孟加拉的MDRTB tx trial, 使用gatifloxacin > ofloxacin
台灣的regimen不太一樣
基本上能不用fluroquinolone就不會用
Treatment of Multidrug-Resistant Tuberculosis
In an observational study, a gatifloxacin-containing regimen for at least 9 months had the highest cure rate.
Multidrug-resistant tuberculosis (MDRTB) is defined as infection caused by an organism resistant to both isoniazid and rifampin. Currently recommended treatment regimens are long, often poorly tolerated, and difficult to monitor. Treatment standardization has been recommended for MDRTB in low-income areas, which generally have low levels of resistance to second-line drugs.
As part of a TB treatment program in Bangladesh, researchers conducted a prospective observational study from May 1997 through December 2007 to examine the effectiveness of this strategy. Patients with laboratory-confirmed MDRTB were treated with one of six regimens based on enrollment date (i.e., without randomization). Each regimen differed from the previous one, usually by a single change. All regimens contained a fluoroquinolone (ofloxacin in regimens 1–5; gatifloxacin in regimen 6), as well as kanamycin and prothionamide. All treatments involved an intensive phase (6 or 7 drugs given for ≥3 months) followed by a continuation phase (4 or 5 drugs, usually for 12 months).
A total of 427 patients were included. The gatifloxacin-based regimen (gatifloxacin combined with isoniazid, ethambutol, pyrazinamide, clofazimine, kanamycin, and prothionamide in an intensive phase lasting ≥4 months; and with pyrazinamide, ethambutol, and clofazimine in a 5-month continuation phase) had a relapse-free cure rate of 82.5%. The likelihood of an adverse outcome, including treatment failure, was significantly lower in patients treated with the gatifloxacin-based regimen than in those treated with ofloxacin-based regimens (hazard ratio, 0.39; 95% confidence interval, 0.26–0.59).
Comment: This study, which used sequentially adapted multiple-drug regimens in patients with MDRTB, identified a gatifloxacin-containing regimen with a high success rate and a relatively short duration. The authors note that the cost of the gatifloxacin regimen — using generic drugs — was {euro}225, making it a promising alternative for low-income countries.
— Neil M. Ampel, MD
Published in Journal Watch Infectious Diseases September 22, 2010
Citation(s):
Van Deun A et al. Short, highly effective, and inexpensive standardized treatment of multidrug-resistant tuberculosis. Am J Respir Crit Care Med 2010 Sep 1; 182:684.
* Original article (Subscription may be required)
* Medline abstract (Free)
https://docs.google.com/fileview?id=0B278nGJMQBk7OWMxM2EzMDktMzY1ZS00OTg0LTllMjctYmM4YWM4MWQ4ODcw&hl=zh_TW
基本上能不用fluroquinolone就不會用
Treatment of Multidrug-Resistant Tuberculosis
In an observational study, a gatifloxacin-containing regimen for at least 9 months had the highest cure rate.
Multidrug-resistant tuberculosis (MDRTB) is defined as infection caused by an organism resistant to both isoniazid and rifampin. Currently recommended treatment regimens are long, often poorly tolerated, and difficult to monitor. Treatment standardization has been recommended for MDRTB in low-income areas, which generally have low levels of resistance to second-line drugs.
As part of a TB treatment program in Bangladesh, researchers conducted a prospective observational study from May 1997 through December 2007 to examine the effectiveness of this strategy. Patients with laboratory-confirmed MDRTB were treated with one of six regimens based on enrollment date (i.e., without randomization). Each regimen differed from the previous one, usually by a single change. All regimens contained a fluoroquinolone (ofloxacin in regimens 1–5; gatifloxacin in regimen 6), as well as kanamycin and prothionamide. All treatments involved an intensive phase (6 or 7 drugs given for ≥3 months) followed by a continuation phase (4 or 5 drugs, usually for 12 months).
A total of 427 patients were included. The gatifloxacin-based regimen (gatifloxacin combined with isoniazid, ethambutol, pyrazinamide, clofazimine, kanamycin, and prothionamide in an intensive phase lasting ≥4 months; and with pyrazinamide, ethambutol, and clofazimine in a 5-month continuation phase) had a relapse-free cure rate of 82.5%. The likelihood of an adverse outcome, including treatment failure, was significantly lower in patients treated with the gatifloxacin-based regimen than in those treated with ofloxacin-based regimens (hazard ratio, 0.39; 95% confidence interval, 0.26–0.59).
Comment: This study, which used sequentially adapted multiple-drug regimens in patients with MDRTB, identified a gatifloxacin-containing regimen with a high success rate and a relatively short duration. The authors note that the cost of the gatifloxacin regimen — using generic drugs — was {euro}225, making it a promising alternative for low-income countries.
— Neil M. Ampel, MD
Published in Journal Watch Infectious Diseases September 22, 2010
Citation(s):
Van Deun A et al. Short, highly effective, and inexpensive standardized treatment of multidrug-resistant tuberculosis. Am J Respir Crit Care Med 2010 Sep 1; 182:684.
* Original article (Subscription may be required)
* Medline abstract (Free)
https://docs.google.com/fileview?id=0B278nGJMQBk7OWMxM2EzMDktMzY1ZS00OTg0LTllMjctYmM4YWM4MWQ4ODcw&hl=zh_TW
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