Role of therapeutic drug monitoring in pulmonary infections : use and potential for expanded use of dried blood spot samples

Respiratory tract infections are among the most common infections in men. We reviewed literature to document their pharmacological treatments, and the extent to which therapeutic drug monitoring (TDM) is needed during treatment. We subsequently examined potential use of dried blood spots as sample procedure for TDM. TDM was found to be an important component of clinical care for many (but not all) pulmonary infections. For gentamicin, linezolid, voriconazole and posaconazole dried blood spot methods and their use in TDM were already evident in literature. For glycopeptides, beta-lactam antibiotics and fluoroquinolones it was determined that development of a dried blood spot (DBS) method could be useful. This review identifies specific antibiotics for which development of DBS methods could support the optimization of treatment of pulmonary infections

Precision and Personalized Medicine and anti-TB treatment:Is TDM feasible for programmatic use?

Therapeutic Drug Monitoring (TDM) is increasingly recommended to ensure the correct drug dose thereby minimizing adverse events and maximizing regimen efficacy. To facilitate implementation in TB programs, a framework for TDM is urgently needed. TDM is only useful for dose optimization if a patient is on an appropriate regimen guided by drug susceptibility testing. TDM using a targeted approach selecting patients with risk factors for suboptimal drug exposure (e.g. diabetes) or not responding to treatment for drugs with a clear concentration-response relationship may provide the best value for money. Semiquantitative point-of-care tests for detection of low or high drug concentration should be implemented at community level while quantitative assays can be performed at regional or central level. Expanding PK/PD research followed by clinical trials including both clinical outcome as well as cost-effectiveness will increase the level of evidence supporting TDM

Nationwide analysis of treatment outcomes in children and adolescents routinely treated for tuberculosis in The Netherlands

Background: As a vulnerable population, children and adolescents with tuberculosis (TB) are faced with many challenges, even those who live in low TB incidence countries. We aimed to evaluate factors associated with TB treatment outcomes allowing more focused interventions to support this population once diagnosed. Methods: A retrospective cohort study using a nationwide surveillance database was performed in children and adolescents (aged 0-18 years) treated for TB in the Netherlands from 1993 to 2018. Logistic regression analyses were used to estimate adjusted odds ratios (aOR) for associated factors of mortality and loss to follow-up (LTFU). Results: Among 3253 eligible patients with known outcomes, 94.4% (95.9% children and 92.8% adolescents) were cured or completed treatment, 0.7% died during treatment and 4.9% were LTFU. There were no reported treatment failures. Risk factors of death included children aged 2-4 years (aOR 10.42), central nervous system TB (aOR 5.14), miliary TB (aOR 10.25), HIV co-infection (aOR 8.60), re-treated TB cases (aOR 10.12) and drug-induced liver injury (aOR 6.50). Active case-finding was a protective factor of death (aOR 0.13). Risk factors of LTFU were adolescents aged 15-18 years (aOR 1.91), illegal immigrants (aOR 4.28), urban domicile (aOR 1.59), unknown history of TB contact (aOR 1.99), drug-resistant TB (aOR 2.31), single adverse drug reaction (aOR 2.12), multiple adverse drug reactions (aOR 7.84) and treatment interruption >14 days (aOR 6.93). Treatment in recent years (aOR 0.94) and supervision by public health nurses (aOR 0.14) were protective factors of LTFU. Conclusion: Highly successful treatment outcomes were demonstrated in children and adolescents routinely treated for TB. Special attention should be given to specific risk groups to improve treatment outcomes

Anti-Tuberculosis Drugs and Adverse Events

Anti-tuberculosis (TB) drugs can cause adverse drug reactions, particularly the older second-line drugs. Early intervention and adequate management of adverse drug reactions are important to prevent complications. Laboratory testing at baseline and during treatment, in addition to clinical monitoring, is protocolized to improve patient and treatment management. This chapter provides an overview of the most frequent and severe adverse effects caused by the first-and second-line drugs used for the treatment of tuberculosis. An approach on how to manage the adverse drugs effects is briefly described.</p

Anti-Tuberculosis Drugs and Adverse Events

Anti-tuberculosis (TB) drugs can cause adverse drug reactions, particularly the older second-line drugs. Early intervention and adequate management of adverse drug reactions are important to prevent complications. Laboratory testing at baseline and during treatment, in addition to clinical monitoring, is protocolized to improve patient and treatment management. This chapter provides an overview of the most frequent and severe adverse effects caused by the first-and second-line drugs used for the treatment of tuberculosis. An approach on how to manage the adverse drugs effects is briefly described.</p

Anti-Tuberculosis Drugs and Adverse Events

Anti-tuberculosis (TB) drugs can cause adverse drug reactions, particularly the older second-line drugs. Early intervention and adequate management of adverse drug reactions are important to prevent complications. Laboratory testing at baseline and during treatment, in addition to clinical monitoring, is protocolized to improve patient and treatment management. This chapter provides an overview of the most frequent and severe adverse effects caused by the first-and second-line drugs used for the treatment of tuberculosis. An approach on how to manage the adverse drugs effects is briefly described.</p

Anti-Tuberculosis Drugs and Adverse Events

Anti-tuberculosis (TB) drugs can cause adverse drug reactions, particularly the older second-line drugs. Early intervention and adequate management of adverse drug reactions are important to prevent complications. Laboratory testing at baseline and during treatment, in addition to clinical monitoring, is protocolized to improve patient and treatment management. This chapter provides an overview of the most frequent and severe adverse effects caused by the first-and second-line drugs used for the treatment of tuberculosis. An approach on how to manage the adverse drugs effects is briefly described.</p

Anti-Tuberculosis Drugs and Adverse Events

Anti-tuberculosis (TB) drugs can cause adverse drug reactions, particularly the older second-line drugs. Early intervention and adequate management of adverse drug reactions are important to prevent complications. Laboratory testing at baseline and during treatment, in addition to clinical monitoring, is protocolized to improve patient and treatment management. This chapter provides an overview of the most frequent and severe adverse effects caused by the first-and second-line drugs used for the treatment of tuberculosis. An approach on how to manage the adverse drugs effects is briefly described.</p