Clinical experience on meropenem/clavulanate (MC) to treat tuberculosis (TB) is anedoctal (case-reports on 10 patients). Aim of our case-control study was to evaluate the contribution of MC when added to linezolid-containing regimens in terms of efficacy, safety/tolerability in treating multidrug- (MDR-) and extensively drug-resistant (XDR-) TB cases after 3 months of second-line treatment.Cases with MDR/XDR-TB (37) were prescribed MC (daily dose: 3 g) in addition to a linezolid-containing regimen (dosage range: 300-1,200 mg·day(-1)), designed according to international guidelines, which was prescribed to controls (61).The clinical severity of cases was worse than that of controls (drug susceptibility profile; proportion of sputum smear positive and of re-treatment cases). The group of cases yielded a higher proportion of sputum smear converters (28/32, 87.5% VS. 9/16, 56.3%; p-value: 0.02) and culture converters (31/37, 83.8% VS. 15/24, 62.5%; p-value: 0.06). Excluding XDR-TB patients (11/98, 11.2%), cases scored a significantly higher proportion of culture converters than controls (p-value: 0.03).One case had to withdraw MC due to increased transaminase levels.The results of our study provide: 1) preliminary evidence on effectiveness and safety/tolerability of MC; 2) reference to design further trials and 3) guide to clinicians for its rationale use within salvage/compassionate regimens.
Efficacy and safety of meropenem/clavunate added to linezolid containing regimens in the treatment of M/XDR-TB.
SPANEVELLO, ANTONIO;
2012-01-01
Abstract
Clinical experience on meropenem/clavulanate (MC) to treat tuberculosis (TB) is anedoctal (case-reports on 10 patients). Aim of our case-control study was to evaluate the contribution of MC when added to linezolid-containing regimens in terms of efficacy, safety/tolerability in treating multidrug- (MDR-) and extensively drug-resistant (XDR-) TB cases after 3 months of second-line treatment.Cases with MDR/XDR-TB (37) were prescribed MC (daily dose: 3 g) in addition to a linezolid-containing regimen (dosage range: 300-1,200 mg·day(-1)), designed according to international guidelines, which was prescribed to controls (61).The clinical severity of cases was worse than that of controls (drug susceptibility profile; proportion of sputum smear positive and of re-treatment cases). The group of cases yielded a higher proportion of sputum smear converters (28/32, 87.5% VS. 9/16, 56.3%; p-value: 0.02) and culture converters (31/37, 83.8% VS. 15/24, 62.5%; p-value: 0.06). Excluding XDR-TB patients (11/98, 11.2%), cases scored a significantly higher proportion of culture converters than controls (p-value: 0.03).One case had to withdraw MC due to increased transaminase levels.The results of our study provide: 1) preliminary evidence on effectiveness and safety/tolerability of MC; 2) reference to design further trials and 3) guide to clinicians for its rationale use within salvage/compassionate regimens.
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