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Neuropsychiatric toxicity and cycloserine concentrations during treatment for multidrug-resistant tuberculosis
- Source :
- International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases, International Journal of Infectious Diseases, Vol 105, Iss, Pp 688-694 (2021)
- Publication Year :
- 2020
-
Abstract
- Background: Cycloserine, or its structural analogue terizidone, has been associated with neuropsychiatric toxicity (psychosis, depression, and neuropathy). Prospective clinical data on the incidence of and risk factors for neuropsychiatric toxicity in TB patients treated with cycloserine are limited. Methods: A prospective evaluation of neuropsychiatric toxicity was performed using validated screening tools in patients with multidrug-resistant tuberculosis treated with terizidone. Cox proportional hazard modelling was performed to explore the effects of clinical variables and measures of cycloserine pharmacokinetics in plasma. Results: A total 144 participants were recruited: 86 were male and 58 were female; their median age was 35.7 years and 91 (63%) were HIV-infected. Fifty-five (38%) participants developed at least one neuropsychiatric event (30 cases per 100 person-months): 50 (35%) neuropathy, 14 (10%) depression, and 11 (8%) psychosis. Neuropathy was independently associated with cycloserine clearance ((adjusted hazard ratio 0.34 (aHR), P = 0.03)) and high-dose pyridoxine (200 mg vs 150 mg daily, aHR: 2.79, P = 0.01). Conclusions: A high incidence of early neuropsychiatric toxicity was observed in this cohort of patients treated with terizidone. Cycloserine clearance and higher doses of pyridoxine are associated with incident or worsening peripheral neuropathy.
- Subjects :
- 0301 basic medicine
Microbiology (medical)
Adult
Male
medicine.medical_specialty
030106 microbiology
Terizidone
HIV Infections
Neuropsychiatric
Infectious and parasitic diseases
RC109-216
Psychoses, Substance-Induced
Article
03 medical and health sciences
0302 clinical medicine
Risk Factors
Internal medicine
Tuberculosis, Multidrug-Resistant
medicine
Humans
Pharmacokinetics
030212 general & internal medicine
Prospective Studies
Antibiotics, Antitubercular
Depression (differential diagnoses)
Oxazolidinones
business.industry
Depression
Incidence (epidemiology)
Incidence
Cycloserine
Peripheral Nervous System Diseases
Pyridoxine
General Medicine
Isoxazoles
Middle Aged
medicine.disease
Neuropathy
Infectious Diseases
Peripheral neuropathy
Toxicity
Cohort
Female
business
medicine.drug
Subjects
Details
- ISSN :
- 18783511
- Volume :
- 105
- Database :
- OpenAIRE
- Journal :
- International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases
- Accession number :
- edsair.doi.dedup.....cc6c4be58deba58ec1245d87298c0fe6