RESUMO
INTRODUCTION: Spinal Tuberculosis (STB) represents between 1% and 2% of total tuberculosis cases. STB management remains challenging; the first-line approach consists of medical treatment, while surgery is reserved for patients with complications. No data regarding STB treatment with bedaquiline-containing regimens are available in the literature. CASE DESCRIPTION: Herein, we report the case of a 21-year-old man from Côte d'Ivoire with a multidrug resistance STB with subcutaneous abscess. After approval of the hospital off-label drug committee, we started bedaquiline 400 mg daily for two weeks, followed by 200 mg three times per week, for 22 weeks, associated with linezolid 600 mg daily, rifabutin 450 mg daily, and amikacin 750 mg daily (interrupted after eight weeks). During treatment, we performed a weekly EKG. No QT prolongation was shown, but inverted T waves appeared, requiring several cardiological consultations and cardiac MRI, but no cardiac dysfunction was found. After 24 weeks, bedaquiline was replaced with moxifloxacin 400 mg daily. The patient continued treatment for another year. We performed another computer tomography at the end of treatment, confirming the cure. DISCUSSION: A salvage regimen containing bedaquiline proved effective in treating multidrug-resistance tuberculosis spinal infection without causing severe adverse effects. However, further studies are needed to evaluate better bedaquiline bone penetration and the correct duration of treatment with bedaquiline in MDR spinal tuberculosis.
Assuntos
Mycobacterium tuberculosis , Osteomielite , Tuberculose Resistente a Múltiplos Medicamentos , Tuberculose da Coluna Vertebral , Abscesso/tratamento farmacológico , Adulto , Amicacina/farmacologia , Amicacina/uso terapêutico , Antituberculosos/efeitos adversos , Diarilquinolinas/farmacologia , Diarilquinolinas/uso terapêutico , Humanos , Linezolida/farmacologia , Masculino , Moxifloxacina/farmacologia , Moxifloxacina/uso terapêutico , Uso Off-Label , Osteomielite/tratamento farmacológico , Rifabutina/farmacologia , Rifabutina/uso terapêutico , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Tuberculose da Coluna Vertebral/induzido quimicamente , Tuberculose da Coluna Vertebral/diagnóstico por imagem , Tuberculose da Coluna Vertebral/tratamento farmacológico , Adulto JovemRESUMO
BACKGROUND Rifamycins are a group of antibiotics mainly used in the treatment of tuberculosis (TB), however they interact with antiretroviral therapy (ART). Rifabutin allows more regimens options for concomitant imunodeficiency virus (HIV) treatment compared to rifampicin. OBJECTIVE Compare the outcomes of TB-HIV co-infected patients who used rifampicin or rifabutin. METHODS We analysed data from a prospective cohort study at National Institute of Infectious Diseases Evandro Chagas, Rio de Janeiro (RJ), Brazil. Patients who were treated for TB and HIV with rifampicin or rifabutin, from February 2011 to September 2016 were included. FINDINGS There were 130 TB-HIV patients, of whom 102 were treated with rifampicin and 28 with rifabutin. All patients in the rifabutin-treated group and 55% of the rifampicin-treated group patients were ART-experienced. Patients treated with rifampicin had similar abandon and cure rates, interruptions in treatment due to adverse reactions, immune reconstitution inflammatory syndrome and a similar mortality rate as those treated with rifabutin. However, rifampicin-treated patients had higher CD4 counts and more frequently undetectable HIV viral load by the end of treatment (67% versus 18%, p < 0.001) compared to rifabutin-treated patients, even when only ART-experienced patients were evaluated (66,6% versus 36,3%, p = 0.039). CONCLUSIONS Patients who used rifabutin had worst immune and virological control. This group had more ART-experienced patients. New and simpler regimens are needed for patients who do not respond to previous antiretroviral therapies.
Assuntos
Humanos , Rifamicinas/uso terapêutico , Tuberculose/prevenção & controle , Avaliação de Resultados em Cuidados de Saúde , Rifabutina/uso terapêutico , Rifampina , HIVRESUMO
La infección diseminada por Mycobacterium avium Complex (MAC) es una complicación relativamente frecuente en estadios avanzados de la enfermedad por el virus de la inmunodeficiencia humana. Con el advenimiento de la terapia antiretroviral de gran eficacia, la incidencia de MAC ha disminuido sustancialmente, pero los pacientes con un bajo recuento de linfocitos CD4+ permane-cen en riesgo. Pese a ello, el compromiso meningoencefálico es infrecuente. Presentamos un caso de meningoencefalitis por MAC en una mujer con Sida con inmunodepresión severa. La presencia de MAC debe ser considerada en todo paciente con Sida que presente síntomas compatibles con micobacteriosis diseminada y compromiso neurológico
Assuntos
Adulto , Feminino , Humanos , HIV-1 , Infecções por HIV , Meningoencefalite/diagnóstico , Meningoencefalite/microbiologia , Meningoencefalite/prevenção & controle , Meningoencefalite/terapia , Síndrome da Imunodeficiência Adquirida , Claritromicina/uso terapêutico , Complexo Mycobacterium avium/isolamento & purificação , Quinolonas/uso terapêutico , Rifabutina/uso terapêuticoRESUMO
PURPOSE: The aim of this study was to report on the possible development of corneal endothelial deposits resulting from the use of rifabutin. METHODS: Case series consisting of 3 patients treated with rifabutin were retrospectively studied. Two of the patients were infected with human immunodeficiency virus. A corneal and external disease specialist performed a complete ophthalmologic exam and obtained medical histories of the patients. RESULTS: All cases developed corneal endothelial deposits after previous use of rifabutin. The deposits were bilateral, yellow-white colored, stellate, and mainly peripheral. CONCLUSIONS: In these 3 cases, the unique positive ocular finding was corneal endothelial deposits, which may be related to the use of rifabutin.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/prevenção & controle , Antibacterianos/efeitos adversos , Endotélio Corneano/efeitos dos fármacos , Infecção por Mycobacterium avium-intracellulare/prevenção & controle , Rifabutina/efeitos adversos , Tuberculose dos Linfonodos/tratamento farmacológico , Adulto , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Criança , Técnicas de Diagnóstico Oftalmológico , Esquema de Medicação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Rifabutina/administração & dosagem , Rifabutina/uso terapêuticoRESUMO
With the exception of rifampin-like drugs, there is a lack of scientific evidence supporting the ability of commonly prescribed antibiotics, including all those routinely employed in outpatient dentistry, to either reduce blood levels and/or the effectiveness of oral contraceptives. To date, all clinical trials studying the effects of concomitant antibiotic therapy (with the exception of rifampin and rifabutin) have failed to demonstrate an interaction. Like all drugs, oral contraceptives are not 100 per cent effective with the failure rate in the typical United States population reported to be as high as 3 per cent. It is thus possible that the case reports of unintended pregnancies during antibiotic therapy may simply represent the normal failure rate of these drugs. Considering that both drug classes are prescribed frequently to women of childbearing potential, one would expect a much higher rate of oral contraceptive failure in this group of patients if a true drug:drug interaction existed. On the other hand, if the interaction does exist but is a relatively rare event, occurring in, say, 1 in 5000 women, clinical studies such as those described in this article would not detect the interaction. The pharmacokinetic studies of simultaneous antibiotic and oral contraceptive ingestion, and the retrospective studies of pregnancy rates among oral contraceptive users exposed to antibiotics, all suffer from one potential common weakness, i.e., their relatively small sample size. Sample sizes in the pharmacokinetic trials ranged from 7 to 24 participants, whereas the largest retrospective study of pregnancy rates still evaluated less than 800 total contraceptive users. Still, the incidence of such a rare interaction would not differ from the accepted normal failure rate of oral contraceptive therapy. The medico-legal ramifications of what looks like at best a rare interaction remains somewhat "murky." On one hand, we have medico-legal experts advising the profession to exercise caution and warn all oral contraceptive users of a potential reduction in efficacy during antibiotic therapy. These opinions are not evidence-based and rely heavily on one or two legal proceedings that cannot even be substantiated. On the other hand, there is one recently published legal proceeding in which the outcome was in favor of the oral surgeon. There is clearly...
Assuntos
Feminino , Humanos , Gravidez , Absorção Intestinal , Antibacterianos/farmacocinética , Antibacterianos/uso terapêutico , Anticoncepcionais Orais/antagonistas & inibidores , Anticoncepcionais Orais/farmacocinética , Anticoncepcionais Orais/uso terapêutico , Disponibilidade Biológica , Estudos Retrospectivos , Rifabutina/uso terapêutico , Rifampina/uso terapêutico , Viés , Ensaios Clínicos como Assunto , Interações Medicamentosas , Jurisprudência , Tamanho da AmostraAssuntos
Animais , Camundongos , Camundongos Endogâmicos BALB C , Hansenostáticos/administração & dosagem , Hansenostáticos/farmacologia , Hansenostáticos/uso terapêutico , Hanseníase/microbiologia , Hanseníase/tratamento farmacológico , Modelos Animais de Doenças , Mycobacterium leprae , Mycobacterium leprae/crescimento & desenvolvimento , Rifabutina/administração & dosagem , Rifabutina/farmacologia , Rifabutina/uso terapêutico , Tatus , Testes de Sensibilidade MicrobianaRESUMO
SETTING: Patients with newly-diagnosed drug-sensitive, radiographically active and bacteriologically confirmed pulmonary tuberculosis recruited at 6 centres in Argentina, Brazil and Thailand. OBJECTIVE: To assess the efficacy, tolerability and toxicity of two regimens containing different daily dosages of rifabutin in comparison with rifampicin. DESIGN: Multicentred, randomised, comparative study. In each group, study medications were administered daily for 6 months combined with isoniazid (6 months), and with pyrazinamide and ethambutol (both stopped after 2 months). Treatment success patients were followed-up for up to 2 years. RESULTS: A total of 520 patients were enrolled and randomly assigned to receive either rifampicin (n = 175), or rifabutin 150 mg (n = 174) or rifabutin 300 mg (n = 171). Considering all patients with positive baseline culture, the success rates at the last valid observation for each patient were 89%, 94% and 92% in the rifampicin, rifabutin 150 mg, and rifabutin 300 mg groups, respectively. The median time to culture conversion was comparable in the 3 groups and was 34 days for rifampicin and 37 days for each of the rifabutin groups. During the drug-free follow-up period, one relapse occurred in the rifampicin group, and two in each of the rifabutin groups. The 3 treatment schedules appeared well tolerated. No patients had to discontinue therapy because of an adverse event in the rifabutin 150 mg group, compared to one in the rifampicin and 5 in the rifabutin 300 mg group. CONCLUSION: All 3 regimens proved effective and well tolerated. Rifabutin at 150 mg/d showed the best risk-to-benefit ratio, in that this group had the highest proportion of patients completing treatment, the highest bacteriological conversion rates and the lowest incidence of adverse events.