RESUMO
BACKGROUND: Extensively drug-resistant tuberculosis (XDR-TB), defined as TB caused by a Mycobacterium strain resistant to at least rifampicin, isoniazid, any fluoroquinolone and one of the injectable anti-tuberculosis drugs, remains a worldwide public health threat. Among repurposed drugs empirically used for XDR-TB cases, carbapenems have been studied in vitro and in animal models, with encouraging results. However, only short-term follow-up data from clinical studies are currently available. OBJECTIVES: To study the long-term follow-up of XDR-TB cases treated with a regimen containing meropenem-clavulanate (M/Clav). DESIGN: Retrospective observational case series study at a single hospital. METHODS: All hospitalised drug-resistant TB patients who received M/Clav as part of their treatment from 2009 to 2016 were included. Demographic and clinical data were extracted from medical records. RESULTS: Eighteen XDR-TB patients were included in the analysis. The successful outcome and mortality rates were respectively 83.3% and 11.1%. No relapses were observed in cured patients after a median follow-up of 4 years. No specific adverse events were attributed to treatment with M/Clav. CONCLUSION: The rate of sustained successful treatment outcome observed here is far higher than the 26% observed in the 2014 World Health Organization XDR-TB cohort, suggesting that carbapenems may be beneficial for the treatment of difficult-to-treat TB cases.
Assuntos
Antituberculosos/administração & dosagem , Ácido Clavulânico/administração & dosagem , Tuberculose Extensivamente Resistente a Medicamentos/tratamento farmacológico , Meropeném/administração & dosagem , Adulto , Quimioterapia Combinada , Tuberculose Extensivamente Resistente a Medicamentos/microbiologia , Feminino , Seguimentos , Humanos , Masculino , Estudos Retrospectivos , Fatores de Tempo , Resultado do TratamentoRESUMO
Tuberculosis is still an important disease in Belgium, mainly in big agglomerations. For this reason, knowledge of this entity by a general practitioner is very important. Genetic tests able to identify the species of Mycobacterium tuberculosis have been developed in recent years, but also identification of resistance to 1st and 2nd line treatment through genetic methods has been developed. The quick availability of results of this tests compared to the standard tests is a big advantage. Treatment of drug-susceptible tuberculosis hasn't changed recently. In contrast a lot has changed in the landscape of multidrug resistant tuberculosis with the development of 2nd line drugs and shortening of treatment duration in specific cases of multidrug resistant tuberculosis.
La tuberculose reste une maladie importante en Belgique, surtout au niveau des grandes agglomérations. Il est donc toujours important qu'un praticien connaisse bien cette entité. Les évolutions récentes au niveau du diagnostic sont certainement les tests génétiques qui nous permettent de diagnostiquer l'espèce de Mycobacterium tuberculosis, mais également les éventuelles résistances au traitement de 1re et 2e ligne et ce dans un délai beaucoup moins important que les tests standards. Au niveau thérapeutique, rien n'a changé ces dernières années pour la tuberculose multisensible. Par contre, on a récemment observé de nombreuses évolut ions avec de nouveaux médicaments de 2e ligne et une réduction de la durée du traitement dans certains cas de tuberculose multirésistante.
Assuntos
Medicina Geral , Tuberculose , Bélgica , Humanos , Tuberculose/diagnóstico , Tuberculose/terapiaRESUMO
The emergence of drug-resistant tuberculosis (TB) is a challenge to TB control in Europe. We evaluated second-line drug susceptibility testing in Mycobacterium tuberculosis isolates from patients with multidrug-resistant, pre-extensively drug-resistant (pre-XDR-TB) and XDR-TB at 23 TBNET sites in 16 European countries. Over 30% of bacilli from patients with pre-XDR-TB showed resistance to any fluoroquinolone and almost 70% to any second-line injectable drug. Respectively >90% and >80% of the XDR-TB strains tested showed phenotypic resistance to pyrazinamide and ethambutol. Resistance to prothionamide/ethionamide was high in bacilli from pre-XDR-TB patients (43%) and XDR-TB patients (49%).
Assuntos
Antituberculosos/uso terapêutico , Tuberculose Extensivamente Resistente a Medicamentos/tratamento farmacológico , Mycobacterium tuberculosis/efeitos dos fármacos , Adulto , Etambutol/uso terapêutico , Etionamida/uso terapêutico , Europa (Continente) , Feminino , Fluoroquinolonas/uso terapêutico , Humanos , Modelos Logísticos , Masculino , Testes de Sensibilidade Microbiana , Pirazinamida/uso terapêuticoRESUMO
Mycobacterium tuberculosis strains resistant to almost all available anti-tuberculosis drugs are an increasing threat to public health worldwide. Among existing drugs with potential antimycobacterial effects, the combination of meropenem with clavulanate has been shown to have potent in vitro bactericidal activity against extensively drug-resistant tuberculosis (XDR-TB). To explore its potential clinical efficacy, a meropenem-clavulanate-containing salvage regimen was started in six patients with severe pulmonary XDR-TB, in association with the only one or two remaining active second-line drugs. Encouraging preliminary data are detailed and discussed.
