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Free Content Impact of food and antacids on the pharmacokinetics of anti-tuberculosis drugs: systematic review and meta-analysis [Review article]

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OBJECTIVE: To compare the effects of food and antacids on the bioavailability of first-line anti-tuberculosis drugs.

METHOD: Systematic search of electronic databases PubMed (January 1950–May 2009), and the Cochrane Library database (January 1974–May 2009), including the Cochrane Centre register of controlled trials, and ongoing trials from research registers using key terms ‘food’, ‘antacids’, ‘meal’, ‘controlled trial’, ‘diet’, and the first-line anti-tuberculosis drugs isoniazid (INH), rifampicin (RMP), ethambutol (EMB) and pyrazinamide (PZA). Meta-analysis was performed using RevMan software 5 to assess the impact of food or antacids on the maximum plasma concentrations (Cmax) and area under the plasma concentration time curve (AUC) of anti-tuberculosis drugs.

RESULTS: Twelve trials involving 157 patients were included in the meta-analysis. The overall effects showed that food significantly reduced the Cmax mean difference (Cmax MD; Cmax MD −1.42, 95%CI −1.56–−1.28, P < 0.00001) and AUC (Cmax MD −3.33, 95%CI −4.05–−2.62, P < 0.00001) of INH but antacids did not. Food also significantly reduced the Cmax MD (Cmax MD −2.47, 95%CI −3.30–−1.64, P < 0.00001) but not the AUC of RMP. Antacids had no effect on the Cmax MD or AUC of RMP. The Cmax and AUC of PZA were unaffected by both food and antacids. Both food and antacids reduced the Cmax but not the AUC of EMB.

CONCLUSION: From a pharmacokinetic point of view, it seems that the better option for patients with gastrointestinal upsets during chemotherapy would be to add antacids rather than dosing with meals.

Keywords: antacids; bioavailability; first-line anti-tuberculosis drugs; food

Document Type: Review Article

Affiliations: 1: Department of Pharmacy, Tian-Sheng Memorial Hospital, Tong-Kang, Ping-Tong County, Taiwan, Republic of China 2: School of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China 3: Division of Chest Medicine, Department of Internal Medicine, Tian-Sheng Memorial Hospital, Tong-Kang, Ping-Tong County, Taiwan, Republic of China

Publication date: 2010-07-01

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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