TY - JOUR
T1 - Therapeutic drug monitoring
T2 - How to improve drug dosage and patient safety in tuberculosis treatment
AU - Sotgiu, Giovanni
AU - Alffenaar, Jan Willem C
AU - Centis, Rosella
AU - D'Ambrosio, Lia
AU - Spanevello, Antonio
AU - Piana, Andrea
AU - Migliori, Giovanni Battista
PY - 2015/3/1
Y1 - 2015/3/1
N2 - In this article we describe the key role of tuberculosis (TB) treatment, the challenges (mainly the emergence of drug resistance), and the opportunities represented by the correct approach to drug dosage, based on the existing control and elimination strategies. In this context, the role and contribution of therapeutic drug monitoring (TDM) is discussed in detail. Treatment success in multidrug-resistant (MDR) TB cases is low (62%, with 7% failing or relapsing and 9% dying) and in extensively drug-resistant (XDR) TB cases is even lower (40%, with 22% failing or relapsing and 15% dying). The treatment of drug-resistant TB is also more expensive (exceeding €50000 for MDR-TB and €160000 for XDR-TB) and more toxic if compared to that prescribed for drug-susceptible TB. Appropriate dosing of first- and second-line anti-TB drugs can improve the patient's prognosis and lower treatment costs. TDM is based on the measurement of drug concentrations in blood samples collected at appropriate times and subsequent dose adjustment according to the target concentration. The 'dried blood spot' technique offers additional advantages, providing the rationale for discussions regarding a possible future network of selected, quality-controlled reference laboratories for the processing of dried blood spots of difficult-to-treat patients from reference TB clinics around the world.
AB - In this article we describe the key role of tuberculosis (TB) treatment, the challenges (mainly the emergence of drug resistance), and the opportunities represented by the correct approach to drug dosage, based on the existing control and elimination strategies. In this context, the role and contribution of therapeutic drug monitoring (TDM) is discussed in detail. Treatment success in multidrug-resistant (MDR) TB cases is low (62%, with 7% failing or relapsing and 9% dying) and in extensively drug-resistant (XDR) TB cases is even lower (40%, with 22% failing or relapsing and 15% dying). The treatment of drug-resistant TB is also more expensive (exceeding €50000 for MDR-TB and €160000 for XDR-TB) and more toxic if compared to that prescribed for drug-susceptible TB. Appropriate dosing of first- and second-line anti-TB drugs can improve the patient's prognosis and lower treatment costs. TDM is based on the measurement of drug concentrations in blood samples collected at appropriate times and subsequent dose adjustment according to the target concentration. The 'dried blood spot' technique offers additional advantages, providing the rationale for discussions regarding a possible future network of selected, quality-controlled reference laboratories for the processing of dried blood spots of difficult-to-treat patients from reference TB clinics around the world.
KW - Drug dosage
KW - MDR-TB
KW - Prevention
KW - Therapeutic drug monitoring
KW - Treatment
KW - XDR-TB
UR - http://www.scopus.com/inward/record.url?scp=84925234402&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84925234402&partnerID=8YFLogxK
U2 - 10.1016/j.ijid.2014.12.001
DO - 10.1016/j.ijid.2014.12.001
M3 - Article
C2 - 25809764
AN - SCOPUS:84925234402
VL - 32
SP - 101
EP - 104
JO - International Journal of Infectious Diseases
JF - International Journal of Infectious Diseases
SN - 1201-9712
ER -