Primary study showed hypoglycemic effect of gynostema pentaphyllum (GP) on mice. Objective: (I) To determine the hypoglycemic effect of (GP) and (2) To look for effective mechanism of GP on normal and diabetic mice and rats. Method: The ethanol extract of GP were introdiced to normal and pre diabetic & diabectic mice or rats. The blood glucose levels were measured at just (0h) before and at 2h, 4h and 6h after oral use or 1h, 2h and 3h after intraperitoneal use of GP. Results: On normal mice, 300 mg/kg-ip of GP decreased the blood glucose level with max. 33% at 3rd hour; 1500 mg/kg-po. with 20% at 6th hour; the dose of 500 mg/kg x 7 days consecutive decreased this level with 24%. On normal Wistar rats 500 mg/kg-po, diminished glycemia with max. 20% at 4th hour. But on genetic diabetic rats (GK rats), the doses 500 mg/kg-po, and 1000 mg/kg-po, decreased the blood glucose concentrations by 22% and 36%, respectively at the same time. In the glucose toleance test on mice the dose 1000 mg/kg-po, inhibited the hyperglycemic effect with 55% (after 30 minutes) and 63% (after 60 minutes) in comparison to control group. Conclusion: GP has the mild hypoglycemic effect on normal mouse/rat, but it causes more higher effect on mouse/rat having hyperglycemia. Thus, beside the insulin secreting stimulation, GP may sensitive the target tissues to insulin.
Tuberculosis, Rifampin

57 rifampicin-resistant tuberculosis strains isolated from Ha Noi Institute of Tuberculosis and Lung Diseases and Pham Ngoc Thach Tuberculosis Center of Ho Chi Minh City were involved in this study. The regimen included 2-month SHRZ and 4-month HR. All of these strains were resistant to rifampicin. It was found that rifampicin-resistant tuberculosis strains had mutations on rpoB gene. The mutation frequency of tuberculosis trains isolated from Ha Noi and Ho Chi Minh City was highest on 526 locus (55% and 41.6%, respectively) and 531 locus (30% and 33%, respectively).
Tuberculosis ; Mutation ; Rifampin

In this prospective study, 56 re-treatment pulmonary tuberculosis patients with smear-positive were examined to investigate possible variations in plasma rifampicin concentration using fixed dose combination drugs. 2-hour and 3-hour plasma rifampicin concentration were measured by HPLC method among 56 smear-positive re-treatment pulmonary tuberculosis patients. Results: Plasma rifampicin concentrations were generally low: 2-hour and 3-hour plasma rifampicin concentration below 8mg/ml (93% and 86% of patients, respectively), 55% and 46% of patients had plasma concentration below 4mg/ml (at 2-hour and 3-hour time point, respectively). Although treatment at the same dose levels, there is high variable between individual patients in plasma rifampicin concentration. Plasma rifampicin concentrations at 3 hours after dosed were higher than at 2 hours in most of patients.
Rifampin ; Tuberculosis ; Pulmonary

Report one case of a 45 years old male patient lived in Hoc Mon district, Ho Chi Minh City, and admitted in November 24th 2004. His tuberculosis (TB) was first diagnosed in the year 2000 and he was received anti-TB drugs with 2SHR/6HE regime at the anti-TB station. During hospitalization, after 10 days of SHRZE regime (SM 1/2g, Rif 300mg PO, INH 200mg PO, PZA 750mg PO, EMB 600mg PO), he experienced fatigue, dyspnea, jaundice, fever of 39 degree C, blood pressure: 8/5cmHg, SpO2 = 90%. Hematological analysis revealed low hemoglobin and Hct levels, and increase of reticulocyte count and white blood cell count; a positive direct Coombs test. Biochemical tests revealed elevated total, direct and indirect bilirubin levels, increased LDH; decreased haptoglobin; LE cell and ANA were all negative. Patient was diagnosed immune haemolytic anemia and was treated by blood transfusion with the same blood group. He discharged at December 17th 2004 with the last diagnosis was recurrent tuberculosis M(+), rifampicin-induced immune haemolytic anemia
Tuberculosis ; Rifampin ; Therapeutics

INTRODUCTION: The worldwide prevalence of adverse drug reactions (ADR) to anti-TB medication ranges from 8% to 85%. Major adverse reactions include hepatic, renal, and hematologic disorders of which, Rifampicin-induced thrombocytopenia is one of these rare complications. CASE: A 58-year-old Filipino male developed respiratory and gastrointestinal bleeding with a severe drop in platelet count after several days of anti-tuberculosis (anti-TB) medications. The patient had oral mucosal petechiae, blood-streaked sputum, and epistaxis. The symptoms progressed to the formation of small adherent clots beneath the tongue, gum bleeding, melena, massive epistaxis, and hemoptysis with continued intake of the anti-TB drugs. The patient had anemia, normal WBC and differential count, and thrombocytopenia of 3 x 10^3/uL, a drop from 235 x 10^3/uL five days prior. The bleeding resolved with the discontinuation of the drugs. A slow graded oral challenge to each of the drugs was done to identify the culprit medication. There was a recurrence of bleeding and a decrease in the platelet count after administration of rifampicin. The anti-TB medications were modified not to include rifampicin. The patient was discharged with no signs of bleeding and a normal complete blood count. CONCLUSION TB is a prevalent disease in our country, and its medications can cause adverse drug reactions. Rifampicin-induced thrombocytopenia is a rare and life-threatening condition that physicians must be aware of and able to recognize promptly and treat properly to prevent recurrence of similar cases in the future. The patient should be forewarned not to take rifampicin and any fixed-dose combination drugs containing rifampicin.
Rifampin ; Thrombocytopenia ; Blood Platelets ; Tuberculosis

The rpoB gene based sequencing analysis enabled not only the detection of rifampin resistant Mycobacterium tuberculosis, but also the differentiation of species in the genus Mycobacterium. In the present study, we applied the method to 68 isolates of M. tuberculosis (29 from initial treatment cases and 39 from recurrent cases) and 11 clinical isolates of nontuberculous mycobacteia (NTM) isolated from patients in Jeju island. Among rifampin resistant M. tuberculosis, two of 29 strains isolated from patients of initial cases (6.9%) and five of 39 strains isolated from patients of recurrent cases (12.8%) were confirmed to have rifampin resistant genotypes harboring mutations in rif r region of the rpoB gene. In NTM strains, M. fortuitum complex was the most frequently isolated species at the frequency of 54.5% (6/11).
Genotype ; Humans ; Mycobacterium ; Mycobacterium tuberculosis ; Rifampin ; Tuberculosis

BACKGROUND: Rifabutin (ansamycin) is a spiro-piperidyl rifamycin, which is highly active against Mycobacterium tuberculosis. It has been found that some clinical isolates of tubercle bacilli that are resistant to rifampicin are susceptible to rifabutin, with some patients with multi-drug resistant pulmonary tuberculosis having shown favorable clinical and bacteriological responses to the rifabutin. This study was conducted to find the proportion of rifabutin- susceptible strains among rifampicin-resistant isolates from Korean MDR-TB patients, and investigate the presence of specific rpoB mutations, which may confer resistance to rifampicin, but not to rifabutin. METHODS: 201 rifampicin-resistant and 50 pan-susceptible M. tuberculosis isolates were randomly selected for this study. The isolates were retested at rifampicin and rifabutin concentrations of 0, 20, 40 and 80 microgram/ml, respectively. The isolates that grew at and/or over a rifabutin concentration of 20 microgram/ml were judged rifabutin-resistant. The rpoB gene was extracted from the isolates, and then amplified for direct sequencing to investigate specific rpoB mutations that conferred rifabutin- susceptibility but rifampicin-resistance. RESULTS: Out of the 201 rifampicin-resistant M. tuberculosis, 41 strains (20.4%) were susceptible to rifabutin using the absolute concentration method on Lowenstein-Jensen media. The rpoB mutation types that showed susceptibility to rifabutin were Leu511Pro, Ser512Arg, Gln513Glu, Asp516Ala, Asp516Gly, Asp516Val, Asp516Tyr, Ser522Leu, His526Asn, His526Leu, His526Cys, Arg529Pro and Leu533Pro. A reverse hybridization technique was able to detect 92.5% of the rifabutin-susceptible isolates, with a specificity of 96.1% among 195 M. tuberculosis isolates with the rpoB mutation. CONCLUSIONS: Around 20% of the rifampicin-resistant isolates in Korea showed susceptibility to rifabutin, which was associated with some specific mutations of rpoB. Rifabutin could be used for the treatment of MDR-TB patients, especially when drug susceptibility testing reveals susceptibility to rifabutin.
Humans ; Korea ; Mycobacterium tuberculosis ; Rifabutin ; Rifampin ; Tuberculosis ; Tuberculosis, Pulmonary

BACKGROUND: Development of rapid drug susceptibility testing provides the opportunity for rapid identification of individuals with drug resistant tubercle bacilli, allowing selection of appropriate therapeutic regimens. METHODS: A total of 502 drug resistant isolates were subjected to reverse blot hybridization assay to detect mutations within genes (rpoB, katG, inhA, and ahpC) associated with rifampicin (RMP) and isoniazid (INH) resistance. RESULTS: Among the 264 RMP resistant strains (RMPR) tested, the most prevalent mutation was the Ser531Leu seen in 121 strains (46%). The second common mutation occurred in 84 strains (32%) at codon 526. And 27 strains (10%) showed the mutation at codon 516. Among all 469 INH resistant strains (INHR), the katG mutation was responsible for INH. The inhA mutation was present in 88 strains (19%). In 11 isolates (2%), coexisting of the katG and inhA mutations were identified. Reverse hybridization assay successfully detected over 80% of INHR and over 92% of RMPR among Korean isolates. CONCLUSION: Reverse hybridization was useful for rapid detection of INHR and RMPR.
Codon ; Genotype ; Isoniazid* ; Korea ; Mycobacterium tuberculosis ; Rifampin*

Setting: Although rifampicin is an essential anti-tuberculosis drugs, but there is variable inter-individual on plasma rifampicin concentration. In addition, poor bioavailability is concern problem when using fixed-dose combination drugs in treatment of tuberculosis. Objective: To investigate possible variations in plasma rifampicin concentration in tuberculosis patients using fixed dose combination drugs in National Tuberculosis Programme. Design: 2-hour plasma rifampicin concentration was measured by HPLC method among 50 smear-positive pulmonary tuberculosis patients. Results: Plasma rifampicin concentrations were generally low: 86% of patients had 2-hour plasma rifampicin concentration below 80g/ml, and 40% of patients had plasma concentration below 40g/ml. Although treatment at the same dose levels, there is high variable between individual patients in plasma rifampicin concentration. Rifampicin concentration was higher in female,> 60 years old, < 40 kg body weight. There is no difference in mean plasma concentration between new tuberculosis patients and re-treatment tuberculosis patients groups. Conclusion: The unexpected low plasma concentration of rifampicin in this setting are most likely due to poor bioavailability in fixed dose combination drugs. A study on bioavailability of rifampicin from fixed dose combination using in National Tuberculosis Programme is necessary.
Rifampin ; Tuberculosis, Pulmonary ; Pharmaceutical Preparations ; Plasma

BACKGROUND: Multidrug resistant tuberculosis (MDRTB) strains rely on the prompt availability of drug susceptibility test results. We evaluated the reliability and turnaround time of MGIT 960 system, automated version of the MGIT, for antimicrobial susceptibility test of Mycobacteria tuberculosis. METHODS: Ninety six isolates have been tested for susceptibility to isoniazid (INH), rifampin (RIF), ethambutol (EMB) and streptomycin (SM). Results were compared with those obtained by traditional solid media (absolute concentration method, indirect method). RESULTS: There was no statistically significant difference between the susceptibility testing results of the two methods except for EMB. Discrepant results were obtained for 8 isolates (8.3%) with INH, for 3 isolates (3.1%) with RIF, for 13 isolates (13.5%) with EMB, for 10 isolates (10.4%) with SM. Using the indirect method as the gold standard, the sensitivity of INH, RIF, EMB and SM susceptibility testing by the MGIT system were 94.1%, 98.8%, 86.7% and 90.0%, respectively. The specificity were 85.7%, for INH and RIF and 83.3%, for EMB and SM. Turnaround times were significant shorter in MGIT (average 12 days) than in solid media (average 57 days) (P < 0.05) CONCLUSIONS: These data demonstrate that the MGIT system is accurate and rapid for INH, RIF and SM susceptibility test of M. tuberculosis, but EMB susceptibility testing requires further evaluation.
Ethambutol ; Isoniazid ; Mycobacterium tuberculosis* ; Mycobacterium* ; Rifampin ; Sensitivity and Specificity ; Streptomycin ; Tuberculosis