Outcomes and Use of Therapeutic Drug Monitoring in Multidrug-Resistant Tuberculosis Patients Treated in Virginia, 2009-2014.
- Author:
Scott K HEYSELL
1
;
Jane L MOORE
;
Charles A PELOQUIN
;
David ASHKIN
;
Eric R HOUPT
Author Information
- Publication Type:Original Article
- Keywords: Pharmacokinetics; Cycloserine; Capreomycin; Moxifloxacin; Linezolid
- MeSH: Adult; Aged; Amikacin; Aminosalicylic Acid; Capreomycin; Cohort Studies; Cycloserine; Drug Monitoring*; Ethionamide; Female; Humans; Pharmacokinetics; Retrospective Studies; Tuberculosis; Tuberculosis, Meningeal; Tuberculosis, Multidrug-Resistant*; Virginia*; Linezolid
- From:Tuberculosis and Respiratory Diseases 2015;78(2):78-84
- CountryRepublic of Korea
- Language:English
- Abstract: BACKGROUND: Reports of therapeutic drug monitoring (TDM) for second-line medications to treat multidrug-resistant tuberculosis (MDR-TB) remain limited. METHODS: A retrospective cohort from the Virginia state tuberculosis (TB) registry, 2009-2014, was analyzed for TDM usage in MDR-TB. Drug concentrations, measured at time of estimated peak (Cmax), were compared to expected ranges. RESULTS: Of 10 patients with MDR-TB, 8 (80%) had TDM for at least one drug (maximum 6 drugs). Second-line drugs tested were cycloserine in seven patients (mean C2hr, 16.6+/-10.2 microg/mL; 4 [57%] below expected range); moxifloxacin in five (mean C2hr, 3.2+/-1.5 microg/mL; 1 [20%] below); capreomycin in five (mean C2hr, 21.5+/-14.0 microg/mL; 3 [60%] below); para-aminosalicylic acid in five (mean C6hr, 65.0+/-29.1 microg/mL; all within or above); linezolid in three (mean C2hr, 11.4+/-4.1 microg/mL, 1 [33%] below); amikacin in two (mean C2hr, 35.3+/-3.7 microg/mL; 1 [50%] below); ethionamide in one (C2hr, 1.49 microg/mL, within expected). Two patients died: a 38-year-old woman with human immunodeficiency virus/acquired immune deficiency syndrome and TB meningitis without TDM, and a 76-year-old man with fluoroquinolone-resistant (pre-extensively drug-resistant) pulmonary TB and low linezolid and capreomycin concentrations. CONCLUSION: Individual pharmacokinetic variability was common. A more standardized approach to TDM for MDR-TB may limit over-testing and maximize therapeutic gain.
