Effectiveness and safety of imipenem/clavulanate and linezolid to treat multidrug and extensively drug-resistant tuberculosis at a referral hospital in Brazil
Evidence on effectiveness, safety, and tolerability of imipenem/clavulanate (IC) and linezolid containing regimens to treat multidrug-resistant (MDR-) and extensively drug-resistant tuberculosis (XDR-TB) is scarce. The aim of this observational study is to evaluate the therapeutic contribution of IC...
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| Format: | Article |
| Language: | English |
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Elsevier
2016-11-01
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| Series: | Revista Portuguesa de Pneumologia (English Edition) |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2173511516300707 |
| _version_ | 1811255271430815744 |
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| author | M.A. Arbex E.H. Bonini G. Kawakame Pirolla L. DâAmbrosio R. Centis G.B. Migliori |
| author_facet | M.A. Arbex E.H. Bonini G. Kawakame Pirolla L. DâAmbrosio R. Centis G.B. Migliori |
| author_sort | M.A. Arbex |
| collection | DOAJ |
| description | Evidence on effectiveness, safety, and tolerability of imipenem/clavulanate (IC) and linezolid containing regimens to treat multidrug-resistant (MDR-) and extensively drug-resistant tuberculosis (XDR-TB) is scarce. The aim of this observational study is to evaluate the therapeutic contribution of IC and linezolid to manage MDR/XDR-TB cases at the reference centre of São Paulo state, Brazil. Twelve patients (9 males, 1 HIV positive in antiretroviral treatment, 4 MDR, 8 XDR) were treated with IC, 11 of them within linezolid-containing regimens. They all were previously treated with treatment failure, for a median (IQR, interquartile range) of 4.5 (2â6.5) times, having a severe resistance pattern (median number of resistances: 7 (5â8)) and being sputum smear and culture positive. IC and linezolid were prescribed at the dose of 1000 mg/day and 600 mg/day, respectively. The overall exposure was (median (IQR)) 419 (375.5â658) days for IC and 678 (392â720) days for linezolid. All of them converted their sputum (time to sputum conversion; 60 (37.5â90) days) and culture (75 (60â135) days), and 7 were cured while 5 are still on treatment with a gradually improving clinical picture.While no adverse events were reported for IC, 2 minor side effects, only, were attributed to linezolid (17%); in both cases the drug was re-started without further problems. Our study suggests that IC and linezolid-containing regimens can be used safely and with satisfactory outcomes in reference centres to treat MDR/XDR-TB patients. Keywords: MDR-TB, XDR-TB, Imipenem, Linezolid, Effectiveness, Safety, Tolerability |
| first_indexed | 2024-04-12T17:21:20Z |
| format | Article |
| id | doaj.art-17418db73a5a45908f65fb2ce8923b2e |
| institution | Directory Open Access Journal |
| issn | 2173-5115 |
| language | English |
| last_indexed | 2024-04-12T17:21:20Z |
| publishDate | 2016-11-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Revista Portuguesa de Pneumologia (English Edition) |
| spelling | doaj.art-17418db73a5a45908f65fb2ce8923b2e2022-12-22T03:23:28ZengElsevierRevista Portuguesa de Pneumologia (English Edition)2173-51152016-11-01226337341Effectiveness and safety of imipenem/clavulanate and linezolid to treat multidrug and extensively drug-resistant tuberculosis at a referral hospital in BrazilM.A. Arbex0E.H. Bonini1G. Kawakame Pirolla2L. DâAmbrosio3R. Centis4G.B. Migliori5University Center of Araraquara, Sao Paulo, Brazil; Hospital Nestor Goulart Reis, Sao Paulo State Secretary of Health, Sao Paulo, BrazilUniversity Center of Araraquara, Sao Paulo, Brazil; Hospital Nestor Goulart Reis, Sao Paulo State Secretary of Health, Sao Paulo, BrazilHospital Nestor Goulart Reis, Sao Paulo State Secretary of Health, Sao Paulo, BrazilWHO Collaborating Centre for TB and Lung Diseases, Fondazione S. Maugeri, Tradate, Italy; Public Health Consulting Group, Lugano, SwitzerlandWHO Collaborating Centre for TB and Lung Diseases, Fondazione S. Maugeri, Tradate, ItalyWHO Collaborating Centre for TB and Lung Diseases, Fondazione S. Maugeri, Tradate, Italy; Corresponding author.Evidence on effectiveness, safety, and tolerability of imipenem/clavulanate (IC) and linezolid containing regimens to treat multidrug-resistant (MDR-) and extensively drug-resistant tuberculosis (XDR-TB) is scarce. The aim of this observational study is to evaluate the therapeutic contribution of IC and linezolid to manage MDR/XDR-TB cases at the reference centre of São Paulo state, Brazil. Twelve patients (9 males, 1 HIV positive in antiretroviral treatment, 4 MDR, 8 XDR) were treated with IC, 11 of them within linezolid-containing regimens. They all were previously treated with treatment failure, for a median (IQR, interquartile range) of 4.5 (2â6.5) times, having a severe resistance pattern (median number of resistances: 7 (5â8)) and being sputum smear and culture positive. IC and linezolid were prescribed at the dose of 1000 mg/day and 600 mg/day, respectively. The overall exposure was (median (IQR)) 419 (375.5â658) days for IC and 678 (392â720) days for linezolid. All of them converted their sputum (time to sputum conversion; 60 (37.5â90) days) and culture (75 (60â135) days), and 7 were cured while 5 are still on treatment with a gradually improving clinical picture.While no adverse events were reported for IC, 2 minor side effects, only, were attributed to linezolid (17%); in both cases the drug was re-started without further problems. Our study suggests that IC and linezolid-containing regimens can be used safely and with satisfactory outcomes in reference centres to treat MDR/XDR-TB patients. Keywords: MDR-TB, XDR-TB, Imipenem, Linezolid, Effectiveness, Safety, Tolerabilityhttp://www.sciencedirect.com/science/article/pii/S2173511516300707 |
| spellingShingle | M.A. Arbex E.H. Bonini G. Kawakame Pirolla L. DâAmbrosio R. Centis G.B. Migliori Effectiveness and safety of imipenem/clavulanate and linezolid to treat multidrug and extensively drug-resistant tuberculosis at a referral hospital in Brazil Revista Portuguesa de Pneumologia (English Edition) |
| title | Effectiveness and safety of imipenem/clavulanate and linezolid to treat multidrug and extensively drug-resistant tuberculosis at a referral hospital in Brazil |
| title_full | Effectiveness and safety of imipenem/clavulanate and linezolid to treat multidrug and extensively drug-resistant tuberculosis at a referral hospital in Brazil |
| title_fullStr | Effectiveness and safety of imipenem/clavulanate and linezolid to treat multidrug and extensively drug-resistant tuberculosis at a referral hospital in Brazil |
| title_full_unstemmed | Effectiveness and safety of imipenem/clavulanate and linezolid to treat multidrug and extensively drug-resistant tuberculosis at a referral hospital in Brazil |
| title_short | Effectiveness and safety of imipenem/clavulanate and linezolid to treat multidrug and extensively drug-resistant tuberculosis at a referral hospital in Brazil |
| title_sort | effectiveness and safety of imipenem clavulanate and linezolid to treat multidrug and extensively drug resistant tuberculosis at a referral hospital in brazil |
| url | http://www.sciencedirect.com/science/article/pii/S2173511516300707 |
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