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Therapeutic drug monitoring: how to improve drug dosage and patient safety in tuberculosis treatment

Sotgiu, Giovanni and Alffenaar, Jan-William C. and Centis, Rosella and D'Ambrosio, Lia and Spanevello, Antonio and Piana, Andrea Fausto and Migliori, Giovanni Battista (2015) Therapeutic drug monitoring: how to improve drug dosage and patient safety in tuberculosis treatment. International Journal of Infectious Diseases, Vol. 32 , p. 101-104. ISSN 1201-9712. Article.

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DOI: 10.1016/j.ijid.2014.12.001

Abstract

In this article we describe the key role of tuberculosis (TB) treatment, the challenges (mainly the emergence of drug resistance), and the opportunities represented by the correct approach to drug dosage, based on the existing control and elimination strategies. In this context, the role and contribution of therapeutic drug monitoring (TDM) is discussed in detail. Treatment success in multidrug-resistant (MDR) TB cases is low (62%, with 7% failing or relapsing and 9% dying) and in extensively drug-resistant (XDR) TB cases is even lower (40%, with 22% failing or relapsing and 15% dying). The treatment of drug-resistant TB is also more expensive (exceeding €50 000 for MDR-TB and €160 000 for XDR-TB) and more toxic if compared to that prescribed for drug-susceptible TB. Appropriate dosing of first- and second-line anti-TB drugs can improve the patient's prognosis and lower treatment costs. TDM is based on the measurement of drug concentrations in blood samples collected at appropriate times and subsequent dose adjustment according to the target concentration. The ‘dried blood spot’ technique offers additional advantages, providing the rationale for discussions regarding a possible future network of selected, quality-controlled reference laboratories for the processing of dried blood spots of difficult-to-treat patients from reference TB clinics around the world.

Item Type:Article
ID Code:10922
Status:Published
Refereed:Yes
Uncontrolled Keywords:MDR-TB, XDR-TB, prevention, treatment, therapeutic drug monitoring, drug dosage
Subjects:Area 06 - Scienze mediche > MED/42 Igiene generale e applicata
Area 06 - Scienze mediche > MED/01 Statistica medica
Divisions:001 Università di Sassari > 01-a Nuovi Dipartimenti dal 2012 > Scienze Biomediche
Publisher:Elsevier
ISSN:1201-9712
Copyright Holders:© 2015 International Society for Infectious Diseases
Additional Information:Special Issue: Commemorating World Tuberculosis Day 2015
Deposited On:25 May 2015 10:33

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