1. Effectiveness and safety of meropenem/clavulanate-containing regimens in the treatment of multidrug-resistant tuberculosis
- Author
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Andrea Piana, Valentina Alarcon Guizado, Gerard De Vries, Alena Aleksa, Onno W. Akkerman, Simon Tiberi, Rosella Centis, Alberto Matteelli, Giovanni Sotgiu, Janina Artsukevich, Edith Alarcon Arrascue, Giogia Sulis, Felix Antonio Chong Marin, Fabrizio Palmieri, Lia D'Ambrosio, Marina Tadolini, Jan-Willem C. Alffenaar, Aurora Jazmín Roby Arias, Eduardo Henrique Bonini, Alena Skrahina, Mina Gaga, Veronica White, Heinke Kunst, Gina Gualano, Yvan Solovic, Pietro Viggiani, Jose A. Caminero, Marcos Abdo Arbex, Charalampos Moschos, Simone Dore, Dante Vargas Vasquez, Lorena Collahuazo López, Marie-Christine Payen, Vera Avchinko, Saviero De Lorenzo, Anna Scardigli, Apostolos Papavasileiou, Antonio Spanevello, Alimuddin Zumla, and Giovanni Battista Migliori
- Subjects
medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Meropenem ,Surgery ,Sputum culture ,Regimen ,Tolerability ,Internal medicine ,Cohort ,Culture conversion ,medicine ,Sputum ,medicine.symptom ,business ,medicine.drug ,Cohort study - Abstract
Background: Meropenem/clavulanate (MC) has been prescribed to treat MDR/XDR-TB cases, although limited scientific evidence exists. Aim: To retrospectively evaluate the effectiveness, safety, and tolerability of MC added to build an optimal regimen when treating MDR/XDR-TB patients. Methods: An observational, retrospective, cohort study was performed in 5 countries across Europe and South America, where consecutive patients with bacteriologically proven MDR-TB were recruited and divided by MC exposure. Information on demographic, epidemiological, microbiological, and clinical variables were collected from the clinical files using standardized e-forms. Results: A cohort of 264 MDR-TB patients was established: 96 patients were treated with MC-containing regimens and 168 without. Only thirteen (5.2%) were HIV-infected. The proportion of XDR-TB was higher in those exposed to MC-containing regimens (49.0% vs. 6.0%), as was the median (IQR) number of antibiotic resistances (8[6-9] vs 5[4-6]). Sputum smear and culture conversion rates were not statistically different in MDR-TB cases exposed and not exposed to MC-containing regimens, including the XDR-TB subgroup (88.0% vs. 100.0%, P=1.00, and 88.0% vs. 100.0%, P=1.00, respectively). Only 6 MC-related adverse events were reported. In 4 cases, MC was re-started after interruption Conclusion: MC-containing regimens can help achieve sputum culture conversion in MDR/XDR-TB cases with no significant toxicity. This study suggests a potential added value of MC in severe forms of drug-resistant TB when an optimal regimen can not be built with available drugs.
- Published
- 2016
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