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Chapter 8 : The Role of Therapeutic Drug Monitoring in Mycobacterial Infections

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Abstract:

The treatment of active tuberculosis (TB) disease began in the 1940s ( ). With the introduction of each new drug, different combinations were tried until investigators settled on the current regimen in the 1970s (while this author was still in high school) ( ). The regimen of rifampin, isoniazid, pyrazinamide, and ethambutol (RIPE) became the standard regimen for TB in countries with developed economies, while countries with smaller economies continued to use rifampin-sparing regimens in order to save money. Eventually, nearly all countries adopted the RIPE regimen, once it was clearly shown that treatment outcomes were significantly better with rifampin, despite the initial greater cost of the drug ( ). This focus on cost remains a major driving force in the treatment of TB.

Citation: Peloquin C. 2017. The Role of Therapeutic Drug Monitoring in Mycobacterial Infections, p 119-127. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Seventh Edition. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.TNMI7-0029-2016
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Figure 1

CDC slide showing that 88% of U.S. TB patients complete treatment at 12 months, not 6 months.

Citation: Peloquin C. 2017. The Role of Therapeutic Drug Monitoring in Mycobacterial Infections, p 119-127. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Seventh Edition. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.TNMI7-0029-2016
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References

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Tables

Generic image for table
Table 1

Patients who especially may benefit from TDM

Citation: Peloquin C. 2017. The Role of Therapeutic Drug Monitoring in Mycobacterial Infections, p 119-127. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Seventh Edition. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.TNMI7-0029-2016
Generic image for table
Table 2

Pharmacokinetic parameters of the anti-TB drugs

Citation: Peloquin C. 2017. The Role of Therapeutic Drug Monitoring in Mycobacterial Infections, p 119-127. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Seventh Edition. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.TNMI7-0029-2016

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