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Free Content Therapeutic drug monitoring in the treatment of tuberculosis: a retrospective analysis

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SETTING: Tuberculosis (TB) in-patient treatment unit in Vancouver, Canada.

OBJECTIVE: To examine the results of therapeutic drug monitoring (TDM) in anti-tuberculosis treatment.

DESIGN: We performed a retrospective analysis of TDM data from 2000 to 2010. All in-patients treated for TB with TDM performed during their treatment course were included.

RESULTS: TDM was performed on 52 patients in 76 treatment episodes from 2000 to 2010. Overall, 103/213 (48.4%) drug levels measured were low, and 5/213 (2.3%) were high. At least one drug level was low in 47/52 (90.3%) patients. Initial serum levels were low in respectively 76.6% and 68.4% of isoniazid (INH) and rifampicin (RMP) levels. In contrast, only 2.9% of initial pyrazinamide levels were low. Five patients with a susceptible strain on initial presentation later developed drug-resistant disease, with all five patients demonstrating at least one low drug level and two demonstrating multiple low levels. Dose adjustments were made in response to 26 INH and RMP levels, with variable serum responses.

CONCLUSION: In this population with high rates of treatment failure and acquired resistance, we demonstrate that most patients had low drug levels. Prospective studies are required to examine the relationship between drug levels and clinical outcomes.

Keywords: monitoring; treatment; tuberculosis

Document Type: Research Article


Affiliations: 1: Division of Respiratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada 2: Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada 3: Division of Respiratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada

Publication date: 2013-02-01

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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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