs that have shown effectiveness against MDR. Within these 4 drugs must be included at least one drug from each group.
- Treatment duration will depend on the culture results. The duration of therapy should be > 18 months after culture is negative.
- Chronic cases with severe pulmonary disease may require more than 24 months of therapy.
- Empirical treatment should start immediately and the regimen should be modified according to the DST (Drug susceptibility testing) results.
- Drugs in each group must be used, in order of preference, as shown below.[2]
- The following treatment regimens show daily dosing for each drug.
▸ Click on the following categories to expand treatment regimens.
MDR Tuberculosis ▸ Adults ▸ Children |
|
References
- ↑ 1.0 1.1 1.2 1.3 "2013 WHO Treatment of Tuberculosis: Guidelines for National Programmes (4th Edition)".
- ↑ Caminero, José A; Sotgiu, Giovanni; Zumla, Alimuddin; Migliori, Giovanni Battista (2010). "Best drug treatment for multidrug-resistant and extensively drug-resistant tuberculosis". The Lancet Infectious Diseases. 10 (9): 621–629. doi:10.1016/S1473-3099(10)70139-0. ISSN 1473-3099.
- ↑ "WHO Guidance for national tuberculosis programmes on the management of tuberculosis in children, 2014" (PDF).