Carbapenems to Treat Multidrug and Extensively Drug-Resistant Tuberculosis: A Systematic Review

Background: Carbapenems (ertapenem, imipenem, meropenem) are used to treat multidrug-resistant (MDR-) and extensively drug-resistant tuberculosis (XDR-TB), even if the published evidence is limited, particularly when it is otherwise difficult to identify the recommended four active drugs to be inclu...

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Published in:International journal of molecular sciences Vol. 17; no. 3; p. 373
Main Authors: Sotgiu, Giovanni, D’Ambrosio, Lia, Centis, Rosella, Tiberi, Simon, Esposito, Susanna, Dore, Simone, Spanevello, Antonio, Migliori, Giovanni
Format: Journal Article
Language:English
Published: Switzerland MDPI 12.03.2016
Subjects:
Antitubercular Agents - adverse effects
Antitubercular Agents - therapeutic use
beta-Lactams - adverse effects
beta-Lactams - therapeutic use
Carbapenems - adverse effects
Carbapenems - therapeutic use
Clinical Studies as Topic
Ertapenem
Extensively Drug-Resistant Tuberculosis - drug therapy
Humans
Imipenem - adverse effects
Imipenem - therapeutic use
Meropenem
Mycobacterium
Review
Thienamycins - adverse effects
Thienamycins - therapeutic use
Treatment Outcome
Tuberculosis, Multidrug-Resistant - drug therapy
effectiveness
imipenem
safety
tolerability
meropenem
MDR-TB
carbapenems
XDR-TB
ertapenem
ISSN:1422-0067, 1422-0067
Online Access:Get full text
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Summary:Background: Carbapenems (ertapenem, imipenem, meropenem) are used to treat multidrug-resistant (MDR-) and extensively drug-resistant tuberculosis (XDR-TB), even if the published evidence is limited, particularly when it is otherwise difficult to identify the recommended four active drugs to be included in the regimen. No systematic review to date has ever evaluated the efficacy, safety, and tolerability of carbapenems. Methods: A search of peer-reviewed, scientific evidence was carried out, aimed at evaluating the efficacy/effectiveness, safety, and tolerability of carbapenem-containing regimens in individuals with pulmonary/extra-pulmonary disease which was bacteriologically confirmed as M/XDR-TB. We used PubMed to identify relevant full-text, English manuscripts up to the 20 December 2015, excluding editorials and reviews. Results: Seven out of 160 studies satisfied the inclusion criteria: two on ertapenem, one on imipenem, and four on meropenem, all published between 2005 and 2016. Of seven studies, six were retrospective, four were performed in a single center, two enrolled children, two had a control group, and six reported a proportion of XDR-TB cases higher than 20%. Treatment success was higher than 57% in five studies with culture conversion rates between 60% and 94.8%. Conclusions: The safety and tolerability is very good, with the proportion of adverse events attributable to carbapenems below 15%.
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These authors contributed equally to this work.
ISSN:1422-0067
1422-0067
DOI:10.3390/ijms17030373