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Pharmacokinetics of Second-Line Anti-Tubercular Drugs

The Indian Journal of Pediatrics volume 86, pages 714–716 (2019)Cite this article

Abstract

Multidrug-resistant tuberculosis (MDR TB) has become a major global health concern and is also an issue in children. Children with MDR TB need longer duration of treatment with multiple drugs. The MDR TB treatment regimen usually comprises of a fluoroquinolone, an aminoglycoside, ethionamide, cycloserine, pyrazinamide and ethambutol. In the absence of pediatric friendly tablets/formulations, in most cases the adult tablets are either crushed or broken. This is likely to lead to inaccurate dosing. Very limited information is available on the pharmacokinetics of second-line anti-TB drugs in children with MDR TB, except for few studies from South Africa and one from India. Drugs such as linezolid, clofazimine are also being considered for the treatment of MDR TB in children. However, their pharmacokinetics is not known in the pediatric population. It is important to generate pharmacokinetic studies of drugs used to treat MDR TB in children in different settings, which would provide useful information on the adequacy of drug doses.

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References

  1. Abdullah A, Peloquin CA. Therapeutic drug monitoring in the treatment of tuberculosis: an update. Drugs. 2014;74:839–54.

    Article  CAS  Google Scholar 

  2. Denti P, Garcia-Prats AJ, Draper HR, et al. Levofloxacin population pharmacokinetics in south African children treated for multidrug-resistance tuberculosis. Antimicrob Agents Chemother. 2017. https://doi.org/10.1128/AAC.01521-17.

  3. Thee S, Garcia-Prats AJ, Draper HR, et al. Pharmacokinetics and safety of moxifloxacin in children with multidrug-resistant tuberculosis. Clin Infect Dis. 2015;60:549–56.

    Article  CAS  PubMed  Google Scholar 

  4. Thee S, Garcia-Prats AJ, Mclleron HM, et al. Pharmacokinetics of ofloxacin and levofloxacin for prevention and treatment of multidrug-resistant tuberculosis in children. Antimicrob Agents Chemother. 2014;58:2948–51.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Hemanth Kumar AK, Kumar A, Kannan T, et al. Pharmacokinetics of second-line anti-tuberculosis drugs in children with multidrug-resistant tuberculosis in India. Antimicrob Agents Chemother. 2018;62:e2410–7.

  6. Capparelli EV, Reed MD, Bradley JS, et al. Pharmacokinetics of gatifloxacin in infants and children. Antimicrob Agents Chemother. 2005;49:1106–12.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Chien S, Wells TG, Blumber JL, et al. Levofloxacin pharmacokinetics in children. J Clin Pharmacol. 2005;45:153–60.

    Article  CAS  PubMed  Google Scholar 

  8. Mase SR, Jereb JA, Gonzalez D, et al. Pharmacokinetics and dosing of levofloxacin in children treated for active or latent multidrug-resistant tuberculosis Federated States of Micronesia and Republic of the Marshall Islands. Pediatr Infect Dis J. 2016;35:414–21.

  9. Savic RM, Ruslami R, Hibma JE, et al. Pediatric tuberculosis meningitis: model-based approach to determining optimal doses of the anti-tuberculosis drugs rifampin and levofloxacin for children. Clin Pharmacol Ther. 2015;98:622–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Garcia-Prats AJ, Draper HR, Thee S, et al. Pharmacokinetics and safety of ofloxacin in children in children with drug-resistant tuberculosis. Antimicrob Agents Chemother. 2015;59:6073–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Hesseling AC. 43rd World Union Conference on TB and lung health, 2012. Available at: https://www.theunion.org/what-we-do/journals/ijtld/.../abstract_book_2012_web.pdf. Accessed 10th July 2018.

  12. Thee S, Seifart HI, Rosenkranz B, et al. Pharmacokinetics of ethinomaide in children. Antimicrob Agents Chemother. 2011;55:4594–600.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Zhu M, Namdar R, Stambaugh JJ, et al. Population pharmacokinetics of ethionamide in patients with tuberculosis. Tuberculosis (Edinb). 2002;82:91–6.

    Article  CAS  Google Scholar 

  14. DeVincenzo JP, Berning SE, Peloquin CA, Husson RN. Multidrug-resistant tuberculosis meningitis: clinical problems and concentrations of second-line antituberculosis medications. Ann Pharmacother. 1999;33:1184–8.

    Article  CAS  PubMed  Google Scholar 

  15. Soderhjelm L. Serum para-aminosalicylic acid following oral ingestion in children. Tex Rep Biol Med. 1949;7:471–9.

    CAS  PubMed  Google Scholar 

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  1. National Institute for Research in Tuberculosis (Indian Council of Medical Research), Mayor Sathyamoorthy Road, Chetpet, Chennai, 600 031, India

    Geetha Ramachandran

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  1. Geetha Ramachandran
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Correspondence to Geetha Ramachandran.

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Ramachandran, G. Pharmacokinetics of Second-Line Anti-Tubercular Drugs. Indian J Pediatr 86, 714–716 (2019). https://doi.org/10.1007/s12098-019-02923-6

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  • DOI: https://doi.org/10.1007/s12098-019-02923-6

Keywords

  • MDR TB
  • Children
  • Pharmacokinetics
  • Second-line anti-TB drugs