Extract
Later-generation fluoroquinolones (moxifloxacin, gatifloxacin) are crucial to all treatment regimens in current use for multidrug-resistant (MDR) tuberculosis (TB) (i.e. joint resistance to at least rifampicin and isoniazid) [1]. Resistance to them is known to occur in different geographical settings [2]. L. Davies Forsman and co-workers advocate for therapeutic drug monitoring (TDM) as a means to help keep blood levels of fluoroquinolones within the ranges considered effective during MDR-TB treatment. They refer to reports of substantial variability in fluoroquinolone pharmacokinetics between patients, which makes it difficult to predict when sub-therapeutic levels occur, and could thus predispose to treatment failure and to the emergence of resistant strains. The authors maintain that TDM employing a dried blood spot technique and newer microbroth dilution plate-based methods to test for minimum inhibitory concentration (MICs) now make it possible for clinicians in low-resource settings to ensure that therapeutic levels of fluoroquinolones can be achieved during treatment.
Abstract
Could therapeutic drug monitoring for fluoroquinolones have a role in the programmatic management of MDR-TB? http://ow.ly/wGdP309R7Z4
Acknowledgements
Authors are staff members of the World Health Organization (WHO). They alone are responsible for the views expressed in this publication and they do not necessarily represent the decisions or policies of WHO. The designations used and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of WHO concerning the legal status of any country, territory, city or area, or of its authorities, nor concerning the delimitation of its frontiers or boundaries.
Footnotes
Conflict of interest: None declared.
- Received February 14, 2017.
- Accepted March 8, 2017.
- Copyright ©ERS 2017