MDR-TB is a manmade problem..it is costly, deadly, debilitating, and the biggest threat to our current TB control strategies 2
|
|
- Kelly Burke
- 6 years ago
- Views:
Transcription
1 1 MDR-TB is a manmade problem..it is costly, deadly, debilitating, and the biggest threat to our current TB control strategies 2 1
2 India has the highest TB burden in the world 3 4 2
3 5 M. tuberculosis Resistance Indian Perspective 6 3
4 M. tuberculosis Resistance Bangladesh Perspective Bangladesh First National TB Drug Resistance Survey ( ): 2011) 1.4% in new cases (lower than estimation, Global:3.4%), 28.5 % in previously treated cases ( higher than estimation, Global: 20%). No XDR TB. Total estimated number of MDR TB in 2012 was about Basic Concepts of Resistance of M. Tuberculosis Resistance is a man mademade amplification of a natural phenomenon. Inadequate drug delivery is main cause of secondary drug resistance. Secondary drug resistance is the main cause of primary drug resistance due to transmission of resistant strains. 8 4
5 9 M. tuberculosis Resistance Natural Resistance When any live species reach a certain number of divisions (in order to perpetuate the species), they undergo genomic mutations at random. Spontaneous mutations develop as bacilli proliferate This always occurs in the successive divisions of each species. It is therefore a dynamic function. 10 5
6 M. tuberculosis Resistance Natural Resistance Therefore, when live species attain a number about 10,000 to 1 million, many of the individual organisms contain genetic mutations Fortunately, the majority of these mutations do not have an obvious phenotypic expression Sometimes, it is necessary to expose the species to selective pressure to express the selected mutation Man-made phenomenon starts 11 M. tuberculosis Resistance Natural Resistance Ever since M. tuberculosis has attacked humans, it has always presented multiple genomic mutations in its continuous divisions Some of these mutations affect the genes in which anti-tuberculous drugs work This means that these antibiotics cannot work against M. tuberculosis, and therefore phenotypically, they show resistance to them 12 6
7 Genetic Markers of Resistance to Anti-TB Drugs Drug Isoniazid Rifampicin Ethambutol Streptomycin Pyrazinamide Fluoroquinolones Gene katg, InhA rpob embb rpsl pnca gyra, gyrb 13 No. of bacilli required for the appearance of a mutant gene Estimated bacterial populations in the different TB lesions Isoniazid 1X bacilli Sm+ve TB bacilli Rifampicin 1 X bacilli Cavitary TB bacilli Streptomycin 1 X bacilli Caseous foci bacilli Ethambutol 1 X bacilli EPTB bacilli Pyrazinamide 1 X bacilli? Sm ve TB bacilli Fluoroquinolone 1 X bacilli? Lymph node bacilli In larger bacterial populations, the probability that resistant mutants are present is higher The prevalence of wild type resistant mutants in an untreated M. 14 tuberculosis populations is very small 7
8 Basic Concept of Resistance Spontaneous mutations develop as bacilli proliferate to > M. tuberculosis Resistance Selection of resistant mutants If Smear positive TB is treated with just ONE drug (H), for each million bacilli, it will kill 9,99,999 (10 6-1), but it will select the ONE resistant mutant that exists. If this TB has a minimum of 1,000 million (10 9 ) organisms, in 2-8 weeks it will have selected the 1,000 mutant bacilli (1 per million) that are resistant in this population. These 1,000 bacilli are insufficient to cause clinical symptoms or to be smear +ve; Good Clinical Progress! The problem is that these 1,000 soon will be
9 Drug resistant mutants in large bacterial population Multidrug therapy: No bacteria resistant to all 3 drugs INH RIF PZA Monotherapy: INH resistant bacteria proliferate INH 17 Appearance of resistance to INH administered as Monotherapy Resistant Mutants The fall and Rise Mechanism Sensitive Bacilli No. of viable bacilli Months after Start of Treatment Mitchison DA. En: Heaf F, et al. Churchill, London,
10 INH resistant bacteria multiply li l to large numbers INH 2 nd spontaneous mutations develop as bacilli proliferate to >10 8 INH RIF INH mono resistant mutants killed, IR resistant mutants proliferate MDR TB IRP 19 Bacteriological Principles of TB Treatment Drug combinations The combination of drugs prevents the appearance of resistance, because it avoids the selection of naturally resistant mutants 20 10
11 M. Tuberculosis Resistance Mono-Resistance: Resistance to single drug Poly-Resistance: Resistance to 2 or more drugs independent of which drugs The worst situation is resistance to H+R which is more difficult to cure For this reason, these patients receive a special name MDR 21 Extensively-Drug-Resistant TB (XDR) MDR + resistance it to fluoroquinolone and 1 of the 3 secondline injectable drugs (amikacin, kanamycin, capreomycin) TDR TB: Resistant to all locally tested anti TB drugs 22 11
12 A controversial Issue Do we need a new definition of resistance beyond XDR TB 23 Already there are TB Cases with organisms Resistant to all these Drugs Totally-Drug Resistant (TDR-TB)? TB)? Ma Z, Lienhard C. Clin Chest Med 30 (2009)
13 TDR-TB Definition: Some Issues Raised The definition should be based on testing for all drugs 11 categories of drugs Does testing 1. INH of only 1 drug in a class mean resistance to all 2. Rifamycins drugs in 3. that Pyrazinamide class? 4. Ethambutol Third line 5. Quinolones drugs (Group 5 drugs) are now used and are found to be working 6. Streptomycin 7. Second line aminoglycosides Amx/Clav, 8. Polypeptides Cfz, Lzd, monobactams, clarithromycin etc. 9. Thioamides DST for 10. several Serine anti TB drugs is not reliable or reproducible 11. PAS Several new anti-tb drugs are in the pipeline Unintentionally labeling the patient incurable or untreatable 25 Totally Drug Resistant (TDR TB) W.H.O. Meeting March, 2012 So, a new definition iti of resistance beyond XDR TB is not recommended,because: Technical difficulties with DST of many anti TB drugs The lack of standardised DST methods for several anti TB drugs (including new investigational drugs) Insufficient evidence to link such DST results to treatment outcomes of patients 26 13
14 MDR-TB Suspects 1. Failure of Category I 2. Fil Failure of Ct Category II re treatment t t regimens and Chronic TB cases 3. Close contact of MDR TB cases 4. Failure of anti TB Treatment in the Private sector 5. Delayed convertors of Cat I/Cat II (remains positive at months 3/4 6. Relapses (Category I and Category II) 7. Return after Defaults (Category I and Category II) 27 MDR-TB Suspects 7. Exposure in institutions that have MDR TB out breaks or ahigh MDR TB prevalence 8. Residence inareas with high h MDR TB prevalence 9. HO using anti tuberculosistuberculosis drugs of poor or unknown quality 10. Treatment in programs that operate poorly (especially HO frequent drug stock outs) outs) 11. Co morbid conditions associated itd with malabsorption 12.HIV co infection 13.Any smear negative or EPTB doing clinically poor on anti TB 28 14
15 4/9/2015 Multidrug-Resistant TB I have been treated several times over the past five years and I m still coughing and can t gain weight! The image cannot be display ed. Your computer may not hav e enough memory to open the image, or the image may hav e been corrupted. Restart y our computer, and then open the file again. If the red x still appears, y ou may hav e to delete the image and then insert it again. The image cannot be display ed. Your computer may not hav e enough memory to open the image, or the image may hav e been corrupted. Restart y our computer, and then open the file again. If the red x still appears, y ou may hav e to delete the image and then insert it again. 29 Diagnosis of MDR-TB Gold standard test: Culture of patient specimen (sputum) to assess inhibition of M tuberculosis growth in the presence of antibiotics (phenotypic assay) Solid media assays: Result may not be available for 3 6 wks Automated liquid culture systems: Faster and more sensitive than solid media cultures; results available in 1 2 wks Rapid molecular tests can identify genotypic resistance very early Xpert TB/RIF identifies M tuberculosis and rifampicin resistance using cartridge based real time PCR in 2 hours Line probe assays (eg, Hain Line probe assays (eg Hain GenoType) identify genotypic resistance to GenoType) identify genotypic resistance to both isoniazid and rifampicin in 1 2 days Average Turnaround Time for Diagnostic Tests Rapid Molecular Tests 2 hrs -2 days Liquid Culture Media 1-2 wks Solid Culture Media 3-6 wks Phenotypic DST 4-12 wks 30 15
16 Factors determining Success in Treatment of MDR TB Culture of mycobacterium tuberculosis Reliable susceptibility Reliable history of previous drug regimens Correct choice of modified treatment regimen Availability of drugs Program to assure delivery of prescribed drugs Reliable follow up 31 Initiating Treatment: WHO Ensure laboratory services for hematology, biochemistry; and audiometry Establish a clinical and laboratory baseline before starting the regimen Initiate treatment gradually when using drugs that cause gastro intestinal intolerance Ensure availability of ancillary drugs to manage adverse effects Use DOT for all doses 32 16
17 Treatment of DR-TB Anti-tuberculosis drug regimen for DR- TB should always include at least FOUR effective but possibly as many as SIX or SEVEN drugs The number of drugs used varies depending on the extent of disease and the potency of the available agents 33 Rational Classification of Anti-TB Drugs Caminero JA, et al. Lancet Infect Dis 2010; 10: Group 1: First Line Drugs, Oral: (R,H,E,Z) Z E Group 2: Quinolones: (Ofx, Lfx, Mfx,Gfx) 1 Group 3: 2 nd line Injectables: (Km, Ak, Cm) Group 4: Other Less Effective Second Line Drugs: Eto/Pto, Cs/Tz, PAS) Group 5: Reinforcement Drugs: (Cfz., Amx/Clv, Lzd, Ipm, Thz, Clr, High dose INH): 0.5 drug 1 Until 4 New Exceptional If <
18 Designing an MDR/XDR Treatment Regimen: General Principles, WHO Regimens should be based on the history of drugs taken by the patient Drugs commonly used in the country and the prevalence of resistance to first and 2nd line drugs should be considered in developing a regimen Use at least four drugs highly likely to be effective The regimen should include at least one injectable and one FQ Use daily DOT, not intermittent administration Contd.. 35 Designing an MDR/XDR Treatment Regimen: General Principles, WHO Do not use drugs for which there is cross resistance Eliminate drugs that are unsafe for the patient Include drugs from groups 1 5 in a hierarchical order based on potency The regimen chosen may be standardized or individualized based on DST Be prepared to prevent, monitor and manage adverse drug reactions Optimize management of underlying medical conditions 36 18
19 Standard Regimen for MDR -TB Treatment Minimum total 20 months and at least 18 months past culture conversion o Intensive Phase Minimum 8 months (or four months after culture conversion) Pyrazinamide (Z) 500 mg Levofloxacin (Lfx) 250 mg Ethionamide (Eto) 250 mg Cycloserine (Cs) 250 mg Kanamycin (Km) 1gm Continuation Phase Minimum 12 months Pyrazinamide (Z) 500 mg Levofloxacin (Lfx) 250 mg Ethionamide (Eto) 250 mg Cycloserine (Cs) 250 mg 37 MDR-TB: Monitoring Monthly collect sputum until smear and culturebecome negative Obtain end of treatment sputum specimen for smear and culture to document cure Perform chest radiograph periodically during treatment and at end of treatment Monitor ( clinical & sputum) minimum of two years following treatment: quarterly during first year, every six months during second year 38 19
20 39 Linezolid for Extensively Drug Resistant Tuberculosis N Engl J Med 2013; 368: Original Article Multidrug Resistant Tuberculosis and Culture Conversion with Bedaquiline N Engl J Med 2014; 371: August 21, 2014 Original Article Delamanid for Multidrug Resistant Pulmonary Tuberculosis N Engl J Med 2012; 366: June 7,
21 Role of SURGERY in MDR-TB - Only indicated if : - 4 drugs are not available (rare) - The lesion is localised (very rare) - There is sufficient respiratory reserve (very rare) - Even in this situation, it must be remembered: - High morbidity-mortalitymortality - Lesions are not sterilised Only indicated in exceptional circumstances (in XDR)! 41 Caminero JA. Int J Tuberc Lung Dis 2006, 10: Common adverse effects of 2nd-line drugs Drugs Ethionamide, prothionamide PAS Cycloserine Kanamycin, amikacin Capreomycin Fluoroquinolones Adverse effects GI upset, hepatitis, hypothyroidism GI upset, hepatitis, hypothyroidism Neurological ad psychiatric disturbances (suicidal ideation) Nephrotoxicity, ototoxicity electrolyte imbalance Well tolerated 42 21
22 Management of MDR-TB in Special Situations Pregnancy: aminoglycosides arenot safe Liver dysfunction: Z, eth/pro, PAS, FQs are hepatotoxic Renal dysfunction: Requires dose adjustment HIV Co infection: 43 THE BEST WAY TO AVOID MDR-TB To Give the best initial treatment when the patient presents with TB for the first time 2 HRZE / 4 HR - Advisable Daily, at least in the Intensive Phase, but preferably throughout treatment - EMB throughout treatment if Smear + at the end of the 2 nd month, or until susceptibility H+R is known 44 22
23 THE BEST WAY TO AVOID MDR-TB Directly Observed Treatment is fundamental to prevent emergence of Resistance 45 Professor Michael Iseman, the US Guru of MDR-TB has Ten commandments for physicians: The first is never to add a single drug to a failing regimen And the other nine are To repeat the first commandment nine times to make sure that the message is understood! 46 23
24 Challenges Long duration ADRs HIV Co infection Infection control 47 Treatment Issue: Shorter Regimen Damien Foundation regimen of just 9 months with SLDs achieved relapse freecure rates approaching 85%. This promising 9 month regimen includes 4 month intensive phase (or until smear conversion) with high doses of gatifloxacin, high dose H, km, prothionamide, clofazimine (Cf), E and Z, and 5 month Continuation Phase with high doses of gatifloxacin, Cf, E and Z. *Van deum A, et al. Short, highly effective, and inexpensive standardized treatment regimen of MDR TB. Am J Respir Crit Care Med 2010; 182: *Aung KJM, et al. Successful 9 month Bangladesh regimen for MDR TB among over 500 consecutive patients. Int J Tubercl Lung Dis 2014;18: Resource poor countries can implement Damien Foundation experience. (Guideline for clinical and operational Management of DR TB. IUATLD 2003) 48 24
25 Summary Treatment of MDR TB is complex and costly. It is much easier to prevent than to treat. t XDR TB is even more difficult! Expert consultation should be obtained whenever possible when MDR or XDR TB is suspected.. 49 Summary (cont.) Patients can be treated with a standardized or an empiric ii regimen. Ideally the regimen should be guided by drug susceptibilitytests. Lab tests do not replace clinical judgment. There are sound principles that can be used to guidein designingtreatment regimens
26 Summary (cont.) Considerable attention must be paid to treatmentt tmonitoring i and support. A patient centered approach to DOT is an important element of successful care. Adverse effects of second line drugs are common and may be severe. Monitoring for these effects is essential. 51 Thank You All National Martyrs Memorial, Bangladesh 52 26
Clinical Management : DR-TB
Clinical Management : DR-TB Charoen Chuchottaworn MD., Senior Medical Advisor, Central Chest Institute of Thailand, Department of Medical Services, MoPH. Tuberculosis Classification Drug susceptible TB
More informationMultidrug-resistant Tuberculosis. Charles L. Daley, MD National Jewish Health Chair, Global GLC, WHO and Stop TB Partnership
Multidrug-resistant Tuberculosis Charles L. Daley, MD National Jewish Health Chair, Global GLC, WHO and Stop TB Partnership Disclosures World Health Organization Chair, Global GLC Otsuka Chair, Data Monitoring
More informationChallenges to treat MDR TB
Challenges to treat MDR TB Manfred Danilovits Tartu University Hospital, Estonian NTP Program 2nd European Advanced Course in Clinical Tuberculosis 22-24 September 2014, Amsterdam MDR-TB control; WHO Europe,
More informationTHE NEW DR-TB NATIONAL POLICY AND STATE OF IMPLEMENTATION
1 THE NEW DR-TB NATIONAL POLICY AND STATE OF IMPLEMENTATION Dr. Norbert Ndjeka MD, DHSM (Wits), MMed(Fam Med) (MED), Dip HIV Man (SA) Director Drug-Resistant TB, TB and HIV National Department of Health
More informationDrug-resistant TB therapy: the future is now
Drug-resistant TB therapy: the future is now Gary Maartens Thanks to Francesca Conradie for sharing slides Division of Clinical Pharmacology UNIVERSITY OF CAPE TOWN IYUNIVESITHI YASEKAPA UNIVERSITEIT VAN
More informationTreatment of Multidrug-resistant Tuberculosis (MDR-TB)
Treatment of Multidrug-resistant Tuberculosis (MDR-TB) 2006 2008 2011 2013 2014 2016 2019 Charles L. Daley, MD National Jewish Health University of Colorado Disclosures Research grant Insmed: Phase II
More informationDR-TB PATIENT IDENTITY CARD
Ministry of Health Community Development Gender Elderly and Children National Tuberculosis and Leprosy Programme DR-TB 02 DR-TB Treatment Unit: DR-TB PATIENT IDENTITY CARD DR-TB Reg. Number: Date of registration:
More informationTB Grand Rounds. MDR-TB: Management of Adverse Drug Reactions. Reynard J. McDonald, M.D. September 18, Patient History
TB Grand Rounds MDR-TB: Management of Adverse Drug Reactions Reynard J. McDonald, M.D. September 18, 2007 Patient History This 30 y/o H/M was born in Ecuador and immigrated to the US in 2001 On 11-22-05
More informationTreatment of MDR/XDR-TB. Short course chemotherapy for MDR-TB: practical issues. CHIANG Chen-Yuan MD, MPH, DrPhilos
Treatment of MDR/XDR-TB Short course chemotherapy for MDR-TB: practical issues CHIANG Chen-Yuan MD, MPH, DrPhilos Treatment strategies for MDR-TB Standardized treatment: drug resistance survey data from
More informationDrug resistant TB: The role of the laboratory
Drug resistant TB: The role of the laboratory 26 Oct 2012 Andrew Whitelaw NHSLS / UCT TB lab functions: Outline Resistance testing Genotypic Phenotypic Which tests are done when, and why Reporting of
More informationMDR treatment. Shanghai, May 2012 Arnaud Trébucq The Union
MDR treatment Shanghai, May 2012 Arnaud Trébucq The Union Why to diagnose MDR-TB? Outcome of SS+ new MDR-TB cases, treated with First Line TB (FLD) drugs Setting Success Died Fail LFFU Transf. Corea 20(56)
More informationSummary of outcomes from WHO Expert Group Meeting on Drug Susceptibility Testing - PRELIMINARY -
Summary of outcomes from WHO Expert Group Meeting on Drug Susceptibility Testing PRELIMINARY 4 th Annual GLI meeting 17 April 2012 Fuad Mirzayev Laboratories, Diagnostics and Drug Resistance unit, Stop
More informationMDR TB AND CASE STUDIES
MDR TB AND CASE STUDIES Chris Keh, MD Director, TB Prevention and Control Program, SFDPH HS Assistant Clinical Professor, Infectious Diseases, UCSF Seattle, CITC Clinical Intensive June 15, 2018 Slide
More informationMDR/XDR TB. Barbara Seaworth, MD, FIDSA, FACP October 27, TB Intensive October 24 27, 2017 San Antonio, TX
MDR/XDR TB Barbara Seaworth, MD, FIDSA, FACP October 27, 2017 TB Intensive October 24 27, 2017 San Antonio, TX EXCELLENCE EXPERTISE INNOVATION Barbara Seaworth, MD, FIDSA, FACP, has the following disclosures
More informationStrategies for Successful Treatment of Drug Resistant Tuberculosis in the U.S.
Strategies for Successful Treatment of Drug Resistant Tuberculosis in the U.S. Barbara J. Seaworth, M.D. Professor of Medicine University of Texas Health Science Center, Tyler Medical Director, Heartland
More informationTB Intensive San Antonio, Texas
TB Intensive San Antonio, Texas April 6-8, 2011 Drug Resistant TB Barbara Seaworth, MD Thursday April 7, 2011 Barbara Seaworth, MD has the following disclosures to make: Has received research funding from
More informationManagement of MDR and XDR TB Prof. Martin Boeree
Management of MDR and XDR TB 1, MD, PhD Associate Professor Consultant Respiratory Medicine Department of Lung Diseases Radboud University Nijmegen Medical Centre TB Referral Hospital Dekkerswald Nijmegen,
More informationTB Intensive Houston, Texas. Multi-Drug Resistant (MDR) TB Barbara Seaworth, MD
TB Intensive Houston, Texas November 10-12, 12 2009 Multi-Drug Resistant (MDR) TB Barbara Seaworth, MD November 12, 2009 Multi-Drug Resistant (MDR) TB Updates November 12, 2009 Barbara J. Seaworth Professor
More informationPractical. Walk through New Survival Guide
Many faces of TB: Drug resistant it ttbs Survival lgid Guide v3 P B L Ch G Sh t L T P. Barry, L. Chen, G. Schecter, L. True Curry International TB Center/CTCA April 20, 2016 Real case Practical Walk through
More informationMulti-Drug and Extensively Drug Resistant Tuberculosis
Multi-Drug and Extensively Drug Resistant Tuberculosis Gwen A. Huitt, M.D., M.S. Professor, Department of Medicine Director, Adult Infectious Disease Care Unit National Jewish Health Disclosures None Tuberculosis
More informationTreatment of Drug Resistant TB
Treatment of Drug Resistant TB Diana M. Nilsen RN, MD Bureau of TB Control New York City Department of Health & Mental Hygiene Objectives Definition of other drug resistant (ODR), multiple drug resistant
More informationTB Intensive Houston, Texas October 15-17, 2013
TB Intensive Houston, Texas October 15-17, 2013 MDR/XDR TB Barbara J. Seaworth, MD October 16, 2013 Barbara J. Seaworth, MD has the following disclosures to make: No conflict of interests No relevant financial
More informationNew drugs and regimens for treatment of drug-sensitive TB (DS-TB) Patrick
New drugs and regimens for treatment of drug-sensitive TB (DS-TB) Patrick Phillips Patrick.Phillips@ucsf.edu @PPJPhillips Outline Overview of regimen development strategies 1-3 year horizon: Ongoing phase
More informationTB New Drugs, Shorter Courses
TB New Drugs, Shorter Courses Brian Chong John Hunter Hospital, Newcastle NSW Talk supervisor: Chris Coulter Disclosures Unfortunately none 1 Current Situation In 2013, Australia had: 1,263 notified TB
More informationMultidrug resistant Tuberculosis
Multidrug resistant Tuberculosis Pennan Barry, MD, MPH California MDR TB Consult Service Surveillance and Epidemiology Section Curry International Tuberculosis Center Clinical Intensive October 018 Objectives
More informationMultidrug-resistant Tuberculosis
Multidrug-resistant Tuberculosis Pennan Barry, MD, MPH California MDR TB Consult Service Surveillance and Epidemiology Section Curry International Tuberculosis Center Clinical Intensive September 2016
More informationTreatment for NTM: when how.and what next? Pr Claire Andréjak Respiratory and ICU Department University hospital, Amiens, France
Treatment for NTM: when how.and what next? Pr Claire Andréjak Respiratory and ICU Department University hospital, Amiens, France First step = To diagnose NTM disease One NTM positive sample NTM disease
More informationTB Intensive San Antonio, Texas
TB Intensive San Antonio, Texas May 6 9, 2014 MDR/XDR TB Barbara Seaworth, MD May 9, 2014 Barbara Seaworth, MD has the following disclosures to make: No conflict of interests No relevant financial relationships
More informationCDC s Molecular Detection of Drug Resistance (MDDR) Service and Mycobacterium tuberculosis DST Model Performance Evaluation Program (MPEP)
CDC s Molecular Detection of Drug Resistance (MDDR) Service and Mycobacterium tuberculosis DST Model Performance Evaluation Program (MPEP) Beverly Metchock, DrPH, D(ABMM) Mycobacteriology Laboratory Branch/Division
More informationThe New England Journal of Medicine THE TREATMENT OF MULTIDRUG-RESISTANT TUBERCULOSIS IN TURKEY
THE TREATMENT OF MULTIDRUG-RESISTANT TUBERCULOSIS IN TURKEY KEMAL TAHAOĞLU, M.D., TÜLAY TÖRÜN, M.D., TÜLIN SEVIM, M.D., GÜLIZ ATAÇ, M.D., ALTAN KIR, M.D., LEVENT KARASULU, M.D., IPEK ÖZMEN, M.D., AND NILÜFER
More informationCase 1 and Case 2. Case 1 3/23/2016
Case 1 and Deidra D. Parrish, MD, MPH&TM Nashville Metro Public Health Dept TB Symposium March 30, 2016 Case 1 27 yo Indian woman came to the US to join her husband three months prior to clinic visit.
More informationMGIT 2 nd LINE DRUG SUSCEPTIBILITY TESTING A personal experience
MGIT 2 nd LINE DRUG SUSCEPTIBILITY TESTING A personal experience Dr Johan Van Wyk MB.Ch.B, M.Med (Clin Path) Clinical Pathologist ibhayi Region, Eastern Cape GWYNETH PALTROW SHAKESPEARE IN LOVE 1998 PORT
More informationMultidrug resistant tuberculosis. Where next? Professor Peter D O Davies (Liverpool)
Multidrug resistant tuberculosis. Where next? Professor Peter D O Davies (Liverpool) DOTS + and LTBI New drugs for TB and the challenge of resistance talk plan 1. Epidemiology 2. Treatment 3. The MDRTB
More informationMDR-TB drugs per WHO guidelines
New antituberculous agents for drug-resistant resistant TB Symposium Belgian Society of Infectiology and Clinical Microbiology November 9 Jens Van Roey, MD - Tibotec Definitions MDR-TB multidrug resistance
More informationDrug resistant TB: Lisa Chen, MD University of California, San Francisco Curry Interna:onal TB Center Sea=le, June 2016
Drug resistant TB: Lisa Chen, MD University of California, San Francisco Curry Interna:onal TB Center Sea=le, June 2016 Drug- Resistant TB: De1initions Mono- resistant: Resistance to a single drug Poly-
More informationLinezolid: an effective, safe and cheap drug for patients failing multidrug-resistant tuberculosis treatment in India
Eur Respir J 2012; 39: 956 962 DOI: 10.1183/09031936.00076811 CopyrightßERS 2012 Linezolid: an effective, safe and cheap drug for patients failing multidrug-resistant tuberculosis treatment in India R.
More informationIntroduction of Bedaquiline in the Philippines
Introduction of Bedaquiline in the Philippines 24th PhilCAT Annual Convention Crown Plaza Hotel August 18,2107 Vivian S. Lofranco, MD., PHSAE National Clinical Coordinator, BDQ MDR-TB is highly contagious
More informationUniversity of Groningen. Tuberculosis and its sequelae Akkerman, Onno
University of Groningen Tuberculosis and its sequelae Akkerman, Onno IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite from it. Please check the document
More informationDrug Resistant Tuberculosis:
Drug Resistant Tuberculosis: Pearls and other Considerations John W. Wilson, MD Associate Professor of Medicine Division of Infectious Diseases Mayo Clinic, Rochester MN Mayo Clinic Center for Tuberculosis
More informationQuality of 2 nd line medicines for tuberculosis. Ms Lisa Hedman World Health Organization Department of Essential Medicines and Health Products
Quality of 2 nd line medicines for tuberculosis Ms Lisa Hedman World Health Organization Department of Essential Medicines and Health Products Case studies in medicines for tuberculosis Outline: Statistics
More informationExploring Novel Approaches to Shared TB Laboratory Services: California-Wisconsin Shared Services Pilot Study
Exploring Novel Approaches to Shared TB Laboratory Services: California-Wisconsin Shared Services Pilot Study Julie Tans-Kersten, MS, BS-MT (ASCP) Tuberculosis Laboratory Program Coordinator Wisconsin
More informationXDR TB: The Laboratory s Dilemma vs The Clinician s Dilemma
XD TB: The Laboratory s Dilemma vs The Clinician s Dilemma Barbara J. Seaworth, MD, FIDSA, FACP, Heartland National TB Center, San Antonio, TX Kenneth Jost, Jr., M(ASCP) Laboratory Services Section, Texas
More informationTRANSPARENCY COMMITTEE
The legally binding text is the original French version TRANSPARENCY COMMITTEE Opinion 29 October 2014 GRANUPAS, gastro-resistant granules 30 sachets with a calibrated measuring spoon (CIP: 34009 278 801
More informationEffects of Moxifloxacin PK-PD and drug interactions on its use in the Treatment of Tuberculosis(TB)
Effects of Moxifloxacin PK-PD and drug interactions on its use in the Treatment of Tuberculosis(TB) Session: Fanning the Flames of HIV and TB Cointeraction SA AIDS Conference-Durban ICC 13-15 June 2017
More informationTreatment of Nontuberculous Mycobacterial Infections (NTM)
Treatment of Nontuberculous Mycobacterial Infections (NTM) Charles L. Daley, MD National Jewish Health University of Colorado, Denver Disclosures Investigator Insmed (inhaled liposomal amikacin) Advisory
More informationExtensively Drug-Resistant Tuberculosis in South Korea: Risk Factors and Treatment Outcomes among Patients at a Tertiary Referral Hospital
MAJOR ARTICLE Extensively Drug-Resistant Tuberculosis in South Korea: Risk Factors and Treatment Outcomes among Patients at a Tertiary Referral Hospital Christie Y. Jeon, 1,2,a Soo Hee Hwang, 5,a Jin Hong
More informationTb : Recent recommendation. Dr.Ketan Shah
Tb : Recent recommendation Dr.Ketan Shah Tbc : Clinician If you think It is easy to diagnose : u r not good clinician It is difficult to diagnose :U r not alone doctor to think this 6/22/2015 Ketan Shah
More informationInappropriate Use of Antibiotics and Clostridium difficile Infection. Jocelyn Srigley, MD, FRCPC November 1, 2012
Inappropriate Use of Antibiotics and Clostridium difficile Infection Jocelyn Srigley, MD, FRCPC November 1, 2012 Financial Disclosures } No conflicts of interest } The study was supported by a Hamilton
More informationNon-Tuberculous Mycobacterial Pulmonary Disease Diagnosis and Management Jakko van Ingen, MD, PhD
Non-Tuberculous Mycobacterial Pulmonary Disease (NTM-PD) 1 Radbound University Nihmegen Medical Center Milestones in NTM research 1980s: Nodular bronchiectatic lung disease Lady Windermere syndrome 1882-1890
More informationAppropriate antimicrobial therapy in HAP: What does this mean?
Appropriate antimicrobial therapy in HAP: What does this mean? Jaehee Lee, M.D. Kyungpook National University Hospital, Korea KNUH since 1907 Presentation outline Empiric antimicrobial choice: right spectrum,
More informationRisk Factors for Poor Outcomes in Patients with Multi-Drug Resistant Tuberculosis in South Korea
Hanyang Med Rev 2016;36:262-268 https://doi.org/10.7599/hmr.2016.36.4.262 pissn 1738-429X eissn 2234-4446 Original Article Risk Factors for Poor Outcomes in Patients with Multi-Drug Resistant Tuberculosis
More informationDr Sharanjit Dhoot. Chelsea and Westminster Hospital, London. 18 th Annual Conference of the British HIV Association (BHIVA)
18 th Annual Conference of the British HIV Association (BHIVA) Dr Sharanjit Dhoot Chelsea and Westminster Hospital, London 18-20 April 2012, The International Convention Centre, Birmingham 18 th Annual
More informationNew antituberculosis drugs and regimens
New antituberculosis drugs: from clinical trial to programmatic use Gina Gualano, 1 Susanna Capone, 2 Alberto Matteelli, 2 Fabrizio Palmieri 1 1 Respiratory Infectious Diseases Unit, National Institute
More informationGUIDE TO INFECTION CONTROL IN THE HOSPITAL. Antibiotic Resistance
GUIDE TO INFECTION CONTROL IN THE HOSPITAL CHAPTER 4: Antibiotic Resistance Author M.P. Stevens, MD, MPH S. Mehtar, MD R.P. Wenzel, MD, MSc Chapter Editor Michelle Doll, MD, MPH Topic Outline Key Issues
More informationAntibacterial Resistance: Research Efforts. Henry F. Chambers, MD Professor of Medicine University of California San Francisco
Antibacterial Resistance: Research Efforts Henry F. Chambers, MD Professor of Medicine University of California San Francisco Resistance Resistance Dose-Response Curve Antibiotic Exposure Anti-Resistance
More informationTuberculosis in 2017: Searching for new solutions in the face of new challenges
Tuberculosis in 2017: Searching for new solutions in the face of new challenges 6th TB Symposium Ministry of Health of the Republic of Belarus, Republican Scientific and Practical Center for Pulmonology
More informationHosted by Dr. Benedetta Allegranzi, WHO Patient Safety Agency A Webber Training Teleclass
The History of Medicine Antimicrobial Resistance Issues Worldwide and the WHO Approach to Combat It Carmem Lúcia Pessoa-Silva, MD, PhD Health Security and Environment Cluster, WHO HQ, Geneva Hosted by
More informationCurrent Status of Fluoroquinolone Use for Treatment of Tuberculosis in a Tertiary Care Hospital in Korea
ORIGINAL ARTICLE https://doi.org/10.4046/trd.2017.80.2.143 ISSN: 1738-3536(Print)/2005-6184(Online) Tuberc Respir Dis 2017;80:143-152 Current Status of Fluoroquinolone Use for Treatment of Tuberculosis
More informationPrinciples of Anti-Microbial Therapy Assistant Professor Naza M. Ali. Lec 1
Principles of Anti-Microbial Therapy Assistant Professor Naza M. Ali Lec 1 28 Oct 2018 References Lippincott s IIIustrated Reviews / Pharmacology 6 th Edition Katzung and Trevor s Pharmacology / Examination
More informationTitle: Resistance to fluoroquinolones and second line injectable drugs: impact on MDR TB outcomes
ERJ Express. Published on October 25, 2012 as doi: 10.1183/09031936.00134712 Title: Resistance to fluoroquinolones and second line injectable drugs: impact on MDR TB outcomes Authors: D. Falzon, N. Gandhi,
More informationPolicy guidance on drug-susceptibility testing (DST) of second-line antituberculosis drugs World Health Organization Geneva 2008
Policy guidance on drugsusceptibility testing (DST) of secondline antituberculosis drugs World Health Organization Geneva 2008 WHO/HTM/TB/2008.392 1 World Health Organization 2008 All rights reserved.
More informationOnline data supplement
Online data supplement Title: Fluoroquinolone therapy for the prevention of multi-drug resistant tuberculosis in contacts: a cost-effectiveness analysis Authors: Gregory J Fox Olivia Oxlade Dick Menzies
More informationCentral Nervous System Infections
Central Nervous System Infections Meningitis Treatment Bacterial meningitis is a MEDICAL EMERGENCY. ANTIBIOTICS SHOULD BE STARTED AS SOON AS THE POSSIBILITY OF BACTERIAL MENINGITIS BECOMES EVIDENT, IDEALLY
More informationConsiderations in antimicrobial prescribing Perspective: drug resistance
Considerations in antimicrobial prescribing Perspective: drug resistance Hasan MM When one compares the challenges clinicians faced a decade ago in prescribing antimicrobial agents with those of today,
More informationTreatment of Slowly Growing NTM Infections
Treatment of Slowly Growing NTM Infections Charles L. Daley, MD National Jewish Health University of Colorado, Denver Disclosures Investigator Insmed (inhaled liposomal amikacin) Advisory Committee Insmed
More informationAntibiotic stewardship in long term care
Antibiotic stewardship in long term care Shira Doron, MD Associate Professor of Medicine Division of Geographic Medicine and Infectious Diseases Tufts Medical Center Boston, MA Consultant to Massachusetts
More informationMultidrug resistant tuberculosis treatment in the Indian private sector: Results from a tertiary referral private hospital in Mumbai
Original Article Multidrug resistant tuberculosis treatment in the Indian private sector: Results from a tertiary referral private hospital in Mumbai Zarir F. Udwadia, Gautam Moharil Department of Pulmonology,
More informationDisclosures. Principles of Antimicrobial Therapy. Obtaining an Accurate Diagnosis Obtain specimens PRIOR to initiating antimicrobials
Disclosures Principles of Antimicrobial Therapy None Lori A. Cox MSN, ACNP-BC, ACNPC, FCCM Penn State Hershey Medical Center Neuroscience Critical Care Unit Obtaining an Accurate Diagnosis Determine site
More informationSection 6.2.4: Antituberculosis Medicines Application for moving streptomycin to complementary list
Section 6.2.4: Antituberculosis Medicines Application for moving streptomycin to complementary list Stop TB Department World Health Organization Summary According to the recent guideline published in 2010
More informationReceived: Accepted: Access this article online Website: Quick Response Code:
Indian Journal of Drugs, 2016, 4(3), 69-74 ISSN: 2348-1684 STUDY ON UTILIZATION PATTERN OF ANTIBIOTICS AT A PRIVATE CORPORATE HOSPITAL B. Chitra Department of Pharmacy Practice, College of Pharmacy, Sri
More informationPneumonia considerations Galia Rahav Infectious diseases unit Sheba medical center
Pneumonia considerations 2017 Galia Rahav Infectious diseases unit Sheba medical center Sir William Osler (1849 1919) "Father of modern medicine Pneumonia: The old man's friend The captain of the men of
More informationETX2514SUL (sulbactam/etx2514) for the treatment of Acinetobacter baumannii infections
ETX2514SUL (sulbactam/etx2514) for the treatment of Acinetobacter baumannii infections Robin Isaacs Chief Medical Officer, Entasis Therapeutics Dr. Isaacs is a full-time employee of Entasis Therapeutics.
More informationINCIDENCE OF BACTERIAL COLONISATION IN HOSPITALISED PATIENTS WITH DRUG-RESISTANT TUBERCULOSIS
INCIDENCE OF BACTERIAL COLONISATION IN HOSPITALISED PATIENTS WITH DRUG-RESISTANT TUBERCULOSIS 1 Research Associate, Drug Utilisation Research Unit, Nelson Mandela University 2 Human Sciences Research Council,
More informationCHAPTER:1 THE RATIONAL USE OF ANTIBIOTICS. BY Mrs. K.SHAILAJA., M. PHARM., LECTURER DEPT OF PHARMACY PRACTICE, SRM COLLEGE OF PHARMACY
CHAPTER:1 THE RATIONAL USE OF ANTIBIOTICS BY Mrs. K.SHAILAJA., M. PHARM., LECTURER DEPT OF PHARMACY PRACTICE, SRM COLLEGE OF PHARMACY Antibiotics One of the most commonly used group of drugs In USA 23
More informationAntimicrobial Update Stewardship in Primary Care. Clare Colligan Antimicrobial Pharmacist NHS Forth Valley
Antimicrobial Update Stewardship in Primary Care Clare Colligan Antimicrobial Pharmacist NHS Forth Valley Setting the Scene! Consequences of Antibiotic Use? Resistance For an individual patient with
More informationAntimicrobial stewardship
Antimicrobial stewardship Magali Dodemont, Pharm. with the support of Wallonie-Bruxelles International WHY IMPLEMENT ANTIMICROBIAL STEWARDSHIP IN HOSPITALS? Optimization of antimicrobial use To limit the
More informationTuberculosis infection in an Asian elephant at a Japanese Zoo and its first treatment in Japan
Tuberculosis infection in an Asian elephant at a Japanese Zoo and its first treatment in Japan Satoshi Ishikawa, Satomi Suga, Yasuhiko Mukai Fukuyama Zoo, Hiroshima Fukuyama Zoo October 22th, 2017 Tuberculosis
More informationAmerican Association of Feline Practitioners American Animal Hospital Association
American Association of Feline Practitioners American Animal Hospital Association Basic Guidelines of Judicious Therapeutic Use of Antimicrobials August 1, 2006 Introduction The Basic Guidelines to Judicious
More informationRational management of community acquired infections
Rational management of community acquired infections Dr Tanu Singhal MD, MSc Consultant Pediatrics and Infectious Disease Kokilaben Dhirubhai Ambani Hospital, Mumbai Why is rational management needed?
More informationPresenter: Ombeva Malande. Red Cross Children's Hospital Paed ID /University of Cape Town Friday 6 November 2015: Session:- Paediatric ID Update
Emergence of invasive Carbapenem Resistant Enterobacteriaceae CRE infection at RCWMCH Ombeva Oliver Malande, Annerie du Plessis, Colleen Bamford, Brian Eley Presenter: Ombeva Malande Red Cross Children's
More informationCouncil Conclusions on Antimicrobial Resistance (AMR) 2876th EMPLOYMENT, SOCIAL POLICY, HEALTH AND CONSUMER AFFAIRS Council meeting
COUNCIL OF THE EUROPEAN UNION Council Conclusions on Antimicrobial Resistance (AMR) 2876th EMPLOYMT, SOCIAL POLICY, HEALTH AND CONSUMER AFFAIRS Council meeting Luxembourg, 10 June 2008 The Council adopted
More informationManagement of Native Valve
Management of Native Valve Infective Endocarditis 2005 AHA 2015 Baddour LM, et al. Circulation. 2015;132(15):1435-86 2009 ESC 2015 Habib G, et al. Eur Heart J. 2015;36(44):3075-128 ESC 2015: Endocarditis
More informationProtein Synthesis Inhibitors
Protein Synthesis Inhibitors Assistant Professor Dr. Naza M. Ali 11 Nov 2018 Lec 7 Aminoglycosides Are structurally related two amino sugars attached by glycosidic linkages. They are bactericidal Inhibitors
More informationPlease distribute a copy of this information to each provider in your organization.
HEALTH ADVISORY TO: Physicians and other Healthcare Providers Please distribute a copy of this information to each provider in your organization. Questions regarding this information may be directed to
More informationAntibiotic Stewardship in the LTC Setting
Antibiotic Stewardship in the LTC Setting Joe Litsey, Director of Consulting Services Pharm.D., Board Certified Geriatric Pharmacist Thrifty White Pharmacy Objectives Describe the Antibiotic Stewardship
More informationCase Presentations: Non Responding TB Dr. Manoj Yadav
Case Presentations: Non Responding TB Dr. Manoj Yadav mbbs, dtcd, dnb (resp. dis.) Consultant Pulmonologist Kailash Hospital, Kailash Complex Near Mahadev Temple, Productivity Road Vadodara 390007 :: Phone:
More informationClinical Manifestations and Treatment of Plague Dr. Jacky Chan. Associate Consultant Infectious Disease Centre, PMH
Clinical Manifestations and Treatment of Plague Dr. Jacky Chan Associate Consultant Infectious Disease Centre, PMH Update of plague outbreak situation in Madagascar A large outbreak since 1 Aug 2017 As
More informationMicrobiology : antimicrobial drugs. Sheet 11. Ali abualhija
Microbiology : antimicrobial drugs Sheet 11 Ali abualhija return to our topic antimicrobial drugs, we have finished major group of antimicrobial drugs which associated with inhibition of protein synthesis
More informationAntimicrobial Stewardship in the Hospital Setting
GUIDE TO INFECTION CONTROL IN THE HOSPITAL CHAPTER 12 Antimicrobial Stewardship in the Hospital Setting Authors Dan Markley, DO, MPH, Amy L. Pakyz, PharmD, PhD, Michael Stevens, MD, MPH Chapter Editor
More informationThe challenge of managing extensively drug-resistant tuberculosis at a referral hospital in the state of São Paulo, Brazil: a report of three cases
J Bras Pneumol. 2015;41(6):554-559 http://dx.doi.org/10.1590/s1806-37562015000000299 CASE REPORT The challenge of managing extensively drug-resistant tuberculosis at a referral hospital in the state of
More informationGeneral Approach to Infectious Diseases
General Approach to Infectious Diseases 2 The pharmacotherapy of infectious diseases is unique. To treat most diseases with drugs, we give drugs that have some desired pharmacologic action at some receptor
More informationCreating a global community for clinical drug repurposing and development. Leonard Sacks Center for drug evaluation and research FDA
Creating a global community for clinical drug repurposing and development Leonard Sacks Center for drug evaluation and research FDA Neglected tropical diseases 1) Repurposing and developing new drugs 2)
More informationPrinciples of Antimicrobial therapy
Principles of Antimicrobial therapy Laith Mohammed Abbas Al-Huseini M.B.Ch.B., M.Sc, M.Res, Ph.D Department of Pharmacology and Therapeutics Antimicrobial agents are chemical substances that can kill or
More informationNew Insights into the Treatment of Leishmaniasis
New Insights into the Treatment of Leishmaniasis Eric Zini Snow meeting, 14 March 2009 Few drugs available for dogs Initially developed to treat human leishmaniasis, later adopted in dogs None eradicates
More informationORIGINAL INVESTIGATION. Increasing Outpatient Fluoroquinolone Exposure Before Tuberculosis Diagnosis and Impact on Culture-Negative Disease
ORIGINAL INVESTIGATION Increasing Outpatient Fluoroquinolone Exposure Before Tuberculosis Diagnosis and Impact on Culture-Negative Disease Pinky D. Gaba, MD; Connie Haley, MD, MPH; Marie R. Griffin, MD,
More informationPharmacokinetic & Pharmadynamic of Once Daily Aminoglycosides (ODA) and their Monitoring. Janis Chan Pharmacist, UCH 2008
Pharmacokinetic & Pharmadynamic of Once Daily Aminoglycosides (ODA) and their Monitoring Janis Chan Pharmacist, UCH 25-4-2008 2008 Aminoglycosides (AG) 1. Gentamicin 2. Amikacin 3. Streptomycin 4. Neomycin
More informationAuthor - Dr. Josie Traub-Dargatz
Author - Dr. Josie Traub-Dargatz Dr. Josie Traub-Dargatz is a professor of equine medicine at Colorado State University (CSU) College of Veterinary Medicine and Biomedical Sciences. She began her veterinary
More informationOPTIMIZATION OF PK/PD OF ANTIBIOTICS FOR RESISTANT GRAM-NEGATIVE ORGANISMS
HTIDE CONFERENCE 2018 OPTIMIZATION OF PK/PD OF ANTIBIOTICS FOR RESISTANT GRAM-NEGATIVE ORGANISMS FEDERICO PEA INSTITUTE OF CLINICAL PHARMACOLOGY DEPARTMENT OF MEDICINE, UNIVERSITY OF UDINE, ITALY SANTA
More informationIn Vitro Activities of Linezolid against Clinical Isolates of ACCEPTED
AAC Accepts, published online ahead of print on April 00 Antimicrob. Agents Chemother. doi:./aac.001-0 Copyright 00, American Society for Microbiology and/or the Listed Authors/Institutions. All Rights
More informationIntroduction to Pharmacokinetics and Pharmacodynamics
Introduction to Pharmacokinetics and Pharmacodynamics Diane M. Cappelletty, Pharm.D. Assistant Professor of Pharmacy Practice Wayne State University August, 2001 Vocabulary Clearance Renal elimination:
More information