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and doses for treatment of latent tuberculosis infection -guidelines from the Centers for Disease Control and Prevention 67,75
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Tuberculosis remains the world’s second leading infectious cause of death, with nearly one-third of the global population latently infected. Treatment of latent tuberculosis infection is a mainstay of tuberculosis-control efforts in low-to medium-incidence countries. Isoniazid monotherapy has been the standard of care for decades, but its utility i...
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Context 1
... the results of a major study published in December 2011 5 may have improved the LTBI efforts by demonstrating the efficacy of a 3-month regimen of weekly rifapentine plus isoniazid. This article will discuss the current management options of LTBI, including the newly added treatment regimen (Table 1). ...Context 2
... Alternatively, if directly observed therapy is used, adult patients may take 15 mg/kg twice weekly (max 900 mg) and children may take 20 mg/kg (max 900 mg) twice weekly. The 6-month duration is considered an acceptable alternative for healthy adults with no immunosuppressive conditions (such as HIV infection), see Table 1. ...Context 3
... events were similar in all groups, with only one person (who received isoniazid monotherapy) acquiring symptomatic hepatitis. Based on these results, 3 months of rifampin was considered equivalent to 6 months of isoniazid; because 9 months of isoniazid is the standard of care, the recommended duration for rifampin is 4 months (extended to 6 months in children), see Table 1. 6 Additional evidence on rifampin efficacy was provided by a retrospective cohort study conducted in Boston in 1984 among 204 homeless individuals exposed to isoniazid-resistant tuberculosis. ...Citations
... Moxifloxacin is another antimicrobial used in the treatment of first-line drug-resistant LTBI, with daily doses of 400 to 500 mg for 6 months. It should be noted that this regimen is associated with risks of hepatotoxicity and intolerance, requiring rigorous monitoring during treatment [66,67]. ...
Latent tuberculosis infection (LTBI) represents a subclinical, asymptomatic mycobacterial state affecting approximately 25% of the global population. The substantial prevalence of LTBI, combined with the risk of progressing to active tuberculosis, underscores its central role in the increasing incidence of tuberculosis (TB). Accurate identification and timely treatment are vital to contain and reduce the spread of the disease, forming a critical component of the global strategy known as “End TB.” This review aims to examine and highlight the most recent scientific evidence related to new diagnostic approaches and emerging therapeutic treatments for LTBI. While prevalent diagnostic methods include the tuberculin skin test (TST) and interferon gamma release assay (IGRA), WHO’s approval of two specific IGRAs for Mycobacterium tuberculosis (MTB) marked a significant advancement. However, the need for a specific test with global application viability has propelled research into diagnostic tests based on molecular diagnostics, pulmonary immunity, epigenetics, metabolomics, and a current focus on next-generation MTB antigen-based skin test (TBST). It is within these emerging methods that the potential for accurate distinction between LTBI and active TB has been demonstrated. Therapeutically, in addition to traditional first-line therapies, anti-LTBI drugs, anti-resistant TB drugs, and innovative candidates in preclinical and clinical stages are being explored. Although the advancements are promising, it is crucial to recognize that further research and clinical evidence are needed to solidify the effectiveness and safety of these new approaches, in addition to ensuring access to new drugs and diagnostic methods across all health centers. The fight against TB is evolving with the development of more precise diagnostic tools that differentiate the various stages of the infection and with more effective and targeted treatments. Once consolidated, current advancements have the potential to transform the prevention and treatment landscape of TB, reinforcing the global mission to eradicate this disease.
... Rifampin is widely used to treat bacterial infections and tuberculosis as a human antibiotic (Lu et al., 2009;Seung et al., 2004). Besides, rifampin can prevent the RNA production by bacteria to resist vaccinia virus (Norton and Holland, 2012;Charity et al., 2007). It is reported that rifampin can effectively control the bacterial diseases of fish, such as edwardsiellosis and columnaris disease (Olivares-Fuster & Arias, 2011). ...
The occurrence of antibiotics and potential health risk of 300 cultured fish samples from 19 provinces in China were investigated. The levels of 28 antibiotics (15 fluoroquinolones, 4 tetracyclines, 8 macrolides and rifampin) in 8 fish species were measured through liquid chromatography electrospray tandem mass spectrometry. As a result, 10 antibiotics were detected with an overall detection frequency of 24.3%, and the individual detection frequency of antibiotics ranged from 0.33 to 16.7%. The extremely high concentrations (above 100 µg/kg) of doxycycline and erythromycin were found in the samples. Antibiotics with high detection frequency was noticed in largemouth bass (41.2%), followed by snakehead (34.4%) and bream (31.2%). Specifically, Heilongjiang, Xinjiang, Qinghai and Gansu presented high detection frequency values of more than 60%. Moreover, the highest mean concentration was observed in Shandong, and the concentration covered from 34.8 µg/kg to 410 µg/kg. Despite the high detection frequency and levels of antibiotics were found in samples, ingestion of cultured fish was not significantly related to human health risks in China, according to the calculated estimated daily intakes and hazard quotients. These results provided us the actual levels of antibiotics in cultured fish and human health risk assessment of consuming fishery products.
... 69 Peripheral neuropathy is a complication of isoniazid treatment, and seems to be related to interference of isoniazid with metabolism of pyridoxine (vitamin B6). 70,71 Peripheral neuropathy occurs in 2% of patients treated with isoniazid. Additional risk factors for the development of peripheral neuropathy include the use of neurotoxic drugs (eg, bortezomib and thalidomide), alcoholism, HIV, diabetes mellitus, pregnancy, and cancer. ...
Mycobacterial infections, both tuberculosis and nontuberculous, are more common in patients with haematological malignancies and haematopoietic stem cell transplant recipients than in the general population—although these infections remain rare. Mycobacterial infections pose both diagnostic and therapeutic challenges. The management of mycobacterial infections is particularly complicated for patients in haematology because of the many drug–drug interactions between antimycobacterial drugs and haematological and immunosuppressive treatments. The management of mycobacterial infections must also consider the effect of delaying haematological management. We surveyed the management practices for latent tuberculosis infection (LTBI) in haematology centres in Europe. We then conducted a meticulous review of the literature on the epidemiology, diagnosis, and management of LTBI, tuberculosis, and nontuberculous mycobacterial infections among patients in haematology, and we formulated clinical guidelines according to standardised European Conference on Infections in Leukaemia (ECIL) methods. In this Review, we summarise the available literature and the recommendations of ECIL 8 for managing mycobacterial infections in patients with haematological malignancies.
... The standard treatment for TB as per the WHO guidelines include different anti-microbial drug regimens of rifampin (52), isoniazid (53), and isoniazid plus rifapentine (54), administered for a specific duration depending on the suitability to the patient (55). In the event where a patient is diagnosed with multidrug-resistant TB (MDTB) or extensively drug-resistant TB (XDR TB), secondary drugs such as thioamides, ethambutol, cyclic peptides, etc for MDTB and bedaquiline, delamanid, ethambutol, etc for XDR TB will be administered respectively (56). ...
2020 will be marked in history for the dreadful implications of the COVID-19 pandemic that shook the world globally. The pandemic has reshaped the normality of life and affected mankind in the aspects of mental and physical health, financial, economy, growth, and development. The focus shift to COVID-19 has indirectly impacted an existing air-borne disease, Tuberculosis. In addition to the decrease in TB diagnosis, the emergence of the TB/COVID-19 syndemic and its serious implications (possible reactivation of latent TB post-COVID-19, aggravation of an existing active TB condition, or escalation of the severity of a COVID-19 during TB-COVID-19 coinfection), serve as primary reasons to equally prioritize TB. On a different note, the valuable lessons learnt for the COVID-19 pandemic provide useful knowledge for enhancing TB diagnostics and therapeutics. In this review, the crucial need to focus on TB amid the COVID-19 pandemic has been discussed. Besides, a general comparison between COVID-19 and TB in the aspects of pathogenesis, diagnostics, symptoms, and treatment options with importance given to antibody therapy were presented. Lastly, the lessons learnt from the COVID-19 pandemic and how it is applicable to enhance the antibody-based immunotherapy for TB have been presented.
... Other substantial problems are the reluctance of healthcare professionals to initiate preventive therapies due to their lack of knowledge and the fear of the appearance of side effects (Paton et al., 2019). INH monotherapy has been the most established and widely used drug to treat LTBI for decades (Holland & Norton, 2012). However, the high efficacy of the 6 to 12month treatments of INH alone is affected by the low rates of compliance and increased risks of adverse events, such as hepatotoxicity (Hirsch-Moverman Y., 2008;Huaman, 2019;Kopanoff, 1978). ...
Introduction:
Tuberculosis (TB) is a global infectious disease that has plagued human beings for centuries. It currently ranks as one of the primary causes of death by a single agent. Treatment of latent TB (LTBI) is one of the cornerstones used to prevent the activation of TB. The current regimens are lengthy, associated with poor treatment adherence and several side effects. The need for shorter regimens is essential to control TB infection and accomplish the “End TB Strategy,” which has been proclaimed by the World Health Organization (WHO). Our study aims to provide a study design that assesses the efficacy of one month of Isoniazid (IHN) and Rifapentine (RFT) in non-immunosuppressed patients.
Methods:
The proposed study will be a phase III, single-center, randomized, two-arms (1:1 ratio), double-blinded, placebo-controlled non-inferiority trial. We will include immunocompetent patients above the age of 18 with a new diagnosis of LTBI. Participants will be randomized, either receiving one month of INH with RFT or 6 months of INH alone with respective placebo to maintain blinding. The primary study outcome is the cumulative incidence of active TB in the studied treatment arms. The secondary outcome is the cumulative incidence and severity of adverse effects of the studied regimens.
Discussion:
Given the scope and spread of LTBI around the globe, shorter and safer treatment options are of the utmost importance to eradicate TB. The proposed trial can contribute to this objective by improving the current standard of care. Potential disadvantages of the trial design include the need for many participants, trial duration, and costs.
... The majority of the recommendations are adopted or adapted from[15]. Recommendations #38-40 are adopted or adapted from[63] #The KAR 2018 recommendations for the screening and treatment of infections in patients with RA, and treatment of RA in patients with infections ...
The Kuwait Association of Rheumatology (KAR) aimed to develop a set of recommendations for the treatment of patients with rheumatoid arthritis (RA), tailored to the unique patient population and healthcare system of Kuwait. Each recommendation was developed based on expert opinion and evaluation of clinical practice guidelines from other international and national rheumatology societies. Online surveys were conducted to collate feedback on each KAR member’s level of agreement (LoA) with definitions of disease-/treatment-related terms used and the draft recommendations. Definitions/recommendations achieving a pre-defined cut-off value of ≥ 70% agreement were accepted for inclusion. Remaining statements were discussed and revised at a face-to-face meeting, with further modifications until consensus was reached. A final online survey was used to collect feedback on each KAR member’s LoA with the final set of recommendation statements on a scale of 0 (complete disagreement) to 10 (complete agreement). Group consensus was achieved on 66 recommendation statements, including 3 overarching principles addressing the pharmacological treatment and management of RA. Recommendations focused on treatment of early RA, established RA, patients with high-risk comorbidities, women during pregnancy and breastfeeding, and screening and treatment of opportunistic infections. The KAR 2018 Treatment Recommendations for RA reported here are based on a synthesis of other national/international guidelines, supporting literature, and expert consensus considering the Kuwaiti healthcare system and RA patient population. These recommendations aim to inform the clinical decisions of rheumatologists treating patients in Kuwait, and to promote best practices, enhance alignment and improve the treatment experience for patients.
... All rights reserved. accordance with clinically accepted dosing regimen guidelines 38 , the dosing intervals simulated were: 6, 12, 24, 48, and 72 hours; doses ranged from 100 -1200 mg in 100 mg steps. ...
... After 10 days of drug exposure (Figure 6c,d), simulated toxicity and effect outcomes are consistent with a commonly used clinical dosing regimen 38 for the treatment of tuberculosis (600 mg every 24 ...
... While all three investigated drugs -cisplatin, gentamicin, and rifampicin -are highly effective in treating bacterial infections and cancer, they also contribute majorly to drug-induced kidney injury 38,46 . Following treatment, renal impairment and dysfunction are common problems limiting these drugs' use and emphasizing the need for better predictive pre-clinical models of nephrotoxicity. ...
Drug‐induced kidney injury (DIKI), a major cause of acute kidney injury (AKI), results in progressive kidney disease and is linked to increased mortality in hospitalized patients. Primary injury sites of DIKI are proximal tubules. Clinically, kidney injury molecule‐1 (KIM‐1), an established tubule‐specific biomarker, is monitored to assess the presence and progression of injury. The ability to accurately predict drug‐related nephrotoxicity pre‐clinically would reduce patient burden and drug attrition rates, yet state‐of‐the‐art in vitro and animal models fail to do so. In this study, we demonstrate the use of KIM‐1 measurement in the kidney MPS as a preclinical model for drug toxicity assessment. To show clinical relevance, we utilize quantitative systems pharmacology (QSP) computational models for in vitro‐in vivo translation of the experimental results and to identify favorable dosing regimens for one of the tested drugs. This article is protected by copyright. All rights reserved.
... En un 90% de los casos, las micobacterias permanecen en estado latente durante el resto de la vida del individuo a partir de la infección; pero alrededor del 10% de las personas infectadas llegan a desarrollar la forma activa de la tuberculosis contagiosa. Este 90% hace referencia a más de 2000 millones de personas en el mundo (3). En Colombia, en el Boletín Epidemiológico Semanal número 52, para 2015 se reportaron 12.918 casos de todas las formas de tuberculosis. ...
Introduction:
Tuberculosis (TB) is an infectious disease caused by Micobacterium tuberculosis. It usually affects the lungs, but can also affect other systems. The objective of this study was to make a comparison of the socioeconomic factors and diagnostic test between pulmonary tuberculosis (PTB) and extrapulmonary tuberculosis (ETB) in Boyacá (Colombia) in 2015.
Methods:
A retrospective analytical observational study was conducted on the data provided by the Boyacá Department of Health about the TB possible cases reported in the SIVIGILA system. 103 TB possible cases were selected, then these cases were divided in accordance with the TB type in two groups, PTB and ETB. Duplicated data were excluded.
Results:
The highest number of isolates was of PTB. With regard to the ETB group, they required more medical attention, and the most frequent isolates were meningeal, pleural and osteoarticular. In addition, undernourishment was related with PTB.
Conclusion:
The creation of new social, cultural and economic approaches against the TB dissemination becomes a primary point for the control of this disease.
... En un 90% de los casos, las micobacterias permanecen en estado latente durante el resto de la vida del individuo a partir de la infección; pero alrededor del 10% de las personas infectadas llegan a desarrollar la forma activa de la tuberculosis contagiosa. Este 90% hace referencia a más de 2000 millones de personas en el mundo (3). En Colombia, en el Boletín Epidemiológico Semanal número 52, para 2015 se reportaron 12.918 casos de todas las formas de tuberculosis. ...
... Other limitations are as follows, a need for a patient visit after PPD administration, inter-observer variability and disability in differentiating recent from latent infection. As a result, TST is not considered as a gold standard test (27,28). ...
Background: Heparin-binding hemagglutinin (HBHA) protein is a surface adhesin that mediates the attachment of Mycobacterium tuberculosis to host cells by its own unique, carboxyl-terminal region. The methylated HBHA has a specific motif with a lysine-, alanine-, and proline-rich domain. More recently, it has been shown that HBHA protein has potential activity in stimulating immune responses, and is a promising new candidate for diagnostic applications besides a protective antigen against tuberculosis. Objectives: The aim of this study was to isolate a mycobacterial latency gene (hbha), and subsequently produce its protein as a new antigen for the Interferon-Gamma Release Assay test (IGRAs). Methods: In the present work, hbha and mtb32C genes were isolated from the Mycobacterium tuberculosis H37Rv genome using the polymerase chain reaction (PCR) method. The PCR products and pet21+ vector were digested with specific restriction enzymes and then submitted to the ligation procedure. Escherichia coli BL21-CodonPlus (DE3) competent cells were transformed with the recombinant mtb32C-hbha -pet21+ vector. Expression of recombinant protein (Mtb32C-HBHA) was confirmed with Sodium Dodecyl Sulfate Polyacrylamide Gel Electrophoresis (SDS-PAGE) and western blot methods. Results: Detection of a 500-bp gene and sequencing of recombinant pet-mtb32C-hbha vector, all confirmed the accuracy of the cloning procedure. A 36-KDa band of Mtb32C-HBHA protein was also detected by western blotting. Conclusions: In this study, expression of Mtb32C-HBHA protein was successfully done, in the prokaryotic system. Further studies are needed to evaluate the efficacy of recombinant Mtb32C-HBHA protein in diagnosis of latent tuberculosis.
