scholarly journals Individualizing Tuberculosis (TB) Treatment: Are TB Programs in High Burden Settings Ready for Prime Time Therapeutic Drug Monitoring?

2018 ◽  
Vol 67 (5) ◽  
pp. 717-718 ◽  
Author(s):  
Jotam G Pasipanodya ◽  
Tawanda Gumbo
Keyword(s):  
Therapeutic Drug Monitoring ◽  
Drug Monitoring ◽  
Prime Time ◽  
Therapeutic Drug ◽  
High Burden ◽  
Tb Treatment

scholarly journals Reduced Chance of Hearing Loss Associated with Therapeutic Drug Monitoring of Aminoglycosides in the Treatment of Multidrug-Resistant Tuberculosis

2017 ◽  
Vol 61 (3) ◽  
Author(s):  
R. van Altena ◽  
J. A. Dijkstra ◽  
M. E. van der Meer ◽  
J. F. Borjas Howard ◽  
J. G. W. Kosterink ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Body Weight ◽  
Therapeutic Drug Monitoring ◽  
Drug Monitoring ◽  
Controlled Trial ◽  
Successful Outcome ◽  
Prolonged Treatment ◽  
Therapeutic Drug ◽  
Tb Treatment ◽  
Resistant Tuberculosis

ABSTRACT Hearing loss and nephrotoxicity are associated with prolonged treatment duration and higher dosage of amikacin and kanamycin. In our tuberculosis center, we used therapeutic drug monitoring (TDM) targeting preset pharmacokinetic/pharmacodynamic (PK/PD) surrogate endpoints in an attempt to maintain efficacy while preventing (oto)toxicity. To evaluate this strategy, we retrospectively evaluated medical charts of tuberculosis (TB) patients treated with amikacin or kanamycin in the period from 2000 to 2012. Patients with culture-confirmed multiresistant or extensively drug-resistant tuberculosis (MDR/XDR-TB) receiving amikacin or kanamycin as part of their TB treatment for at least 3 days were eligible for inclusion in this retrospective study. Clinical data, including maximum concentration (C max), C min, and audiometry data, were extracted from the patients' medical charts. A total of 80 patients met the inclusion criteria. The mean weighted C max/MIC ratios obtained from 57 patients were 31.2 for amikacin and 12.3 for kanamycin. The extent of hearing loss was limited and correlated with the cumulative drug dose per kg of body weight during daily administration. At follow-up, 35 (67.3%) of all patients had successful outcome; there were no relapses. At a median dose of 6.5 mg/kg, a correlation was found between the dose per kg of body weight during daily dosing and the extent of hearing loss in dB at 8,000 Hz. These findings suggest that the efficacy at this lower dosage is maintained with limited toxicity. A randomized controlled trial should provide final proof of the safety and efficacy of TDM-guided use of aminoglycosides in MDR-TB treatment.

scholarly journals Early Therapeutic Drug Monitoring for Isoniazid and Rifampin among Diabetics with Newly Diagnosed Tuberculosis in Virginia, USA

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Scott K. Heysell ◽  
Jane L. Moore ◽  
Debbie Staley ◽  
Denise Dodge ◽  
Eric R. Houpt
Keyword(s):  
Therapeutic Drug Monitoring ◽  
Drug Monitoring ◽  
Prolonged Treatment ◽  
Therapeutic Drug ◽  
Diabetic Patients ◽  
Newly Diagnosed ◽  
Tb Treatment ◽  
A Value ◽  
Drug Concentrations

Slow responders to tuberculosis (TB) treatment in Virginia have prolonged treatment duration and consume more programmatic resources. Diabetes is an independent risk factor for slow response and low serum anti-TB drug concentrations. Thus, a statewide initiative of early therapeutic drug monitoring (TDM) for isoniazid and rifampin at 2 weeks after TB treatment was piloted for all diabetics with newly diagnosed TB. During the period of early TDM, 12/01/2011–12/31/2012, 21 diabetics hadC2 hrconcentrations performed and 16 (76%) had a value below the expected range for isoniazid, rifampin, or both. Fifteen had follow-up concentrations after dose adjustment and 12 (80%) increased to within the expected range (including all for rifampin). Of 16 diabetic patients with pulmonary TB that had early TDM, 14 (88%) converted their sputum culture to negative in <2 months. Early TDM for diabetics was operationally feasible, may speed response to TB therapy, and can be considered for TB programs with high diabetes prevalence.

Diagnose und Monitoring bei chronisch-entzündlicher Darmerkrankung

2018 ◽  
Vol 75 (5) ◽  
pp. 316-328
Author(s):  
Christian Ansprenger ◽  
Emanuel Burri
Keyword(s):  
Therapeutic Drug Monitoring ◽  
Drug Monitoring ◽  
Morbus Crohn ◽  
Therapeutic Drug ◽  
Körperliche Untersuchung

Zusammenfassung. Die Diagnose und auch die Überwachung von chronisch entzündlichen Darmerkrankungen ruht auf mehreren Säulen: Anamnese, körperliche Untersuchung, Laborwerte (im Blut und Stuhl), Endoskopie, Histologie und Bildgebung. Die Diagnose kann nicht anhand eines einzelnen Befundes gestellt werden. In den letzten Jahren hat sich das Therapieziel weg von klinischen Endpunkten hin zu endoskopischen und sogar histologischen Endpunkten entwickelt. Für einige dieser neuen Therapieziele existiert allerdings noch keine allgemein gültige Definition. Regelmässige Endoskopien werden von Patienten schlecht toleriert, weshalb Surrogat-Marker wie Calprotectin untersucht wurden und eine gute Korrelation mit der mukosalen Entzündungsaktivität nachgewiesen werden konnte. Entsprechend zeigte sich bei Morbus Crohn eine Algorithmus-basierte Therapiesteuerung – unter anderem basierend auf Calprotectin – einer konventionellen Therapiesteuerung überlegen. Die Überwachung der medikamentösen Therapie («Therapeutic Drug Monitoring» [TDM]) ist ein zweites Standbein des Monitoring von chronisch entzündlichen Darmerkrankungen. Mit zunehmendem Einsatz vor allem der Biologika-Therapien wurden sowohl reaktives TDM (in Patienten mit klinischem Rezidiv) als auch proaktives TDM (in Patienten in Remission / stabiler Erkrankung) untersucht und haben (teilweise) Eingang in aktuelle Richtlinien gefunden. Zukünftige Studien werden die vorgeschlagenen Therapieziele besser definieren und den Nutzen der medikamentösen Therapieüberwachung auf den Krankheitsverlauf weiter untersuchen müssen.

Therapeutic drug monitoring (TDM) of the recent antipsychotic ziprasidone in dried blood spots (DBS) and plasma

2011 ◽  
Vol 44 (06) ◽  
Author(s):  
L Mercolini ◽  
G Fulgenzi ◽  
M Melis ◽  
G Boncompagni ◽  
LJ Albers ◽  
...  
Keyword(s):  
Therapeutic Drug Monitoring ◽  
Drug Monitoring ◽  
Dried Blood Spots ◽  
Therapeutic Drug ◽  
Blood Spots

Comparison of CE and HPLC for therapeutic drug monitoring of the antiepileptic drug topiramate

2011 ◽  
Vol 44 (06) ◽  
Author(s):  
R Mandrioli ◽  
L Mercolini ◽  
N Ghedini ◽  
M Amore ◽  
E Kenndler ◽  
...  
Keyword(s):  
Therapeutic Drug Monitoring ◽  
Antiepileptic Drug ◽  
Drug Monitoring ◽  
Therapeutic Drug

Therapeutic drug monitoring (TDM) in children and adolescents treated with aripiprazole

2012 ◽  
Vol 45 (06) ◽  
Author(s):  
D Hansen ◽  
R Taurines ◽  
C Wewetzer ◽  
B Pfuhlmann ◽  
P Plener ◽  
...  
Keyword(s):  
Therapeutic Drug Monitoring ◽  
Children And Adolescents ◽  
Drug Monitoring ◽  
Therapeutic Drug

Therapeutic Drug Monitoring (TDM) of donepezil in patients with Alzheimers dementia

2013 ◽  
Vol 46 (06) ◽  
Author(s):  
G Hefner ◽  
A Brueckner ◽  
K Geschke ◽  
C Hiemke ◽  
A Fellgiebel
Keyword(s):  
Therapeutic Drug Monitoring ◽  
Drug Monitoring ◽  
Therapeutic Drug
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