Interim Guidance: 4-Month Rifapentine-Moxifloxacin Regimen for the Treatment of Drug-Susceptible Pulmonary Tuberculosis — United States, 2022

Carr, Wendy; Kurbatova, Ekaterina V.; Starks, Angela M.; Goswami, Neela D.; Allen, Leeanna; Winston, Carla A.

doi:10.15585/mmwr.mm7108a1

Cited by 58 publications

(32 citation statements)

References 8 publications

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“…On chromosomes and in plasmids, there are some strong co-occurrences between fusidic acid resistance and type VII secretion systems (T7SS), suggesting that resistance to this type of antibiotic is an important feature. Fusidic acid is bacteriostatic that is widely used to treat skin infections by Gram-positive bacteria, and that is also active against tuberculosis [ 27 , 38 ]. T7SS plays a significant role in mycobacteria, and in the human pathogen Mycobacterium tuberculosis , the main causative agent of tuberculosis [ 39 ].…”

Section: Discussionmentioning

confidence: 99%

Are Virulence and Antibiotic Resistance Genes Linked? A Comprehensive Analysis of Bacterial Chromosomes and Plasmids

et al. 2022

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Although pathogenic bacteria are the targets of antibiotics, these drugs also affect hundreds of commensal or mutualistic species. Moreover, the use of antibiotics is not only restricted to the treatment of infections but is also largely applied in agriculture and in prophylaxis. During this work, we tested the hypothesis that there is a correlation between the number and the genomic location of antibiotic resistance (AR) genes and virulence factor (VF) genes. We performed a comprehensive study of 16,632 reference bacterial genomes in which we identified and counted all orthologues of AR and VF genes in each of the locations: chromosomes, plasmids, or in both locations of the same genome. We found that, on a global scale, no correlation emerges. However, some categories of AR and VF genes co-occur preferentially, and in the mobilome, which supports the hypothesis that some bacterial pathogens are under selective pressure to be resistant to specific antibiotics, a fact that can jeopardize antimicrobial therapy for some human-threatening diseases.

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Section: Discussionmentioning

confidence: 99%

Are Virulence and Antibiotic Resistance Genes Linked? A Comprehensive Analysis of Bacterial Chromosomes and Plasmids

et al. 2022

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“…Drug-susceptible TB disease can be treated with antibiotic regimens that take 4 to 9 months to complete. A newly proposed 4-month treatment course consists of 2 months of intense rifapentine, moxifloxacin, isoniazid and pyrazinamide therapy, followed by 9 weeks of rifapentine, moxifloxacin and isoniazid (Carr et al, 2022). Alternatively, rifampicin, isoniazid, pyrazinamide and ethambutol can be administered for 2 months, followed by rifampicin and isoniazid for 4 months.…”

Section: Treatment and Prophylaxismentioning

confidence: 99%

Drug resistant tuberculosis: Implications for transmission, diagnosis, and disease management

Liebenberg

Gordhan

Kana

2022

Front. Cell. Infect. Microbiol.

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Drug resistant tuberculosis contributes significantly to the global burden of antimicrobial resistance, often consuming a large proportion of the healthcare budget and associated resources in many endemic countries. The rapid emergence of resistance to newer tuberculosis therapies signals the need to ensure appropriate antibiotic stewardship, together with a concerted drive to develop new regimens that are active against currently circulating drug resistant strains. Herein, we highlight that the current burden of drug resistant tuberculosis is driven by a combination of ongoing transmission and the intra-patient evolution of resistance through several mechanisms. Global control of tuberculosis will require interventions that effectively address these and related aspects. Interrupting tuberculosis transmission is dependent on the availability of novel rapid diagnostics which provide accurate results, as near-patient as is possible, together with appropriate linkage to care. Contact tracing, longitudinal follow-up for symptoms and active mapping of social contacts are essential elements to curb further community-wide spread of drug resistant strains. Appropriate prophylaxis for contacts of drug resistant index cases is imperative to limit disease progression and subsequent transmission. Preventing the evolution of drug resistant strains will require the development of shorter regimens that rapidly eliminate all populations of mycobacteria, whilst concurrently limiting bacterial metabolic processes that drive drug tolerance, mutagenesis and the ultimate emergence of resistance. Drug discovery programs that specifically target bacterial genetic determinants associated with these processes will be paramount to tuberculosis eradication. In addition, the development of appropriate clinical endpoints that quantify drug tolerant organisms in sputum, such as differentially culturable/detectable tubercle bacteria is necessary to accurately assess the potential of new therapies to effectively shorten treatment duration. When combined, this holistic approach to addressing the critical problems associated with drug resistance will support delivery of quality care to patients suffering from tuberculosis and bolster efforts to eradicate this disease.

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“… 8 Duration of DS-TB treatment may be reduced to 4 months with the regimen from Study 31 (2HPZMfx/2HPMfx), 14 except in certain circumstances, e.g., complex forms of extrapulmonary TB and HIV-infected persons with CD4 <100 cells/ml. 14 , 68 In children with non-severe (i.e., intrathoracic TB confined to opacification of <1 lobe with no cavities, no signs of miliary TB, no complex pleural effusion and no clinically significant airway obstruction; or only peripheral lymph node TB), drug-susceptible, smear-negative TB, a shorter 4-month regimen of 2HRZ(E)/2HR has recently been shown to be non-inferior to 2HRZ(E)/4HR, and is now recommended by the WHO in children with non-severe PTB (See also Table 3 ). 69 , 70 The availability of palatable paediatric formulations and tolerability of medications may help with adherence to treatment.…”

Section: Standardmentioning

confidence: 99%

Clinical standards for drug-susceptible pulmonary TB

Akkerman

Duarte

Tiberi

et al. 2022

int j tuberc lung dis

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BACKGROUND: The aim of these clinical standards is to provide guidance on ‘best practice´ for diagnosis, treatment and management of drug-susceptible pulmonary TB (PTB).METHODS: A panel of 54 global experts in the field of TB care, public health, microbiology, and pharmacology were identified; 46 participated in a Delphi process. A 5-point Likert scale was used to score draft standards. The final document represents the broad consensus and was approved by all 46 participants.RESULTS: Seven clinical standards were defined: Standard 1, all patients (adult or child) who have symptoms and signs compatible with PTB should undergo investigations to reach a diagnosis; Standard 2, adequate bacteriological tests should be conducted to exclude drug-resistant TB; Standard 3, an appropriate regimen recommended by WHO and national guidelines for the treatment of PTB should be identified; Standard 4, health education and counselling should be provided for each patient starting treatment; Standard 5, treatment monitoring should be conducted to assess adherence, follow patient progress, identify and manage adverse events, and detect development of resistance; Standard 6, a recommended series of patient examinations should be performed at the end of treatment; Standard 7, necessary public health actions should be conducted for each patient. We also identified priorities for future research into PTB.CONCLUSION: These consensus-based clinical standards will help to improve patient care by guiding clinicians and programme managers in planning and implementation of locally appropriate measures for optimal person-centred treatment for PTB.

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Interim Guidance: 4-Month Rifapentine-Moxifloxacin Regimen for the Treatment of Drug-Susceptible Pulmonary Tuberculosis — United States, 2022

Cited by 58 publications

References 8 publications

Are Virulence and Antibiotic Resistance Genes Linked? A Comprehensive Analysis of Bacterial Chromosomes and Plasmids

Are Virulence and Antibiotic Resistance Genes Linked? A Comprehensive Analysis of Bacterial Chromosomes and Plasmids

Drug resistant tuberculosis: Implications for transmission, diagnosis, and disease management

Clinical standards for drug-susceptible pulmonary TB

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