Download or read book Towards individualised treatment of tuberculosis written by Katarina Niward and published by Linköping University Electronic Press. This book was released on 2019-04-24 with total page 115 pages. Available in PDF, EPUB and Kindle. Book excerpt: Each year, around 10 million of individuals develop active tuberculosis (TB). Worldwide, TB is the leading cause of death from an infectious agent surpassing both malaria and HIV. Current treatment regimens are long and therefore encompass a risk of nonadherence and development of acquired drug-resistance, reflected in the increase of multidrug-resistant (MDR) and extensively drug-resistant (XDR) TB. Indeed, this calls for prudent use of existing TB drugs and improvement of TB treatment strategies. The aim of this thesis was to investigate the current drug susceptibility testing (DST) breakpoints for Mycobacterium tuberculosis (M. tuberculosis), the pharmacokinetics and pharmacodynamics (PK/PD) of TB treatment and to explore the role of therapeutic drug monitoring (TDM) for optimising TB treatment. Drug resistance in M. tuberculosis is expressed over a continuous scale and for some drugs it may be identified as low- and high-level resistance. This has been poorly reflected in currently used binary susceptibility breakpoints for TB drugs. Results from genome sequencing and phenotypic DST of ofloxacin and levofloxacin were compared in study I and current breakpoints were found to misclassify up to 25% of M. tuberculosis isolates with resistance mutations in gyrA as susceptible to fluoroquinolones. This finding may have implications for the classification of XDR-TB, treatment of MDR-TB and the evaluation of fluoroquinolones in clinical studies. Study II was a prospective cohort study of susceptible TB in Sweden, where drug concentrations of first-line TB drugs were measured along with the susceptibility level of the bacteria defined by the minimum inhibitory concentration (MIC) of M. tuberculosis. First-line drug concentrations below the reference range (16-42%) were common and most pronounced for rifampicin (13/31, 42%). An exploratory investigation of PK/PD parameters displayed a wide distribution of ratios between drug exposures and MICs. Rifampicin exhibited higher level of individual fluctuations over time during TB treatment compared with isoniazid. In study III the plasma drug concentrations of rifampicin were compared to the tuberculosis drug activity assay (TDA) and results showed that rifampicin drug levels, but not drug levels of the other first-line drugs, correlated with TDA. Patients with rifampicin drug levels below 8 mg/L had significantly lower median TDA. This finding supports the use of TDA as a potential indicator for low rifampicin exposure in resource-constrained settings without access to drug concentration analysis. The study design in study II has been further developed in study IV, which is a prospective cohort study of MDR-TB in China, where drug exposure will be explored in relation to individual bacterial MIC and measurements of treatment outcome. In summary, the work in this thesis emphasises the importance of reliable DST of M. tuberculosis and the need to re-evaluate the currently used breakpoints. Therapeutic drug monitoring (TDM) based on drug concentrations and MICs is a useful tool to avoid suboptimal drug exposure and to individualise TB treatments. Such strategies may improve treatment regimens and avoid further development of resistance.
Download or read book Disease Control Priorities Third Edition Volume 6 written by King K. Holmes and published by World Bank Publications. This book was released on 2017-11-06 with total page 1027 pages. Available in PDF, EPUB and Kindle. Book excerpt: Infectious diseases are the leading cause of death globally, particularly among children and young adults. The spread of new pathogens and the threat of antimicrobial resistance pose particular challenges in combating these diseases. Major Infectious Diseases identifies feasible, cost-effective packages of interventions and strategies across delivery platforms to prevent and treat HIV/AIDS, other sexually transmitted infections, tuberculosis, malaria, adult febrile illness, viral hepatitis, and neglected tropical diseases. The volume emphasizes the need to effectively address emerging antimicrobial resistance, strengthen health systems, and increase access to care. The attainable goals are to reduce incidence, develop innovative approaches, and optimize existing tools in resource-constrained settings.
Download or read book Treatment of Tuberculosis written by World Health Organization and published by . This book was released on 1993 with total page 60 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Guidelines for the Programmatic Management of Drug resistant Tuberculosis written by World Health Organization and published by World Health Organization. This book was released on 2008 with total page 271 pages. Available in PDF, EPUB and Kindle. Book excerpt: The emergence of extensively drug-resistant strains of tuberculosis, especially in countries with a high prevalence of human immunodeficiency virus, is a serious threat to global public health and jeopardizes efforts to effectively control the disease. This publication offers updated recommendations for the diagnosis and management of drug-resistant tuberculosis in a variety of geographical, economic and social settings, and the recording of data that enables the monitoring and evaluation of programs.--Publisher's description.
Download or read book Guidelines for the Programmatic Management of Drug Resistant Tuberculosis written by World Health Organization and published by . This book was released on 2015-04-20 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: This 2011 update of Guidelines for the programmatic management of drug-resistant tuberculosis is intended as a tool for use by public health professionals working in response to the Sixty-second World Health Assembly's resolution on prevention and control of multidrug-resistant tuberculosis and extensively drug-resistant tuberculosis. Resolution WHA62.15, adopted in 2009, calls on Member States to develop a comprehensive framework for the management and care of patients with drug-resistant TB. The recommendations contained in these guidelines address the most topical questions concerning the programmatic management of drug-resistant TB: case-finding, multidrug resistance, treatment regimens, monitoring the response to treatment, and selecting models of care. The guidelines primarily target staff and medical practitioners working in TB treatment and control, and partners and organizations providing technical and financial support for care of drug-resistant TB in settings where resources are limited.
Download or read book WHO consolidated guidelines on drug resistant tuberculosis treatment written by World Health Organization and published by World Health Organization. This book was released on 2018-11-07 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: Tuberculosis (TB) strains with drug resistance (DR-TB) are more difficult to treat than drug-susceptible ones, and threaten global progress towards the targets set by the End TB Strategy of the World Health Organization (WHO). There is thus a critical need for evidence-based policy recommendations on the treatment and care of patients with DR-TB, based on the most recent and comprehensive evidence available. In this regard, the WHO consolidated guidelines on drug-resistant tuberculosis treatment fulfil the mandate of WHO to inform health professionals in Member States on how to improve treatment and care for patients with DR-TB. Between 2011 and 2018, WHO has developed and issued evidence-based policy recommendations on the treatment and care of patients with DR-TB. These policy recommendations have been presented in several WHO documents and their associated annexes, including the WHO treatment guidelines for multidrug- and rifampicin-resistant tuberculosis, 2018 update, issued by WHO in December 2018. The policy recommendations in each of these guidelines have been developed by WHO-convened Guideline Development Groups (GDGs), using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach to summarize the evidence, and formulate policy recommendations and accompanying remarks. The present Consolidated guidelines include a comprehensive set of WHO recommendations for the treatment and care of DR-TB, derived from these WHO guidelines documents. The consolidated guidelines include policy recommendations on treatment regimens for isoniazid-resistant TB (Hr-TB) and MDR/RR-TB, including longer and shorter regimens, culture monitoring of patients on treatment, the timing of antiretroviral therapy (ART) in MDR/RR-TB patients infected with the human immunodeficiency virus (HIV), use of surgery for patients receiving MDR-TB treatment, and optimal models of patient support and care.
Download or read book Management of MDR TB written by World Health Organization and published by World Health Organization. This book was released on 2009 with total page 61 pages. Available in PDF, EPUB and Kindle. Book excerpt: Multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) are increasingly encountered in resource-limited settings. In the context of a national response to MDR- and XDR-TB, health workers in TB clinics (in district hospitals and some accredited health centers) will need to diagnose MDR-TB, initiate second-line anti-TB drugs, and monitor MDR-TB treatment. This Field Guide was created to help health workers carry out these tasks. It is a job aid that medical officers and TB nurses are meant to use frequently during the day for quick reference. It is based on the Emergency Update 2008 of Guidelines for Programmatic Management of Drug-resistant Tuberculosis, and may be considered a companion document to these guidelines. It also draws on the experience of the international health NGO Partners In Health (PIH) in many countries. This module should be introduced to health workers in the context of a training course with a strong emphasis on TB-HIV co-management.
Download or read book WHO consolidated guidelines on tuberculosis Module 4 written by World Health Organization and published by World Health Organization. This book was released on 2022-04-30 with total page 72 pages. Available in PDF, EPUB and Kindle. Book excerpt: Between 2011 and 2019, WHO has developed and issued evidence-based policy recommendations on the treatment and care of patients with DR-TB. These policy recommendations have been presented in several WHO documents and their associated annexes, including the WHO Consolidated Guidelines on Drug Resistant Tuberculosis Treatment, issued by WHO in March 2019. The policy recommendations in each of these guidelines have been developed by WHO-convened Guideline Development Groups, using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach to summarize the evidence, and formulate policy recommendations and accompanying remarks. The present WHO Consolidated Guidelines on Tuberculosis, Module 4: Treatment - Drug-Resistant Tuberculosis Treatment includes a comprehensive set of WHO recommendations for the treatment and care of DR-TB. The document includes two new recommendations, one on the composition of shorter regimens and one on the use of the BPaL regimen (i.e. bedaquiline, pretomanid and linezolid). In addition, the consolidated guidelines include existing recommendations on treatment regimens for isoniazid-resistant TB and MDR/RR-TB, including longer regimens, culture monitoring of patients on treatment, the timing of antiretroviral therapy (ART) in MDR/RR-TB patients infected with the human immunodeficiency virus (HIV), the use of surgery for patients receiving MDR-TB treatment, and optimal models of patient support and care. The guidelines are to be used primarily in national TB programmes, or their equivalents in Ministries of Health, and for other policy-makers and technical organizations working on TB and infectious diseases in public and private sectors and in the community.
Download or read book Strategies to Improve Cardiac Arrest Survival written by Institute of Medicine and published by National Academies Press. This book was released on 2015-09-29 with total page 291 pages. Available in PDF, EPUB and Kindle. Book excerpt: Cardiac arrest can strike a seemingly healthy individual of any age, race, ethnicity, or gender at any time in any location, often without warning. Cardiac arrest is the third leading cause of death in the United States, following cancer and heart disease. Four out of five cardiac arrests occur in the home, and more than 90 percent of individuals with cardiac arrest die before reaching the hospital. First and foremost, cardiac arrest treatment is a community issue - local resources and personnel must provide appropriate, high-quality care to save the life of a community member. Time between onset of arrest and provision of care is fundamental, and shortening this time is one of the best ways to reduce the risk of death and disability from cardiac arrest. Specific actions can be implemented now to decrease this time, and recent advances in science could lead to new discoveries in the causes of, and treatments for, cardiac arrest. However, specific barriers must first be addressed. Strategies to Improve Cardiac Arrest Survival examines the complete system of response to cardiac arrest in the United States and identifies opportunities within existing and new treatments, strategies, and research that promise to improve the survival and recovery of patients. The recommendations of Strategies to Improve Cardiac Arrest Survival provide high-priority actions to advance the field as a whole. This report will help citizens, government agencies, and private industry to improve health outcomes from sudden cardiac arrest across the United States.
Download or read book Global Tuberculosis Control written by World Health Organization and published by World Health Organization. This book was released on 2008 with total page 305 pages. Available in PDF, EPUB and Kindle. Book excerpt: WHO's twelfth annual report on global tuberculosis control in a series that started in 1997.
Download or read book A Tuberculosis Guide for Specialist Physicians written by José A. Caminero Luna and published by . This book was released on 2003 with total page 368 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Global Tuberculosis Report 2014 written by World Health Organization and published by . This book was released on 2014 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: Some volumes for 2014 includes CD-ROM for 2014 key indicators.
Download or read book Systematic Screening for Active Tuberculosis written by World Health Organization and published by World Health Organization. This book was released on 2013 with total page 140 pages. Available in PDF, EPUB and Kindle. Book excerpt: There have been calls to revisit the experiences of TB screening campaigns that were widely applied in Europe and North America in the mid-20th century, as well as more recent experiences with TB screening in countries with a high burden of the disease, and to assess their possible relevance for TB care and prevention in the 21st century. In response, WHO has developed guidelines on screening for active TB. An extensive review of the evidence has been undertaken. The review suggests that screening, if done in the right way and targeting the right people, may reduce suffering and death, but the review also highlights several reasons to be cautious. As discussed in detail in this book, there is a need to balance potential benefits against the risks and costs of screening; this conclusion is mirrored by the history of TB screening. This publication presents the first comprehensive assessment by WHO of the appropriateness of screening for active TB since the recommendations made in 1974 by the Expert Committee. However, the relative effectiveness and cost effectiveness of screening remain uncertain, a point that is underscored by the systematic reviews presented in this guideline. Evidence suggests that some risk groups should always be screened, whereas the prioritization of other risk groups as well as the choice of screening approach depend on the epidemiology, the health-system context, and the resources available. This book sets out basic principles for prioritizing risk groups and choosing a screening approach; it also emphasizes the importance of assessing the epidemiological situation, adapting approaches to local situations, integrating TB screening into other health-promotion activities, minimizing the risk of harm to individuals, and engaging in continual monitoring and evaluation. It calls for more and better research to assess the impact of screening and to develop and evaluate new screening tests and approaches.
Download or read book Adherence to Long term Therapies written by Eduardo Sabaté and published by World Health Organization. This book was released on 2003 with total page 232 pages. Available in PDF, EPUB and Kindle. Book excerpt: This report is based on an exhaustive review of the published literature on the definitions, measurements, epidemiology, economics and interventions applied to nine chronic conditions and risk factors.
Download or read book Ending Neglect written by Institute of Medicine and published by National Academies Press. This book was released on 2000-08-31 with total page 288 pages. Available in PDF, EPUB and Kindle. Book excerpt: Tuberculosis emerged as an epidemic in the 1600s, began to decline as sanitation improved in the 19th century, and retreated further when effective therapy was developed in the 1950s. TB was virtually forgotten until a recent resurgence in the U.S. and around the worldâ€"ominously, in forms resistant to commonly used medicines. What must the nation do to eliminate TB? The distinguished committee from the Institute of Medicine offers recommendations in the key areas of epidemiology and prevention, diagnosis and treatment, funding and organization of public initiatives, and the U.S. role worldwide. The panel also focuses on how to mobilize policy makers and the public to effective action. The book provides important background on the pathology of tuberculosis, its history and status in the U.S., and the public and private response. The committee explains how the U.S. can act with both self-interest and humanitarianism in addressing the worldwide incidence of TB.
Download or read book The Use of Bedaquiline in the Treatment of Multidrug resistant Tuberculosis written by World Health Organization and published by . This book was released on 2015-04-20 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: WHO estimates that up to half a million new cases of multidrug-resistant tuberculosis (MDR-TB) occur worldwide, each year. Current treatment regimens for MDR-TB present many challenges: treatment lasts 20 months or more, requiring daily administration of drugs that are more toxic, less effective, and far more expensive than those used to treat drug-susceptible TB. Globally, less than half of all patients who start MDR-TB therapy are treated successfully. For the first time in over 40 years, a new TB drug with a novel mechanism of action - bedaquiline- is available, and was granted accelerated approval by the United States Food and Drug Administration in December 2012. There is considerable interest in the potential of this drug to treat MDR-TB. However, information about this new drug remains limited. It has only been through two Phase IIb trials for safety and efficacy. The World Health Organization (WHO) is therefore issuing "interim policy guidance". This interim guidance provides advice on the inclusion of bedaquiline in the combination therapy of MDR-TB in accordance with the existing WHO Guidelines for the Programmatic Management of Drug-resistant TB (2011 Update).
Download or read book Respiratory Epidemiology written by Isabella Annesi-Maesano and published by European Respiratory Society. This book was released on 2014-09-01 with total page 308 pages. Available in PDF, EPUB and Kindle. Book excerpt: Over the last decade, the volume of research into the pathophysiology and genetics of pulmonary diseases has increased greatly. This has led to the development of new treatments and therapies for many diseases, including lung cancer, asthma and cystic fibrosis. This issue of the ERS Monograph comprehensively demonstrates the developments in respiratory medicine in recent years. It outlines the importance of epidemiology in respiratory medicine, and will prove a methodological tool that will help disease management. It should also be used as an advocacy tool for the sake of public health.
