Inadequate Therapeutic Response to a Recommended Antituberculosis Fixed-Dose Combination Regimen in an Overweight Patient with Mycobacterium bovis Infection
OBJECTIVE To report a case of an overweight man with lymph node tuberculosis due to Mycobacterium bovis, a part of the Mycobacterium tuberculosis complex, treated with fixed-dose combination (FDC) chemotherapy. CASE REPORT Following guidelines, according to the patient's weight (92 kg), we pres...
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| Veröffentlicht in: | The Annals of pharmacotherapy 2013-01, Vol.47 (1), p.e4-e4 |
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| container_title | The Annals of pharmacotherapy |
| container_volume | 47 |
| creator | Lloret-Linares, Célia Mouly, Stéphane Hoang-Nguyen, Dan-Tranh Evans, John Raskine, Laurent Lopes, Amanda Cambau, Emmanuelle Bergmann, Jean-François Sellier, Pierre |
| description | OBJECTIVE
To report a case of an overweight man with lymph node tuberculosis due to Mycobacterium bovis, a part of the Mycobacterium tuberculosis complex, treated with fixed-dose combination (FDC) chemotherapy.
CASE REPORT
Following guidelines, according to the patient's weight (92 kg), we prescribed the maximum recommended doses of isoniazid-rifampin-pyrazinamide FDC. It led initially to underdosing, with a poor clinical outcome, justifying increased doses and a complex regimen using separate drugs (isoniazid 600 mg, rifampin 1200 mg, and levofloxacin 1000 mg) to achieve therapeutic drug concentrations and clinical response.
DISCUSSION
Usually recommended doses of FDC chemotherapies may be inappropriate in overweight patients. We discuss here the different factors that may be involved in poor clinical outcomes, particularly the consequences of excess weight on drug metabolism: drug-drug interaction, FDC use, generic formulation use, intestinal malabsorption, and acetylation profile.
CONCLUSIONS
Therapeutic drug monitoring in overweight patients may be useful in the clinical setting to help clinicians individualize drug therapeutic regimens and optimize drug response, adherence, and safety. |
| doi_str_mv | 10.1345/aph.1R452 |
| format | Article |
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To report a case of an overweight man with lymph node tuberculosis due to Mycobacterium bovis, a part of the Mycobacterium tuberculosis complex, treated with fixed-dose combination (FDC) chemotherapy.
CASE REPORT
Following guidelines, according to the patient's weight (92 kg), we prescribed the maximum recommended doses of isoniazid-rifampin-pyrazinamide FDC. It led initially to underdosing, with a poor clinical outcome, justifying increased doses and a complex regimen using separate drugs (isoniazid 600 mg, rifampin 1200 mg, and levofloxacin 1000 mg) to achieve therapeutic drug concentrations and clinical response.
DISCUSSION
Usually recommended doses of FDC chemotherapies may be inappropriate in overweight patients. We discuss here the different factors that may be involved in poor clinical outcomes, particularly the consequences of excess weight on drug metabolism: drug-drug interaction, FDC use, generic formulation use, intestinal malabsorption, and acetylation profile.
CONCLUSIONS
Therapeutic drug monitoring in overweight patients may be useful in the clinical setting to help clinicians individualize drug therapeutic regimens and optimize drug response, adherence, and safety.</description><identifier>ISSN: 1060-0280</identifier><identifier>EISSN: 1542-6270</identifier><identifier>DOI: 10.1345/aph.1R452</identifier><identifier>PMID: 23324515</identifier><language>eng</language><publisher>Los Angeles, CA: SAGE Publications</publisher><subject><![CDATA[Adult ; Antitubercular Agents - administration & dosage ; Antitubercular Agents - therapeutic use ; Drug Combinations ; Drug Monitoring ; Drug Therapy, Combination ; Humans ; Isoniazid - administration & dosage ; Isoniazid - therapeutic use ; Levofloxacin ; Male ; Mycobacterium bovis ; Mycobacterium bovis - isolation & purification ; Mycobacterium tuberculosis ; Ofloxacin - administration & dosage ; Ofloxacin - therapeutic use ; Overweight ; Practice Guidelines as Topic ; Pyrazinamide - administration & dosage ; Pyrazinamide - therapeutic use ; Rifampin - administration & dosage ; Rifampin - therapeutic use ; Treatment Outcome ; Tuberculosis, Lymph Node - drug therapy ; Tuberculosis, Lymph Node - microbiology]]></subject><ispartof>The Annals of pharmacotherapy, 2013-01, Vol.47 (1), p.e4-e4</ispartof><rights>2013 Annals of Pharmacotherapy</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c309t-234653d71135fef12595411b6c32db51b2f18182798596446a0719afd2a448863</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1345/aph.1R452$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1345/aph.1R452$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,776,780,21798,27901,27902,43597,43598</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23324515$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lloret-Linares, Célia</creatorcontrib><creatorcontrib>Mouly, Stéphane</creatorcontrib><creatorcontrib>Hoang-Nguyen, Dan-Tranh</creatorcontrib><creatorcontrib>Evans, John</creatorcontrib><creatorcontrib>Raskine, Laurent</creatorcontrib><creatorcontrib>Lopes, Amanda</creatorcontrib><creatorcontrib>Cambau, Emmanuelle</creatorcontrib><creatorcontrib>Bergmann, Jean-François</creatorcontrib><creatorcontrib>Sellier, Pierre</creatorcontrib><title>Inadequate Therapeutic Response to a Recommended Antituberculosis Fixed-Dose Combination Regimen in an Overweight Patient with Mycobacterium bovis Infection</title><title>The Annals of pharmacotherapy</title><addtitle>Ann Pharmacother</addtitle><description>OBJECTIVE
To report a case of an overweight man with lymph node tuberculosis due to Mycobacterium bovis, a part of the Mycobacterium tuberculosis complex, treated with fixed-dose combination (FDC) chemotherapy.
CASE REPORT
Following guidelines, according to the patient's weight (92 kg), we prescribed the maximum recommended doses of isoniazid-rifampin-pyrazinamide FDC. It led initially to underdosing, with a poor clinical outcome, justifying increased doses and a complex regimen using separate drugs (isoniazid 600 mg, rifampin 1200 mg, and levofloxacin 1000 mg) to achieve therapeutic drug concentrations and clinical response.
DISCUSSION
Usually recommended doses of FDC chemotherapies may be inappropriate in overweight patients. We discuss here the different factors that may be involved in poor clinical outcomes, particularly the consequences of excess weight on drug metabolism: drug-drug interaction, FDC use, generic formulation use, intestinal malabsorption, and acetylation profile.
CONCLUSIONS
Therapeutic drug monitoring in overweight patients may be useful in the clinical setting to help clinicians individualize drug therapeutic regimens and optimize drug response, adherence, and safety.</description><subject>Adult</subject><subject>Antitubercular Agents - administration & dosage</subject><subject>Antitubercular Agents - therapeutic use</subject><subject>Drug Combinations</subject><subject>Drug Monitoring</subject><subject>Drug Therapy, Combination</subject><subject>Humans</subject><subject>Isoniazid - administration & dosage</subject><subject>Isoniazid - therapeutic use</subject><subject>Levofloxacin</subject><subject>Male</subject><subject>Mycobacterium bovis</subject><subject>Mycobacterium bovis - isolation & purification</subject><subject>Mycobacterium tuberculosis</subject><subject>Ofloxacin - administration & dosage</subject><subject>Ofloxacin - therapeutic use</subject><subject>Overweight</subject><subject>Practice Guidelines as Topic</subject><subject>Pyrazinamide - administration & dosage</subject><subject>Pyrazinamide - therapeutic use</subject><subject>Rifampin - administration & dosage</subject><subject>Rifampin - therapeutic use</subject><subject>Treatment Outcome</subject><subject>Tuberculosis, Lymph Node - drug therapy</subject><subject>Tuberculosis, Lymph Node - microbiology</subject><issn>1060-0280</issn><issn>1542-6270</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkctuFDEQRS0EIiGw4AeQV4gsOrj86McyGgiMFBQUhXXL7a6ecTRtd_xIyL_kY3GYwAqJlW353FNSXULeAjsBIdVHvWxP4FIq_owcgpK8qnnDnpc7q1nFeMsOyKsYrxljHfDuJTngQnCpQB2Sh7XTI95knZBebTHoBXOyhl5iXLyLSJOnuryMn2d0I4701CWb8oDB5J2PNtIz-xPH6pMv8MrPg3U6We9KZmNLhFpHtaMXtxju0G62iX4v_-gSvbNpS7_dGz9okzDYPNPB3xbh2k1oHh2vyYtJ7yK-eTqPyI-zz1err9X5xZf16vS8MoJ1qeJC1kqMDYBQE07AVackwFAbwcdBwcAnaKHlTdeqrpay1qyBTk8j11K2bS2OyIe9dwn-JmNM_Wyjwd1OO_Q59qAU1NCoMuW_KG85k0K2oqDHe9QEH2PAqV-CnXW474H1j731pbf-d2-FffekzcOM41_yT1EFeL8Hot5gf-1zcGUj_zD9AlLmoOA</recordid><startdate>201301</startdate><enddate>201301</enddate><creator>Lloret-Linares, Célia</creator><creator>Mouly, Stéphane</creator><creator>Hoang-Nguyen, Dan-Tranh</creator><creator>Evans, John</creator><creator>Raskine, Laurent</creator><creator>Lopes, Amanda</creator><creator>Cambau, Emmanuelle</creator><creator>Bergmann, Jean-François</creator><creator>Sellier, Pierre</creator><general>SAGE Publications</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>7QL</scope><scope>C1K</scope></search><sort><creationdate>201301</creationdate><title>Inadequate Therapeutic Response to a Recommended Antituberculosis Fixed-Dose Combination Regimen in an Overweight Patient with Mycobacterium bovis Infection</title><author>Lloret-Linares, Célia ; Mouly, Stéphane ; Hoang-Nguyen, Dan-Tranh ; Evans, John ; Raskine, Laurent ; Lopes, Amanda ; Cambau, Emmanuelle ; Bergmann, Jean-François ; Sellier, Pierre</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c309t-234653d71135fef12595411b6c32db51b2f18182798596446a0719afd2a448863</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Adult</topic><topic>Antitubercular Agents - administration & dosage</topic><topic>Antitubercular Agents - therapeutic use</topic><topic>Drug Combinations</topic><topic>Drug Monitoring</topic><topic>Drug Therapy, Combination</topic><topic>Humans</topic><topic>Isoniazid - administration & dosage</topic><topic>Isoniazid - therapeutic use</topic><topic>Levofloxacin</topic><topic>Male</topic><topic>Mycobacterium bovis</topic><topic>Mycobacterium bovis - isolation & purification</topic><topic>Mycobacterium tuberculosis</topic><topic>Ofloxacin - administration & dosage</topic><topic>Ofloxacin - therapeutic use</topic><topic>Overweight</topic><topic>Practice Guidelines as Topic</topic><topic>Pyrazinamide - administration & dosage</topic><topic>Pyrazinamide - therapeutic use</topic><topic>Rifampin - administration & dosage</topic><topic>Rifampin - therapeutic use</topic><topic>Treatment Outcome</topic><topic>Tuberculosis, Lymph Node - drug therapy</topic><topic>Tuberculosis, Lymph Node - microbiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lloret-Linares, Célia</creatorcontrib><creatorcontrib>Mouly, Stéphane</creatorcontrib><creatorcontrib>Hoang-Nguyen, Dan-Tranh</creatorcontrib><creatorcontrib>Evans, John</creatorcontrib><creatorcontrib>Raskine, Laurent</creatorcontrib><creatorcontrib>Lopes, Amanda</creatorcontrib><creatorcontrib>Cambau, Emmanuelle</creatorcontrib><creatorcontrib>Bergmann, Jean-François</creatorcontrib><creatorcontrib>Sellier, Pierre</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Environmental Sciences and Pollution Management</collection><jtitle>The Annals of pharmacotherapy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lloret-Linares, Célia</au><au>Mouly, Stéphane</au><au>Hoang-Nguyen, Dan-Tranh</au><au>Evans, John</au><au>Raskine, Laurent</au><au>Lopes, Amanda</au><au>Cambau, Emmanuelle</au><au>Bergmann, Jean-François</au><au>Sellier, Pierre</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Inadequate Therapeutic Response to a Recommended Antituberculosis Fixed-Dose Combination Regimen in an Overweight Patient with Mycobacterium bovis Infection</atitle><jtitle>The Annals of pharmacotherapy</jtitle><addtitle>Ann Pharmacother</addtitle><date>2013-01</date><risdate>2013</risdate><volume>47</volume><issue>1</issue><spage>e4</spage><epage>e4</epage><pages>e4-e4</pages><issn>1060-0280</issn><eissn>1542-6270</eissn><abstract>OBJECTIVE
To report a case of an overweight man with lymph node tuberculosis due to Mycobacterium bovis, a part of the Mycobacterium tuberculosis complex, treated with fixed-dose combination (FDC) chemotherapy.
CASE REPORT
Following guidelines, according to the patient's weight (92 kg), we prescribed the maximum recommended doses of isoniazid-rifampin-pyrazinamide FDC. It led initially to underdosing, with a poor clinical outcome, justifying increased doses and a complex regimen using separate drugs (isoniazid 600 mg, rifampin 1200 mg, and levofloxacin 1000 mg) to achieve therapeutic drug concentrations and clinical response.
DISCUSSION
Usually recommended doses of FDC chemotherapies may be inappropriate in overweight patients. We discuss here the different factors that may be involved in poor clinical outcomes, particularly the consequences of excess weight on drug metabolism: drug-drug interaction, FDC use, generic formulation use, intestinal malabsorption, and acetylation profile.
CONCLUSIONS
Therapeutic drug monitoring in overweight patients may be useful in the clinical setting to help clinicians individualize drug therapeutic regimens and optimize drug response, adherence, and safety.</abstract><cop>Los Angeles, CA</cop><pub>SAGE Publications</pub><pmid>23324515</pmid><doi>10.1345/aph.1R452</doi></addata></record> |
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| subjects | Adult Antitubercular Agents - administration & dosage Antitubercular Agents - therapeutic use Drug Combinations Drug Monitoring Drug Therapy, Combination Humans Isoniazid - administration & dosage Isoniazid - therapeutic use Levofloxacin Male Mycobacterium bovis Mycobacterium bovis - isolation & purification Mycobacterium tuberculosis Ofloxacin - administration & dosage Ofloxacin - therapeutic use Overweight Practice Guidelines as Topic Pyrazinamide - administration & dosage Pyrazinamide - therapeutic use Rifampin - administration & dosage Rifampin - therapeutic use Treatment Outcome Tuberculosis, Lymph Node - drug therapy Tuberculosis, Lymph Node - microbiology |
| title | Inadequate Therapeutic Response to a Recommended Antituberculosis Fixed-Dose Combination Regimen in an Overweight Patient with Mycobacterium bovis Infection |
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