DOCSLIB.ORG

Successful Treatment of Rifampicin Resistant Case of Leprosy by WHO Recommended Ofloxacin and Minocycline Regimen

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Successful Treatment of Rifampicin Resistant Case of Leprosy by WHO Recommended Ofloxacin and Minocycline Regimen Lepr Rev (2019) 90, 456–459 CASE REPORT Successful treatment of rifampicin resistant case of leprosy by WHO recommended ofloxacin and minocycline regimen MALLIKA LAVANIAa, JOYDEEPA DARLONGb, ABHISHEK REDDYb, MADHVI AHUJAa, ITU SINGHa, R.P. TURANKARa & U. SENGUPTAa aStanley Browne Laboratory, The Leprosy Mission Community Hospital, Nand Nagri, New Delhi 110093, India bThe Leprosy Mission Hospital, Purulia, West Bengal 723101, India Accepted for publication 15 July 2019 Summary A 25-year-old male treated for leprosy at the age of 15, with MDT, visited TLM Purulia Hospital in July 2017. He was provisionally diagnosed as a lepromatous relapse with ENL reaction. A biopsy was done to test for drug resistance. Drug resistance testing showed resistance to rifampicin. Second line drug regimen recommended by WHO for rifampicin-resistance was started. Within 6 months of taking medication the clinical signs and symptoms improved rapidly and the BI dropped by 1·66 log within 6 months. This case highlights the need for investigations in cases of relapse and the efficacy of WHO recommended second line drug regimen treatment in rifampicin-resistant leprosy cases. Keywords: leprosy, rifampicin-resistance, second-line treatment Introduction Leprosy, also known as Hansen’s disease (HD), is a chronic infectious disease caused by the bacterium Mycobacterium leprae or Mycobacterium lepromatosis.1,2 Leprosy is curable with administration of a rifampicin, clofazimine and dapsone known as multidrug therapy (MDT). Since the introduction of MDT in 1983 the prevalence of leprosy has fallen significantly from 54 cases/10 000 in 1983 to ,1 case/10 000 in 2005 in India. However, from 2005 onwards the annual new case detection rate has remained somewhat static, with only a slight decline.3 While treatment for paucibacillary (PB) leprosy is with dapsone and rifampicin for six months,2 treatment for multibacillary (MB) leprosy is with the combination of rifampicin, dapsone, and clofazimine for 12 months.2 Regular reports of relapse in patients after Correspondence to: Mallika Lavania, Stanley Browne Laboratory, Nand Nagri, New Delhi, India (e-mail: [email protected], [email protected]) 456 0305-7518/19/064053+04 q Lepra Treatment of a rifampicin-resistant case 457 completion of a full course of MDT suggest the possibility of either reinfection, or the emergence of resistant strains of M. leprae under drug pressure. Drug resistance is a potential disrupter for any communicable disease control/elimination program. Although the number of leprosy samples so far tested globally is low,4 the results suggest that drug resistance may pose a serious threat to leprosy control. In recent studies especially from The Leprosy Mission (TLM) Trust India, we reported the emergence of primary rifampicin resistance as well as multidrug resistance cases5,6 from endemic regions of India. This report presents a case of rifampicin resistance and its management with the administration of alternative drug combinations. Case Summary A 25-year-old male treated for MB leprosy at the age of 15, with WHO MDT, visited TLM Hospital, Purulia in July 2017 with complaints of painful swelling on legs and a history of fever on and off for 2 weeks. There was no history of joint pains, red eyes or painful eruptions in the past. His family was of lower socioeconomic status and he worked as an apprentice in a garage. His mother has been treated for leprosy 10 years ago and his father and two brothers were also diagnosed cases of leprosy. He was of average height and moderate nutritional status and his systemic examination was normal. He was afebrile and had numerous flesh coloured nodules and papules on the extensor surfaces of hands and feet. They were painless and unnoticed by the patient. There were also a few subcutaneous nodules on the lower leg that were painful and reddish. There was grade 1 pitting oedema on both feet. Routine investigation revealed mild anaemia, Hb 9 gm/dl. Ziehl-Nelson staining of the slit skin smear was positive, with a bacteriological index (BI) of 5·66þ. He was provisionally diagnosed as having Erythema Nodosum Leprosum (ENL), complicating relapsed lepromatous leprosy. A skin biopsy was done for histopathology and polymerase chain reaction (PCR) for drug resistance testing. Histopathology reports confirmed active lepromatous leprosy with necrotizing ENL reaction. Sections showed atrophy of the epidermis. The dermis had a diffuse granulomatous inflammatory cell collection consisting of foamy macrophages, lymphocytes and neutrophils around blood vessels, along neuro vascular bundles and around one hair follicle. Granuloma fraction was <10%. Acid fast stain showed presence of numerous bacilli in both solid and fragmented forms. The BI of the granuloma was 5þ. Drug resistance testing by PCR sequencing was performed for gene targets rpoB, folP and gyrA pertaining to the drugs rifampicin, dapsone and ofloxacin respectively, followed by DNA sequencing (Figure 1). The M. leprae isolate from the patient was found to be resistant to rifampicin and sensitive to the other two drugs, dapsone and ofloxacin. Second line drug regimen recommended by WHO for rifampicin resistant cases was started from Oct 2017 consisting of minocycline (100 mg), ofloxacin (400 mg) and clofazimine (50 mg) daily for 6 months, followed by clofazimine (50 mg) plus ofloxacin (400 mg) daily for an additional 18 months. Dapsone was also continued. Within 6 months of taking medication the clinical conditions and signs and symptoms improved rapidly. The BI had dropped by 1·66 log to 4þ. 458 M. Lavania et al. Figure 1. Rifampicin resistant patient with mutation in rpoB gene at codon position 456 (Ser456Leu). There were further episodes of severe ENL during the course of his treatment which were treated successfully with steroids and hospitalization. He had gastritis and was treated with proton pump inhibitors. While he was on steroids, his pill burden was large. A general feeling of ill-being was prevalent for the entire course. Prolonged periods of illness prevented him from continuing his job, and he was depressed. This was managed by regular counselling and a supportive family. There was no nerve impairment during the entire treatment period. Discussion As in the cases of other infectious diseases, the relapse rate is a crucial parameter in assessing the long-term efficacy of chemotherapy. Though earlier studies with short-term follow-up have shown a good response, it is the long-term outcome of the treated patients that determines the ultimate utility of the therapeutic regimens.7 In 2017, a total of 35 cases were confirmed as relapse cases in TLM centres, while at national level in India the number was 536. Resistance will not be diagnosed unless it is investigated thoroughly. There must be a high index of suspicion when patients present with new signs and symptoms with a previous history of MDT intake. Clinicians must not hesitate to do histopathological examination and send samples for resistance testing. Protocols for resistant cases must be widely disseminated. The second line drugs for leprosy are essential to address the emerging problem of resistance to MDT, especially rifampicin. Rifampicin has strong bactericidal activities against M. leprae and is the only bactericidal drug in MDT. This drug binds with the b-subunit of RNA polymerase and inhibits RNA synthesis. Emerging reports of rifampicin Treatment of a rifampicin-resistant case 459 resistance stress the need for expansion of surveillance. There is also a need to regulate the global use of antimicrobial agents, as ofloxacin resistance probably develops in relation to the general intake of antibiotics for other infections.8 According to the guidelines of the Global Leprosy Programme for resistant leprosy cases, the patients who were reported to be resistant to dapsone only, standard MB-MDT can be continued, but the patient should be followed at the end of treatment and regularly examined for possible relapse. And for patients with resistance only to quinolones, MDT should be continued. Compliance must be strictly monitored and treatment completion rates must be 100 % in such cases. In cases of laboratory reported rifampicin-resistant M. leprae, second- line treatment consists of 400 mg ofloxacin þ100 mg minocycline þ50 mg clofazimine, daily for 6 months; followed by 400 mg ofloxacin OR 100 mg minocycline þ50 mg clofazimine daily for an additional 18 months. In a previous study, Ji et al.9 observed that gastrointestinal adverse events were mild and transitory among patients treated with the RMP-OFLO-MINO or OFLO-MINO combination, while in our study the patient had recurrent episodes of gastritis, abdominal pain, diarrhoea and vomiting requiring admission and frequent monitoring. Pill burden and loss of workdays caused depression and anxiety. However, there was no disability observed during the duration of treatment. Signs of the infection improved, skin lesions gradually subsided and his bacillary index had dropped by 1·66 log (to 4·0) after 1 year of treatment. To our knowledge, this is the first report of the outcome of second line drug regimen in the management of a rifampicin resistant case. Mono and multi drug resistance has emerged and it requires the expansion of surveillance in country programmes. Though numbers are small, there should be free provision of the alternate drug regimen within the public health system to enable adequate management of such cases. References 1 Hansen’s Disease (Leprosy). Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of High-Consequence Pathogens and Pathology (DHCPP). Archived from the original on 29 May 2019. https://www.cdc.gov/leprosy/index.html. (Accessed 10 February 2017). 2 Suzuki K, Akama T, Kawashima A, Yoshihara A, Yotsu RR, Ishii N. Current status of leprosy: Epidemiology, basic science and clinical perspectives. The J Dermat, 2012; 39(2): 121–129. 3 NLEP Annual Report 2016–17. Available from: http://nlep.nic.in/data.html.
Load more

Recommended publications
  • Clofazimine As a Treatment for Multidrug-Resistant Tuberculosis: a Review
    Scientia Pharmaceutica Review Clofazimine as a Treatment for Multidrug-Resistant Tuberculosis: A Review Rhea Veda Nugraha 1 , Vycke Yunivita 2 , Prayudi Santoso 3, Rob E. Aarnoutse 4 and Rovina Ruslami 2,* 1 Department of Biomedical Sciences, Faculty of Medicine, Universitas Padjadjaran, Bandung 40161, Indonesia; [email protected] 2 Division of Pharmacology and Therapy, Department of Biomedical Sciences, Faculty of Medicine, Universitas Padjadjaran, Bandung 40161, Indonesia; [email protected] 3 Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran—Hasan Sadikin Hospital, Bandung 40161, Indonesia; [email protected] 4 Department of Pharmacy, Radboud University Medical Center, Radboud Institute for Health Sciences, 6255HB Nijmegen, The Netherlands; [email protected] * Correspondence: [email protected] Abstract: Multidrug-resistant tuberculosis (MDR-TB) is an infectious disease caused by Mycobac- terium tuberculosis which is resistant to at least isoniazid and rifampicin. This disease is a worldwide threat and complicates the control of tuberculosis (TB). Long treatment duration, a combination of several drugs, and the adverse effects of these drugs are the factors that play a role in the poor outcomes of MDR-TB patients. There have been many studies with repurposed drugs to improve MDR-TB outcomes, including clofazimine. Clofazimine recently moved from group 5 to group B of drugs that are used to treat MDR-TB. This drug belongs to the riminophenazine class, which has lipophilic characteristics and was previously discovered to treat TB and approved for leprosy. This review discusses the role of clofazimine as a treatment component in patients with MDR-TB, and Citation: Nugraha, R.V.; Yunivita, V.; the drug’s properties.
    [Show full text]
  • Analysis of Mutations Leading to Para-Aminosalicylic Acid Resistance in Mycobacterium Tuberculosis
    www.nature.com/scientificreports OPEN Analysis of mutations leading to para-aminosalicylic acid resistance in Mycobacterium tuberculosis Received: 9 April 2019 Bharati Pandey1, Sonam Grover2, Jagdeep Kaur1 & Abhinav Grover3 Accepted: 31 July 2019 Thymidylate synthase A (ThyA) is the key enzyme involved in the folate pathway in Mycobacterium Published: xx xx xxxx tuberculosis. Mutation of key residues of ThyA enzyme which are involved in interaction with substrate 2′-deoxyuridine-5′-monophosphate (dUMP), cofactor 5,10-methylenetetrahydrofolate (MTHF), and catalytic site have caused para-aminosalicylic acid (PAS) resistance in TB patients. Focusing on R127L, L143P, C146R, L172P, A182P, and V261G mutations, including wild-type, we performed long molecular dynamics (MD) simulations in explicit solvent to investigate the molecular principles underlying PAS resistance due to missense mutations. We found that these mutations lead to (i) extensive changes in the dUMP and MTHF binding sites, (ii) weak interaction of ThyA enzyme with dUMP and MTHF by inducing conformational changes in the structure, (iii) loss of the hydrogen bond and other atomic interactions and (iv) enhanced movement of protein atoms indicated by principal component analysis (PCA). In this study, MD simulations framework has provided considerable insight into mutation induced conformational changes in the ThyA enzyme of Mycobacterium. Antimicrobial resistance (AMR) threatens the efective treatment of tuberculosis (TB) caused by the bacteria Mycobacterium tuberculosis (Mtb) and has become a serious threat to global public health1. In 2017, there were reports of 5,58000 new TB cases with resistance to rifampicin (frst line drug), of which 82% have developed multidrug-resistant tuberculosis (MDR-TB)2. AMR has been reported to be one of the top health threats globally, so there is an urgent need to proactively address the problem by identifying new drug targets and understanding the drug resistance mechanism3,4.
    [Show full text]
  • Drug Delivery Systems on Leprosy Therapy: Moving Towards Eradication?
    pharmaceutics Review Drug Delivery Systems on Leprosy Therapy: Moving Towards Eradication? Luíse L. Chaves 1,2,*, Yuri Patriota 2, José L. Soares-Sobrinho 2 , Alexandre C. C. Vieira 1,3, Sofia A. Costa Lima 1,4 and Salette Reis 1,* 1 Laboratório Associado para a Química Verde, Rede de Química e Tecnologia, Departamento de Ciências Químicas, Faculdade de Farmácia, Universidade do Porto, 4050-313 Porto, Portugal; [email protected] (A.C.C.V.); slima@ff.up.pt (S.A.C.L.) 2 Núcleo de Controle de Qualidade de Medicamentos e Correlatos, Universidade Federal de Pernambuco, Recife 50740-521, Brazil; [email protected] (Y.P.); [email protected] (J.L.S.-S.) 3 Laboratório de Tecnologia dos Medicamentos, Universidade Federal de Pernambuco, Recife 50740-521, Brazil 4 Cooperativa de Ensino Superior Politécnico e Universitário, Instituto Universitário de Ciências da Saúde, 4585-116 Gandra, Portugal * Correspondence: [email protected] (L.L.C.); shreis@ff.up.pt (S.R.) Received: 30 October 2020; Accepted: 4 December 2020; Published: 11 December 2020 Abstract: Leprosy disease remains an important public health issue as it is still endemic in several countries. Mycobacterium leprae, the causative agent of leprosy, presents tropism for cells of the reticuloendothelial and peripheral nervous system. Current multidrug therapy consists of clofazimine, dapsone and rifampicin. Despite significant improvements in leprosy treatment, in most programs, successful completion of the therapy is still sub-optimal. Drug resistance has emerged in some countries. This review discusses the status of leprosy disease worldwide, providing information regarding infectious agents, clinical manifestations, diagnosis, actual treatment and future perspectives and strategies on targets for an efficient targeted delivery therapy.
    [Show full text]
  • PRODUCT MONOGRAPH Prmycobutin
    PRODUCT MONOGRAPH PrMYCOBUTIN® (rifabutin capsules USP) 150 mg Capsules Antibacterial Agent Pfizer Canada ULC Date of Preparation: 17,300 Trans-Canada Highway 24 September 2003 Kirkland, Quebec H9J 2M5 Date of revision: February 11, 2021 Control No. 244143 ® Pharmacia & Upjohn Company LLC Pfizer Canada ULC, licensee Pfizer Canada ULC, 2021 PRODUCT MONOGRAPH NAME OF DRUG PrMYCOBUTIN® (rifabutin capsules USP) 150 mg Capsules THERAPEUTIC CLASSIFICATION Antibacterial Agent ACTION AND CLINICAL PHARMACOLOGY MYCOBUTIN (rifabutin) is a derivative of rifamycin S, belonging to the class of ansamycins. The rifamycins owe their antimycobacterial efficacy to their ability to penetrate the cell wall and to their ability to complex with and to inhibit DNA-dependent RNA polymerase. Rifabutin has been found to interact with and to penetrate the outer layers of the mycobacterial envelope. Rifabutin inhibits DNA-dependent RNA polymerase in susceptible strains of Escherichia coli and Bacillus subtilis but not in mammalian cells. In resistant strains of E. coli, rifabutin, like rifampin, did not inhibit this enzyme. It is not known whether rifabutin inhibits DNA-dependent RNA polymerase in Mycobacterium avium or in M. intracellulare which constitutes M. avium complex (MAC). Rifabutin inhibited incorporation of thymidine into DNA of rifampin-resistant M. tuberculosis suggesting that rifabutin may also inhibit DNA synthesis which may explain its activity against rifampin-resistant organisms. Following oral administration, at least 53% of MYCOBUTIN dose is rapidly absorbed with rifabutin peak plasma concentrations attained in 2 to 4 hours. High-fat meals slow the rate without influencing the extent of absorption of rifabutin from the capsule dosage form. The mean (± SD) absolute bioavailability assessed in HIV positive patients in a multiple dose study was 20% (±16%, n=5) on day 1 and 12% (± 5%, n=7) on day 28.
    [Show full text]
  • MDR-TB): Evidence and Perspectives
    Editorial Classification of drugs to treat multidrug-resistant tuberculosis (MDR-TB): evidence and perspectives Adrian Rendon1,2*, Simon Tiberi3*, Anna Scardigli4*, Lia D’Ambrosio5,6*, Rosella Centis5, Jose A. Caminero7, Giovanni Battista Migliori5 1Center for Research, Prevention and Treatment of Respiratory Infections, University Hospital Dr José Eleuterio Gonzalez, Monterrey, N.L., Mexico; 2Latin American Thoracic Association (ALAT); 3Division of Infection, Barts Health NHS Trust, London, UK; 4The Global Fund to Fight Aids, Tuberculosis and Malaria, Geneva, Switzerland; 5Maugeri Institute, IRCCS, Tradate, Italy; 6Public Health Consulting Group, Lugano, Switzerland; 7Pneumology Department, University Hospital of Gran Canaria “Dr. Negrin”, Las Palmas Gran Canaria, Spain *These authors contributed equally to this work. Correspondence to: Giovanni Battista Migliori. Maugeri Institute, IRCCS, Via Roncaccio 16, 21049 Tradate, Italy. Email: [email protected]. Submitted Aug 30, 2016. Accepted for publication Sep 05, 2016. doi: 10.21037/jtd.2016.10.14 View this article at: http://dx.doi.org/10.21037/jtd.2016.10.14 Multidrug-resistant (MDR) tuberculosis (TB) (defined Rationale basis of anti-TB treatment as resistance to at least isoniazid and rifampicin), has a The historical principles, derived from randomized clinical relevant epidemiological impact, with 480, 000 cases and trials (RCTs), are still valid: (I) combining different effective 190,000 deaths notified in 2014; 10% of them meet the drugs to prevent the selection of resistant mutants of M. criteria for extensively drug-resistant (XDR)-TB [MDR- tuberculosis; and (II) prolonging the treatment to sterilise the TB with additional resistance to any fluoroquinolone, infected tissues and, therefore, prevent relapse (1,9,10). and to at least one injectable second-line drugs (SLDs)] At least four drugs likely to be effective compose (capreomycin, kanamycin or amikacin) (1,2).
    [Show full text]
  • Alphabetical Listing of ATC Drugs & Codes
    Alphabetical Listing of ATC drugs & codes. Introduction This file is an alphabetical listing of ATC codes as supplied to us in November 1999. It is supplied free as a service to those who care about good medicine use by mSupply support. To get an overview of the ATC system, use the “ATC categories.pdf” document also alvailable from www.msupply.org.nz Thanks to the WHO collaborating centre for Drug Statistics & Methodology, Norway, for supplying the raw data. I have intentionally supplied these files as PDFs so that they are not quite so easily manipulated and redistributed. I am told there is no copyright on the files, but it still seems polite to ask before using other people’s work, so please contact <[email protected]> for permission before asking us for text files. mSupply support also distributes mSupply software for inventory control, which has an inbuilt system for reporting on medicine usage using the ATC system You can download a full working version from www.msupply.org.nz Craig Drown, mSupply Support <[email protected]> April 2000 A (2-benzhydryloxyethyl)diethyl-methylammonium iodide A03AB16 0.3 g O 2-(4-chlorphenoxy)-ethanol D01AE06 4-dimethylaminophenol V03AB27 Abciximab B01AC13 25 mg P Absorbable gelatin sponge B02BC01 Acadesine C01EB13 Acamprosate V03AA03 2 g O Acarbose A10BF01 0.3 g O Acebutolol C07AB04 0.4 g O,P Acebutolol and thiazides C07BB04 Aceclidine S01EB08 Aceclidine, combinations S01EB58 Aceclofenac M01AB16 0.2 g O Acefylline piperazine R03DA09 Acemetacin M01AB11 Acenocoumarol B01AA07 5 mg O Acepromazine N05AA04
    [Show full text]
  • Federal Register / Vol. 60, No. 80 / Wednesday, April 26, 1995 / Notices DIX to the HTSUS—Continued
    20558 Federal Register / Vol. 60, No. 80 / Wednesday, April 26, 1995 / Notices DEPARMENT OF THE TREASURY Services, U.S. Customs Service, 1301 TABLE 1.ÐPHARMACEUTICAL APPEN- Constitution Avenue NW, Washington, DIX TO THE HTSUSÐContinued Customs Service D.C. 20229 at (202) 927±1060. CAS No. Pharmaceutical [T.D. 95±33] Dated: April 14, 1995. 52±78±8 ..................... NORETHANDROLONE. A. W. Tennant, 52±86±8 ..................... HALOPERIDOL. Pharmaceutical Tables 1 and 3 of the Director, Office of Laboratories and Scientific 52±88±0 ..................... ATROPINE METHONITRATE. HTSUS 52±90±4 ..................... CYSTEINE. Services. 53±03±2 ..................... PREDNISONE. 53±06±5 ..................... CORTISONE. AGENCY: Customs Service, Department TABLE 1.ÐPHARMACEUTICAL 53±10±1 ..................... HYDROXYDIONE SODIUM SUCCI- of the Treasury. NATE. APPENDIX TO THE HTSUS 53±16±7 ..................... ESTRONE. ACTION: Listing of the products found in 53±18±9 ..................... BIETASERPINE. Table 1 and Table 3 of the CAS No. Pharmaceutical 53±19±0 ..................... MITOTANE. 53±31±6 ..................... MEDIBAZINE. Pharmaceutical Appendix to the N/A ............................. ACTAGARDIN. 53±33±8 ..................... PARAMETHASONE. Harmonized Tariff Schedule of the N/A ............................. ARDACIN. 53±34±9 ..................... FLUPREDNISOLONE. N/A ............................. BICIROMAB. 53±39±4 ..................... OXANDROLONE. United States of America in Chemical N/A ............................. CELUCLORAL. 53±43±0
    [Show full text]
  • Tuberculosis Drug Information Guide, 2Nd Edition
    Tuberculosis Drug Information Guide 2ND EDITION Edmund G. Brown Jr, Governor STATE OF CALIFORNIA Diana S. Dooley, Secretary CALIFORNIA HEALTH & HUMAN SERVICES AGENCY Ron Chapman, MD, MPH, Director DEPARTMENT OF PUBLIC HEALTH Tuberculosis Drug Information Guide 2ND EDITION Edmund G. Brown Jr, Governor STATE OF CALIFORNIA Diana S. Dooley, Secretary CALIFORNIA HEALTH & HUMAN SERVICES AGENCY Ron Chapman, MD, MPH, Director DEPARTMENT OF PUBLIC HEALTH DrugInfo_2ndEd_v9.indd 3 12/5/12 3:55 PM Tuberculosis Drug Information Guide, 2nd edition was created through a collaboration of the Curry International Tuberculosis Center (CITC) and the State of California Department of Public Health, Tuberculosis Control Branch (CDPH). CITC is a project of the University of California, San Francisco, funded by the Centers for Disease Control and Prevention (CDC). The development of this Guide was funded through CDC Cooperative Agreement U52 CCU 900454. Permission is granted for nonprofit educational use and library duplication and distribution. Suggested citation: Curry International Tuberculosis Center and California Department of Public Health, 2012: Tuberculosis Drug Information Guide, 2nd edition. This publication is available on the CITC website: http://www.currytbcenter.ucsf.edu/ tbdruginfo/ Design: Edi Berton Design DrugInfo_2ndEd_v9.indd 4 12/5/12 3:55 PM Contributors Acknowledgments Ann M. Loeffler, MD John S. Bradley, MD Pediatric Infectious Diseases Attending and Director of Pediatric Rady Children’s Hospital San Diego, San Diego, California Hospitalists at Randall Children’s Hospital at Legacy Emanuel, Daniel Deck, Pharm.D. Portland, Oregon Department of Pharmaceutical Services, Pediatric Tuberculosis Consultant, San Francisco General Hospital, California Curry International Tuberculosis Center, San Francisco, California David Forinash, RPh Randall Children’s Hospital at Legacy Emanuel, Portland, Oregon Charles A.
    [Show full text]
  • Antimicrobial Resistance in Bacteria
    Cent. Eur. J. Med. • 4(2) • 2009 • 141-155 DOI: 10.2478/s11536-008-0088-9 Central European Journal of Medicine Antimicrobial resistance in bacteria Review Article Katrijn Bockstael*, Arthur Van Aerschot** Laboratory for Medicinal Chemistry, Rega Institute for Medical Research, Katholieke Universiteit Leuven, 3000 Leuven, Belgium Received 9 July 2008; Accepted 17 November 2008 Abstract: The development of antimicrobial resistance by bacteria is inevitable and is considered as a major problem in the treatment of bacterial infections in the hospital and in the community. Despite efforts to develop new therapeutics that interact with new targets, resistance has been reported even to these agents. In this review, an overview is given of the many therapeutic possibilities that exist for treatment of bacterial infections and how bacteria become resistant to these therapeutics. Keywords: Antimicrobial agents • Resistance development • Efflux • Alteration of drug target • Antibacterials © Versita Warsaw and Springer-Verlag Berlin Heidelberg. 1. Introduction 2. Different mechanisms of resistance to antimicrobials The history of humankind can be regarded from a medical point of view as a struggle against infectious 2.1. Intrinsic resistance diseases. Infections were the leading cause of death Bacteria may be inherently resistant to an antimicrobial. th worldwide at the beginning of the 20 century. Since This passive resistance is a consequence of general the discovery of penicillin by Alexander Fleming in adaptive processes that are not necessary linked to a 1929 and the first introduction of the sulpha drugs by given class of antimicrobials. An example of natural Domagk in 1932, the number of new antimicrobials resistance is Pseudomonas aeruginosa, whose low available has increased tremendously between 1940 membrane permeability is likely to be a main reason for and 1960.
    [Show full text]
  • And Second-Line Drugs in a Murine Model of Tuberculosis
    Sterilizing Activities of Novel Combinations Lacking First- and Second-Line Drugs in a Murine Model of Tuberculosis Kathy Williams,a Austin Minkowski,a Opokua Amoabeng,a Charles A. Peloquin,b Dinesh Taylor,a Koen Andries,c Robert S. Wallis,d Khisimuzi E. Mdluli,e and Eric L. Nuermbergera,f Center for Tuberculosis Research, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USAa; College of Pharmacy, University of Florida, Gainesville, Florida, USAb; Tibotec BVBA, Johnson & Johnson, Beerse, Belgiumc; Pfizer Inc., Groton, Connecticut, USAd; Global Alliance for TB Drug Development, New York, New York, USAe; and Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USAf Novel oral regimens composed of new drugs with potent activity against Mycobacterium tuberculosis and no cross-resis- tance with existing agents are needed to shorten and simplify treatment for both drug-susceptible and drug-resistant tu- berculosis. As part of a continuing effort to evaluate novel drug combinations for treatment-shortening potential in a mu- rine model, we performed two long-term, relapse-based experiments. In the first experiment, several 3- and 4-drug Downloaded from combinations containing new agents currently in phase 2/3 trials (TMC207 [bedaquiline], PA-824 and PNU-100480 [sut- ezolid], and/or clofazimine) proved superior to the first-line regimen of rifampin, pyrazinamide, and isoniazid. TMC207 plus PNU-100480 was the most effective drug pair. In the second experiment, in which 3- and 4-drug combinations com- posed of TMC207 and pyrazinamide plus rifapentine, clofazimine, PNU-100480, or both rifapentine and clofazimine were evaluated, the rank order of drugs improving the sterilizing activity of TMC207 and pyrazinamide was as follows: rifapen- tine plus clofazimine > clofazimine > rifapentine > PNU-100480.
    [Show full text]
  • Common Study Protocol for Observational Database Studies WP5 – Analytic Database Studies
    Arrhythmogenic potential of drugs FP7-HEALTH-241679 http://www.aritmo-project.org/ Common Study Protocol for Observational Database Studies WP5 – Analytic Database Studies V 1.3 Draft Lead beneficiary: EMC Date: 03/01/2010 Nature: Report Dissemination level: D5.2 Report on Common Study Protocol for Observational Database Studies WP5: Conduct of Additional Observational Security: Studies. Author(s): Gianluca Trifiro’ (EMC), Giampiero Version: v1.1– 2/85 Mazzaglia (F-SIMG) Draft TABLE OF CONTENTS DOCUMENT INFOOMATION AND HISTORY ...........................................................................4 DEFINITIONS .................................................... ERRORE. IL SEGNALIBRO NON È DEFINITO. ABBREVIATIONS ......................................................................................................................6 1. BACKGROUND .................................................................................................................7 2. STUDY OBJECTIVES................................ ERRORE. IL SEGNALIBRO NON È DEFINITO. 3. METHODS ..........................................................................................................................8 3.1.STUDY DESIGN ....................................................................................................................8 3.2.DATA SOURCES ..................................................................................................................9 3.2.1. IPCI Database .....................................................................................................9
    [Show full text]
  • WHO Consolidated Guidelines on Drug-Resistant Tuberculosis Treatment WHO Consolidated Guidelines on Drug-Resistant Tuberculosis Treatment
    WHO consolidated guidelines on drug-resistant tuberculosis treatment WHO consolidated guidelines on drug-resistant tuberculosis treatment ISBN 978-92-4-155052-9 © World Health Organization 2019 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. If you create a translation of this work, you should add the following disclaimer along with the suggested citation: “This translation was not created by the World Health Organization (WHO). WHO is not responsible for the content or accuracy of this translation. The original English edition shall be the binding and authentic edition”. Any mediation relating to disputes arising under the licence shall be conducted in accordance with the mediation rules of the World Intellectual Property Organization. Suggested citation. WHO consolidated guidelines on drug-resistant tuberculosis treatment. Geneva: World Health Organization; 2019. Licence: CC BY-NC-SA 3.0 IGO. Cataloguing-in-Publication (CIP) data. CIP data are available at http://apps.who.int/iris. Sales, rights and licensing. To purchase WHO publications, see http://apps.who.int/bookorders.
    [Show full text]