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

Therapeutic Drug Monitoring in Non-Tuberculosis Mycobacteria Infections

Nontuberculous mycobacteria can cause minimally symptomatic self-limiting infections to progressive and life-threatening disease of multiple organs. Several factors such as increased testing and prevalence have made this an emerging infectious disease. Multiple guidelines have been published to guide therapy, which remains difficult owing to the complexity of therapy, the potential for acquired resistance, the toxicity of treatment, and a high treatment failure rate. Given the long duration of therapy, complex multi-drug treatment regimens, and the risk of drug toxicity, therapeutic drug monitoring is an excellent method to optimize treatment. However, currently, there is little available guidance on therapeutic drug monitoring for this condition. The aim of this review is to provide information on the pharmacokinetic/pharmacodynamic targets for individual drugs used in the treatment of nontuberculous mycobacteria disease. Lacking data from randomized controlled trials, in vitro, in vivo, and clinical data were aggregated to facilitate recommendations for therapeutic drug monitoring to improve efficacy and reduce toxicity

Testimony for Hire: Jailhouse Informants

Since DNA testing became available in the late 1980’s, there have been approximately 285 DNA exonerations of wrongly conviction cases. The Innocence Project, which tracks these cases, lists the major contributing factors: eyewitness misidentification, faulty forensic science, false confessions, prosecutorial error, jailhouse informant testimony, and poor lawyering (Innocence Project, 2018). Because of the Innocence Project’s work identifying these leading causes social science researchers have set out to investigate these topics and have sought to make changes in many jurisdictions. There is one leading cause, however, in terms of progress in the realm of science and policy that has remained stagnant, and that is jailhouse informant testimony (Roth, 2016). Jailhouse informants, also commonly known as snitches, are the leading cause of wrongful conviction in capital cases (Warden, 2004). Given that jailhouse informants pose a significant risk, yet are identified as a necessary tool by law enforcement, more needs to be known about how and why the criminal justice system relies on this form of testimony. The current research evaluated 40 exoneration cases that utilized jailhouse informant testimony with the goal of identifying key features that that jurors may have relied upon. Using the framework of Truth Default Theory (Levine, 2014) we examined if the jailhouse informant reported facts consistent with the pattern presented by the prosecution, the reason they stated they were testifying, and whether an incentive for testimony was reported

Cover Editorial- IJID World TB Day 2020 Theme Series

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