Because of this, it is important that we should optimize the use of each agent. However the individual patient becomes lost in the masses that are treated this way. This activity can be centralized, with reference centers performing it for a defined geographical area, just as transplant therapy is now individualized by a central reference service over the web for many areas of France. However, the dosage of current anti-TB drug regimens has never been optimized according to the exposure-effect relationships of each drug. As the world develops, in future years, it may well be possible for this approach to spread further into these presently underserved areas. However, in the initial intermittent phase, between 3% and 40% of patients received anti-tuberculosis drug dosages that were too low. Safety of rifampin and pyrazinamide for the treatment of latent tuberculosis infection. Pérez-Guzmán C, Vargas MH, Martínez-Rossier LA, Torres-Cruz A, Villarreal-Velarde H. Int J Tuberc Lung Dis.
As pointed out above, available data on anti-TB drug toxicity are not sufficient to derive quantitative relationships between drug PK and adverse drug reactions and define the upper limits for safe exposure. Ideally, optimal individualized dosage regimens of anti-TB drugs should take into account toxicity in addition to efficacy and prevention of resistance. ܡ��+� +:�ɣ�O�Dt�w�I��ۧ��1Һ�+��y���l[]n��� S�!�]�dfE�F���%'�T^q���UC@"h�f�L���@0�n~�~v��� ���t`"`M��o�ևl|D x�Fm�Q���z�խ,��L �j{`� ��v�O@| ����/��.$=WSpp:p�hҴ+�$�)�M��P铘�a����3Q���#�QYa�ѕ��X�a�`�+/}�wY����I��F]��*j:�s��9��C�rz`~6�QzO�����3���4� �r�A��� oA[��w/Ӫ�[�&2F�����o>�b�.����d$�������]_�'�[��!t�wY��!�D��FCu#B�I ��>F�����A���G��`,"��`7&T� w �*�� �Ҁ !�Q�c::�*��J�Mp��+ e pK;mڲ��e��'��`�ݤ��٤�?f�����F*:Y�u. The public health, fixed-dose approach ignores important determinants of the response to treatment, including the large PK variability in the PK of anti-TB drugs, variability in M. tuberculosis susceptibility to drugs (MIC), and the existence of quantitative exposure–effect relationships. 2014 Sep 21;4(3):169-73. doi: 10.5588/pha.14.0024. USA.gov. Suggested dosage regimens for the use of H1-blockers in the management of pruritus have been reviewed in an excellent paper by Scott & Miller (1999), and these data are reproduced here (Tables 11.2 and 11.3).
In particular, quantitative relationships between anti-TB drug exposure (eg, AUC24 or Cmax) and antimicrobial effect, emergence of resistance, and clinical outcome itself have been determined and now can provide rational target values to be selected and achieved for patients.
However, TB treatment has been rigidly standardized and coordinated at the international level by the WHO, in spite of the increasing scientific evidence supporting individualization of anti-TB dosage drug regimens. Expert Opin Drug Saf. 20.7). Today, toxicity of anti-TB drugs remains poorly predictable from drug exposure, and clinical monitoring is always the best way to deal with this issue in individual patients. High dosages of gliclazide might lead to severe hypoglycaemia. (20.3)). From: Principles of Clinical Pharmacology (Second Edition), 2007, S. Goutelle, P. Maire, in Individualized Drug Therapy for Patients, 2017. The case fatality rate was 5.9%.
Thus, one should not think that combination therapy can necessarily compensate for poor dosing of individual drugs. Dose- 600mg OD Factors such as cost and frequency of dosing should be considered in selection of an appropriate antihistamine for any individual case. For those receiving correct prescriptions, daily treatment in the initial and continuation phases was generally associated with adequate dosages of drugs. Obviously, the main solution to the problem is money. The individualized approach may also lead to doses of drugs that are significantly lower (in case of infection with a low MIC strain and/or slow drug elimination) or significantly greater (if the MIC of the isolate and/or drug clearance is high) than the current standards. 2002 Nov;6(11):952-8. doi: 10.1371/journal.pone.0044133. RESULTS: Of 1970 patients aged > or = 15 years, 1211 (62%) had treatment cards and pre-treatment weights. There is some evidence that the effect of antihistamines may be enhanced by concurrent supplementation with essential fatty acids.
%PDF-1.4 Chiang CY, Yu MC, Shih HC, Yen MY, Hsu YL, Yang SL, Lin TP, Bai KJ. The use of PK/PD concepts and easy-to-use Bayesian PK software currently available on laptop computers in clinical practice simply requires proper training of users, like any other technique in medicine. We are concerned that the fixed-dose paradigm in TB treatment is unlikely to change unless major clinical evidence shows the superiority of another dosing approach. The authors recommended the use of a slow rate of infusion. However, the high number of adverse events shows that the development of more effective and less toxic drugs remains a top priority. There was no significant difference in serum creatinine concentration between the groups during the study, a dosage of amikacin 15 mg/kg/day achieved higher peak and lower trough concentrations in all infants. Epub 2012 Aug 27. This “one-size-fits-all” dosing approach has had the major advantage of being simple and thus easily applicable worldwide. The first thing we suggest is to determine the MIC of each clinical isolate of M. tuberculosis from each patient.
Evaluation of adherence to national treatment guidelines among tuberculosis patients in three provinces of South Africa. Adequacy of anti-tuberculosis drug prescriptions in Viet Nam. )v/)^� ��l7���� ��������?�N���t����;��|��B�H�R��@���3�#�b2.Fa�T1 E�+�ـ~�>: �@���ه�B#�U�(��v��l�qX�n�Q}�,F���g��wif{EB8p�,��t[���P'�0[�[���i2+!3sD�Y]$� ���M�H��W�:� ��$�X����z��LF�i��E�D�#���t��9�^�b��^k-&�p-#���,�4�2�e�}��+H�~�k� $2�
2003 Sep;7(9 Suppl 1):S38-47. If the MIC is not available yet (eg, at the start of therapy) or cannot be determined, one should use the most probable value, based on the local microbial epidemiology (MIC distribution). These drugs should be used whenever Mycobacterium Tuberculosis organisms are susceptible. This is the job of microbiology laboratories that are already aided by the WHO within its Stop TB strategy [5]. It may also be most useful to monitor both the disease response and concentration-dependent toxicities when high doses appear necessary in other individuals, by controlling the drug exposure most precisely [59], in combination with careful clinical monitoring. Setting:
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