CURRENT STRATEGIES IN THE TREATMENT OF MULTIDRUG-RESISTANT TUBERCULOSIS

Authors

  • Neethu Td Department of Pharmacy Practice, JKK Nattraja College of Pharmacy, Kumarapalayam, Erode, Tamil Nadu, India.
  • Mebin Alias Department of Pharmacy Practice, JKK Nattraja College of Pharmacy, Kumarapalayam, Erode, Tamil Nadu, India.

DOI:

https://doi.org/10.22159/ajpcr.2018.v11i7.25651

Keywords:

Mycobacterium, Multidrug-resistant tuberculosis, Extensively drug-resistant tuberculosis, Totally drug-resistant tuberculosis

Abstract

Objective: The objective of the study was to analyze and review the current knowledge about the principles of treatment of multidrug-resistant tuberculosis (MDR-TB), World Health Organization treatment regimen to treat MDR-TB, mechanism of resistance, and risk factors for emergence of resistance, and novel antitubercular drugs (ATDs) available and control measures to improve treatment outcomes of MDR-TB.

Methods: Various articles were reviewed from PubMed and other databases and were analyzed to write the review.

Results: Mycobacterium is a largely curable infectious disease if proper treatment should be followed. The success of the treatment depends on the designing of proper treatment regimen and patient adherence to that medication.

Conclusion: Mycobacterium tuberculosis is now the most lethal infectious pathogen. Drug resistance has become a major problem in the treatment of TB. In MDR-TB, the bacteria is resistant to at least isoniazid (INH) and rifampicin (RIF), and in extensively drug-resistant TB the bacteria is resistant to INH, RIF, any fluoroquinolone, and at least one of three injectable second-line drugs for TB such as kanamycin, capreomycin, and amikacin. More recently, a more worrying situation has emerged with the description of M. tuberculosis strains that have been found resistant to all antibiotics that were available for testing, a situation labeled as totally drug resistant-TB. Other reasons like poor planning by the authorities and the government may also result in the emergence of resistant strain. Rather than the effective chemotherapy and the moderately protective vaccine, new anti-TB agents, and novel controlled release nanoparticulate system like polymeric nanocarrier systems containing existing ATDs are urgently needed to decrease the global incidence of TB.

Downloads

Download data is not yet available.

References

Falzon D, Schünemann HJ, Harausz E, Gonzaelez-Angulo L, Jaramillo E, Lienhardt C, et al. World health organization treatment guidelines for drug-resistant tuberculosis, 2016 update. Eur Respir J 2017;49:1602308.

Wayne LG. Microbiology of the tubercle bacilli. Am Rev Respir Dis 1982;125:31-41.

D’Ambrosio L, Centis R, Sotgiu G, Pontali E, Spanevello A, Migliori GB. New anti-tuberculosis drugs and regimens: 2015 update. ERJ Open Res 2015;1:10-2015.

Lange C, Abubakar I, Alffenaar JW, Bothamley G, Caminero JA, Carvalho AC, et al. Management of patients with multidrug-resistant/ extensively drug-resistant tuberculosis in europe: A TBNET consensus statement. Eur Respir J 2014;44:23-63.

Nunn AJ, Rusen ID, Van Deun A, Torrea G, Phillips PP, Chiang CY, et al. Evaluation of a standardized treatment regimen of anti-tuberculosis drugs for patients with multi-drug-resistant tuberculosis (STREAM): Study protocol for a randomized controlled trial. Trials 2014;15:353.

Johnston JC, Shahidi NC, Sadatsafavi M, Fitzgerald JM. Treatment outcomes of multidrug- resistant tuberculosis: A systematic review and meta-analysis. PLoS One 2009;4: e6914.

Shim TS, Jo KW. Medical treatment of pulmonary multidrug-resistant tuberculosis. Infect Chemother 2013;45:367-74.

Diacon AH, Pym A, Grobusch M, Patientia R, Rustomjee R, Page- Shipp L, et al. The diarylquinoline TMC207 for multi drug resistant tuberculosis. N Engl J Med 2009;360:2397-405.

Ndjeka N, Conradie F, Schnippel K, Hughes J, Bantubani N, Ferreira H, et al. Treatment of drug-resistant tuberculosis with bedaquiline in a high HIV prevalence setting: An interim cohort analysis. Int J Tuberc Lung Dis 2015;19:979-85.

Diacon AH, Donald PR, Pym A, Grobusch M, Patientia RF, Mahanyele R, et al. Randomized pilot trial of eight weeks of bedaquiline (TMC207) treatment for multidrug-resistant tuberculosis: Long-term outcome, tolerability, and effect on emergence of drug resistance. Antimicrob Agents Chemother 2012;56:3271-6.

Skripconoka V, Danilovits M, Pehme L, Tomson T, Skenders G, Kummik T, et al. Delamanid improves outcomes and reduces mortality for multidrug-resistant tuberculosis. Eur Respir J 2013;41:2393-400.

Brigden G, Hewison C, Varaine F. New developments in the treatment of drug-resistant tuberculosis: Clinical utility of bedaquiline and delamanid. Infection and drug resistance. Infect Drug Resist 2015;8:367-78.

Davies PD. Drug-resistant tuberculosis. J R Soc Med 2001;94:261-3.

Manda SO, Masenyetse LJ, Lancaster JL, van der Walt ML. Risk of death among HIV co-infected multidrug resistant tuberculosis patients, compared to mortality in the general population of South Africa. J AIDS Clin Res 2013;Suppl 3:7.

Bastos ML, Hussain H, Weyer K, Garcia-Garcia L, Leimane V, Leung CC, et al. Treatment outcomes of patients with multidrug-resistant and extensively drug-resistant tuberculosis according to drug susceptibility testing to first- and second-line drugs: An individual patient data meta-analysis. Clin Infect Dis 2014;59:1364-74.

Velásquez GE, Becerra MC, Gelmanova IY, Pasechnikov AD, Yedilbayev A, Shin SS, et al. Improving outcomes for multidrug-resistant tuberculosis: Aggressive regimens prevent treatment failure and death. Clin Infect Dis 2014;59:9-15.

Gualano G, Capone S, Matteelli A, Palmieri F. New antituberculosis drugs: From clinical trial to programmatic use. Infect Dis Rep 2016;8:6569.

Albanna AS, Smith BM, Cowan D, Menzies D. Fixed-dose combination antituberculosis therapy: A systematic review and meta-analysis. Eur Respir J 2013;42:721-32.

Fonseca JD, Knight GM, Mchugh TD. The complex evaluation of drug resistant mechanism in Mycobacterium tuberculosis. Int J Infect Dis 2015;32:94-100.

Sandhu P, Akhte Y. Evolution of structural fitness and multifunctional aspects of mycobacterial RND family transporters. Arch Microbiol 2018;200:19-31.

Suresh M, Nithya N, Jayasree PR, Kumar PR. Detection and prevalence of efflux pump-mediated drug resistance in clinical isolates of multidrug-resistant gram-negative bacteria from North Kerala, India. Asian J Pharm Clin Res 2016;9:324-7.

Emma S, Brydea MC, Michael T, Ragonnet R, Marais BJ, Guernier V, et al. The risk of global epidemic replacement with drug-resistant Mycobacterium tuberculosis strains. Int J Infect Dis 2017;56:14-20.

Daley CL, Caminero JA. Management of multi-drug resistant tuberculosis. Semin Respir Crit Care Med 2013;34:44-59.

Fair RJ, Tor Y. Antibiotics and bacterial resistance in the 21st century. Perspect Med Chem 2014;6:25-64.

Nikaido H. Multidrug resistance in bacteria. Annu Rev Biochem 2009;78:119-46.

Palomino JC, Martin A. Drug resistance mechanisms in Mycobacterium tuberculosis. Antibiotics 2014;3:317-40.

Hazbón MH, Brimacombe M, Bobadilla del VM, Cavatore M, Guerrero MI, Varma-Basil M, et al. Population genetic study of Isoniazid resistance mutations and evolution of multidrug-resistant Mycobacterium tuberculosis. Antimicrob Agents Chemother 2006;50:2640-9.

Sreevatsan S, Stockbauer KE, Pan X, Kreiswirth BN, Moghazeh SL, Jacobs WR, et al. Ethambutol resistance in Mycobacterium tuberculosis: Critical role of embB mutations. Antimicrob Agents Chemother 1997;41:1677-81.

Scorpio A, Lindholm-Levy P, Heifets L, Gilman R, Siddiqi S, Cynamon M, et al. Characterization of pncA mutations in pyrazinamide-resistant Mycobacterium tuberculosis. Antimicrob Agents Chemother 1997;41:540-3.

Cheng AF, Yew WW, Chan EW, Chin ML, Hui MM, Chan RC, et al. Multiplex PCR amplimer conformation analysis for rapid detection of gyrA mutations in fluoroquinolone-resistant Mycobacterium tuberculosis clinical isolates. Antimicrob Agents Chemother 2004;48:596-601.

Alangaden GJ, Kreiswirth BN, Aouad A, Khetarpal M, Igno FR, Moghazeh SL, et al. Mechanism of resistance to amikacin and kanamycin in Mycobacterium tuberculosis. Antimicrob Agents Chemother 1998;42:1295-7.

Carette X, Blondiaux N, Willery E, Hoos S, Lecat-Guillet N, Lens Z, et al. Structural activation of the transcriptional repressor EthR from Mycobacterium tuberculosis by single amino acid change mimicking natural and synthetic ligands. Nucleic Acids Res 2012;40:3018-30.

Matteelli A, Roggi A, Carvalho AC. Extensively drug-resistant tuberculosis: Epidemiology and management. Clin Epidemiol 2014;6:111-8.

Field SK. Bedaquiline for the treatment of multidrug-resistant tuberculosis: Great promise or disappointment? Ther Adv Chronic Dis 2015;6:170-84.

Gler MT, Skripconoka V, Sanchez-Garavito E, Xiao H, Cabrera- Rivero JL, Vargas-Vasquez DE, et al. Delamanid for multidrug resistant pulmonary tuberculosis. N Engl J Med 2012;366:2151-60.

Wells CD, Gupta R, Hittel N, Geiter LJ. Long-term mortality assessment of multidrug-resistant tuberculosis patients treated with Delamanid. Eur Respir J 2015;45:1498-501.

Sharma P, Pradeep K. Futuristic scpope of biomarkers in tuberculosis. Asian J Pharm Clin Res 2015;8:34-6.

De Moura AM, Mosegui GB, Vianna CM, Cordeiro CB. Cost-effectiveness analysis of directly observed therapy for tuberculosis and its expansion in rio de janeiro. Int J Pharm Pharm Sci 2017;9:171-5.

Heysell SK, Moore JL, Keller SJ, Houpt ER. Therapeutic drug monitoring for slow response to tuberculosis treatment in a state control program, Virginia, USA. Emerg Infect Dis 2010;16:1546-53.

Shaji J, Shaikh M. Drug-resistant tuberculosis: Recent approach in polymer based nanomedicine. Int J Pharm Pharm Sci 2009;8:1-6.

Published

07-07-2018

How to Cite

Td, N., and M. Alias. “CURRENT STRATEGIES IN THE TREATMENT OF MULTIDRUG-RESISTANT TUBERCULOSIS”. Asian Journal of Pharmaceutical and Clinical Research, vol. 11, no. 7, July 2018, pp. 70-75, doi:10.22159/ajpcr.2018.v11i7.25651.

Issue

Section

Original Article(s)