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Intensified regimen containing rifampicin and moxifloxacin for tuberculous meningitis: an open-label, randomised controlled phase 2 trial.

BACKGROUND: Intensified antibiotic treatment might improve the outcome of tuberculous meningitis. We assessed pharmacokinetics, safety, and … ifloxacin 800 mg, or ethambutol 750 mg once daily. All patients were given standard-dose isoniazid, pyrazinamide, and adjunctive corticosteroids. After 14 days of treatment all patients continued with standard treatment for tuberculosis. Endpoints included pharmacokinetic analyses of the blood and cerebrospinal fluid, adverse events attributable to tuberculosi …

The transpedicular approach in the management of thoracic spine tuberculosis: a short-term follow up study.

STUDY DESIGN: A retrospective descriptive assessment of the clinical and radiologic outcomes of 11 patients who underwent transpedicular decompression for thoracic spine tuberculosis. OBJECTIVES: To study the neurologic and radiologic outcomes in patients who underwent transpedicular decompression for thoracic spine tuberculosis. SUMMARY OF BACKGROUND DATA: Several approaches have been used in the management of thoracic spine tuberculosis to achieve the goals of decompression of the cord followed by immobilization and antituberculous therapy. These range from conservative regimens of compute

A rare case of multiple brain abscesses caused by Nocardia abscessus co-infection with tuberculous meningitis in an immunocompetent patient.

BACKGROUND: Nocardial brain abscesses are extremely rare and predominantly affect immunocompromised patients, exhibiting a high overall mort … atient was started on isoniazid 600 mg/day via intravenous injection, rifampicin 600 mg/day orally, pyrazinamide 1500 mg/day (divided into three oral doses), ethambutol 750 mg/day orally, and dexamethasone at an initial dose of 0.4 mg/kg/day, with a planned gradual reduction starting one week later. Despite 10 days of treatment, the patient showed no significa …

Artificial intelligence enabled parabolic response surface platform identifies ultra-rapid near-universal TB drug treatment regimens comprising approved drugs.

BACKGROUND: Shorter, more effective treatments for tuberculosis (TB) are urgently needed. While many TB drugs are available, identification … ent regimens, designated PRS Regimens IV and V, consisting of clofazimine (CFZ), bedaquiline (BDQ), pyrazinamide (PZA), and either amoxicillin/clavulanate (AC) or delamanid (DLM), respectively. We then evaluated the efficacy in mice of optimized PRS Regimens IV and V, as well as a 3-drug regimen, PRS Regimen VI (CFZ, BDQ, and PZA), and compared their efficacy …

Provisional CDC guidelines for the use and safety monitoring of bedaquiline fumarate (Sirturo) for the treatment of multidrug-resistant tuberculosis.

Multidrug-resistant tuberculosis (MDR TB) is caused by Mycobacterium tuberculosis that is resistant to at least isoniazid and rifampin, the two most effective of the four first-line TB drugs (the other two drugs being ethambutol and pyrazinamide). MDR TB includes the subcategory of extensively drug-resistant TB (XDR TB), which is MDR TB with additional resistance to any fluoroquinolone and to at least one of three injectable anti-TB drugs (i.e., kanamycin, capreomycin, or amikacin). MDR TB is difficult to cure, requiring 18-24 months of treatment after sputum culture conversion with a regimen …

Impact of country of origin on drug-resistant tuberculosis among foreign-born persons in British Columbia.

SETTING: Provincial tuberculosis (TB) services, British Columbia, Canada. OBJECTIVES: To estimate the risk of drug resistance among foreign-born TB patients and to identify risk factors associated with drug resistance. DESIGN: Using the provincial TB database, we examined all culture-positive foreign-born TB patients for the years 1990-2001. The risk of having a drug-resistant isolate was estimated according to country and region of origin. RESULTS: Of 1940 foreign-born patients identified, 247 (12.7%, 95%CI 11.3-14.3) cases had isolates resistant to at least one of the first-line drugs, wi

Evolution of Extensively Drug-Resistant Tuberculosis over Four Decades: Whole Genome Sequencing and Dating Analysis of Mycobacterium tuberculosis Isolates from KwaZulu-Natal.

BACKGROUND: The continued advance of antibiotic resistance threatens the treatment and control of many infectious diseases. This is exemplif … e subsequent emergence of MDR and XDR occurring 20 y (rpoB L452P [rifampicin]; pncA 1 bp insertion [pyrazinamide]; 1984 [95% HPD: 1974-1992]) and 10 y (rpoB D435G [rifampicin]; rrs 1400 [kanamycin]; gyrA A90V [ofloxacin]; 1995 [95% HPD: 1988-1999]) prior to the outbreak, respectively. We observed frequent de novo evolution of MDR and XDR, with 56 and nine inde …

Tuberculosis treatment outcome and predictors in northern Ethiopian prisons: a five-year retrospective analysis.

BACKGROUND: The prison situations are notorious for causing interruptions of tuberculosis (TB) treatment and occurrence of unfavorable outcomes. In Ethiopian prisons, though TB treatment programs exist, treatment outcome results and factors contributing to unsuccessful outcome are not well documented. In this study, we assessed the treatment outcome of TB cases and identified risk factors for unsuccessful outcome in northern Ethiopian prisons. METHODS: A retrospective record review was conducted for all prisoners diagnosed with TB between September 2011 and August 2015. Outcome variables were

[Protective effect of anti-idiopathic pulmonary fibrosis drug Pirfenidone and Sufenidone (SC1011) on pulmonary injury induced by tuberculosis in a mouse tuberculosis model].

Objective: To evaluate the protective effect of anti-idiopathic pulmonary fibrosis (IPF) marketed drug Pirfenidone and its clinical drug Sufenidone (SC1011) against lung injury in a mouse tuberculosis model. Methods: C57BL/6 mouse model of tuberculosis was established. A total of 75 C57BL/6 mice were infected with 1×107 CFU/ml H37Rv suspension by aerosol and randomly divided into untreated (n=9) group, isoniazid+rifampicin+pyrazinamide (HRZ) group (n=22), PFD+HRZ group (n=22), and SC1011+HRZ group (n=22). C57BL/6 mice were infected with H37Rv by aerosol for 6 weeks and then treated. Seven mice…

Intermittent versus daily therapy for treating tuberculosis in children.

BACKGROUND: Childhood tuberculosis (TB) is a neglected global public health problem. Short treatment courses with rifampicin-containing anti … from South Africa, and one from Turkey. All trials used rifampicin and isoniazid, three trials used pyrazinamide, and one trial used streptomycin. The drug combination, and the duration of intermittent and daily treatments differed between trials, and no trials used drug combinations and schedules currently recommended for childhood TB. No trial reported if an …

Profile of adverse drug reactions in drug resistant tuberculosis from Punjab.

OBJECTIVE: The aim of the study was to elucidate the profile of adverse drug reactions (ADRs) associated with second-line anti-tubercular treatment for drug-resistant tuberculosis. MATERIAL AND METHODS: ADR profile of diagnosed drug-resistant tuberculosis cases on supervised second-line anti-tubercular drug regimen under Programmatic Management of Drug-resistant Tuberculosis under Revised National Tuberculosis Control Programme, were studied over two years' period. Adverse reactions were categorised into mild, moderate and severe types with subsequent systematic data-analysis. RESULTS: Out o

[Investigation of Mycobacterium bovis subsp. bovis among the strains of Mycobacterium tuberculosis complex isolated in Düzce Province, Turkey].

Throughout the history of mankind, tuberculosis (TB) has caused serious illness and still continues to do so. Archaeobiological studies indi … susceptible to STR, INH and RIF, but resistant to EMB. All of the three isolates were resistant to pyrazinamide. As a result, it was concluded that large-scaled and attentive monitoring of TB infections in animals, as well as searching for M.bovis subsp. bovis in TB cases, especially in high-risk groups would be essential for an accurate diagnosis.

Assessment of the Efficacy of New Anti-Tuberculosis Drugs.

The pathology of tuberculosis in humans starts with an initial Ghon focus in the lungs followed by transmission of bacilli though the blood … ortening of the treatment period to 6 months by the incorporation in the regimens of rifampicin and pyrazinamide, which are the two drug responsible for bactericidal activity during treatment. Prospects for further shortening of treatment rest with the introduction of higher dosage with rifamycins and with new anti-tuberculosis drugs. These new drugs include t …

Pearls and oy-sters: tuberculous meningitis: not a diagnosis of exclusion.

A 21-year-old man presented to his local emergency department with 5 days of headache, which was dull, occipital, bilateral, nonthrobbing, a … tive for Mycobacterium tuberculosis sensitive to streptomycin, isoniazid, ethambutol, rifampin, and pyrazinamide.

Fixed-dose combinations of drugs versus single-drug formulations for treating pulmonary tuberculosis.

BACKGROUND: People who are newly diagnosed with pulmonary tuberculosis (TB) typically receive a standard first-line treatment regimen that consists of two months of isoniazid, rifampicin, pyrazinamide, and ethambutol followed by four months of isoniazid and rifampicin. Fixed-dose combinations (FDCs) of these drugs are widely recommended. OBJECTIVES: To compare the efficacy, safety, and acceptability of anti-tuberculosis regimens given as fixed-dose combinations compared to single-drug formulations for treating people with newly diagnosed pulmonary tuberculosis. SEARCH METHODS: We searched th…

Active Mycobacterium tuberculosis infection at a comprehensive cancer center, 2006-2014.

BackgroundMorbidity and mortality from Mycobacterium tuberculosis (Mtb) infection remain significant in cancer patients. We evaluated clinical characteristics, management, and outcomes in patients with active Mtb infection at our institution who had cancer or suspicion of cancer.MethodsWe retrospectively examined medical records of all patients with laboratory-confirmed active Mtb infection diagnosed between 2006 and 2014.ResultsA total of 52 patients with laboratory-confirmed active Mtb infection were identified during the study period, resulting in an average rate of 6 new cases per year. Th

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… Seven of these 14 isolates (50%) were resistant to pyrazinamide, 3 (22%) to streptomycin, 2 (14%) to isoniazid, and 2 (14%) to both isoniazid and streptomycin. No multidrug resistant (MDR) Mtb isolates, defined as resistance at least to isoniazid and rifampin, were identified in this cohort. … Of note, 2 of the 3 patients with death attributable to active Mtb infection had isolates that were resistant to at least 1 first-line agent (1 to pyrazinamide and 1 to both isoniazid and streptomycin). …

Infectious Diseases

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… . ★ RIPE ★ Rifampin 10 mg/kg or 600 mg PO daily, isoniazid 5 mg/kg or 300 mg PO daily, pyrazinamide 20–25 mg/kg PO daily ×8 weeks. Ethambutol 15–20 mg/kg PO daily is added until drug susceptibility results are available. … Alternatives include isoniazid, rifampin, pyrazinamide, plus ethambutol or streptomycin three times weekly for 24 weeks, or isoniazid, rifampin, pyrazinamide, plus ethambutol for 2 weeks, then twice weekly for 6 weeks, followed by isoniazid and rifampin twice weekly for 16 weeks (see guidelines for exceptions …