| 저자(한글) |
Heysell, Scott K.,Moore, Jane L.,Peloquin, Charles A.,Ashkin, David,Houpt, Eric R. |
| 초록 |
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 ( $C_{max}$ ), 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 $C_{2hr}$ , $16.6{ pm}10.2{ mu}g/mL$ ; 4 [57%] below expected range); moxifloxacin in five (mean $C_{2hr}$ , $3.2{ pm}1.5{ mu}g/mL$ ; 1 [20%] below); capreomycin in five (mean $C_{2hr}$ , $21.5{ pm}14.0{ mu}g/mL$ ; 3 [60%] below); para-aminosalicylic acid in five (mean $C_{6hr}$ , $65.0{ pm}29.1{ mu}g/mL$ ; all within or above); linezolid in three (mean $C_{2hr}$ , $11.4{ pm}4.1{ mu}g/mL$ , 1 [33%] below); amikacin in two (mean $C_{2hr}$ , $35.3{ pm}3.7{ mu}g/mL$ ; 1 [50%] below); ethionamide in one ( $C_{2hr}$ , $1.49{ mu}g/mL$ , 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. |
