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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Vydáno v:	International journal of molecular sciences Ročník 17; číslo 3; s. 373
Hlavní autoři:	Sotgiu, Giovanni, D’Ambrosio, Lia, Centis, Rosella, Tiberi, Simon, Esposito, Susanna, Dore, Simone, Spanevello, Antonio, Migliori, Giovanni
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	Switzerland MDPI 12.03.2016
Témata:	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
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Abstract	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%.
AbstractList	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%. 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. 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. 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%. The safety and tolerability is very good, with the proportion of adverse events attributable to carbapenems below 15%. 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.BACKGROUNDCarbapenems (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.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.METHODSA 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.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%.RESULTSSeven 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%.The safety and tolerability is very good, with the proportion of adverse events attributable to carbapenems below 15%.CONCLUSIONSThe safety and tolerability is very good, with the proportion of adverse events attributable to carbapenems below 15%.
Author	D’Ambrosio, Lia Dore, Simone Spanevello, Antonio Centis, Rosella Tiberi, Simon Migliori, Giovanni Sotgiu, Giovanni Esposito, Susanna
AuthorAffiliation	1 Clinical Epidemiology and Medical Statistics Unit, Department of Biomedical Sciences, University of Sassari—Research, Medical Education and Professional Development Unit, AOU Sassari, Sassari 07100, Italy; gsotgiu@uniss.it (G.S.); simonedore@hotmail.com (S.D.) 6 Pneumology Unit, Fondazione Maugeri, IRCCS (Istituto di Ricovero e Cura a Carattere Sceintifico), Tradate 21049, Italy; antonio.spanevello@fsm.it 7 Department of Clinical and Experimental Medicine, University of Insubria, Varese 21100, Italy 5 Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS (Istituto di Ricovero e Cura a Carattere Sceintifico) Ca’ Granda Ospedale Maggiore Policlinico, Milan 20122, Italy; susanna.esposito@unimi.it 3 Public Health Consulting Group, Lugano 6900, Switzerland 2 World Health Organization Collaborating Centre for Tuberculosis and Lung Diseases, Fondazione S. Maugeri, IRCCS (Istituto di Ricovero e Cura a Carattere
AuthorAffiliation_xml	– name: 1 Clinical Epidemiology and Medical Statistics Unit, Department of Biomedical Sciences, University of Sassari—Research, Medical Education and Professional Development Unit, AOU Sassari, Sassari 07100, Italy; gsotgiu@uniss.it (G.S.); simonedore@hotmail.com (S.D.) – name: 2 World Health Organization Collaborating Centre for Tuberculosis and Lung Diseases, Fondazione S. Maugeri, IRCCS (Istituto di Ricovero e Cura a Carattere Sceintifico), Via Roncaccio 16, Tradate 21049, Italy; lia.dambrosio@fsm.it (L.D.A.); rosella.centis@fsm.it (R.C.) – name: 5 Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS (Istituto di Ricovero e Cura a Carattere Sceintifico) Ca’ Granda Ospedale Maggiore Policlinico, Milan 20122, Italy; susanna.esposito@unimi.it – name: 6 Pneumology Unit, Fondazione Maugeri, IRCCS (Istituto di Ricovero e Cura a Carattere Sceintifico), Tradate 21049, Italy; antonio.spanevello@fsm.it – name: 3 Public Health Consulting Group, Lugano 6900, Switzerland – name: 7 Department of Clinical and Experimental Medicine, University of Insubria, Varese 21100, Italy – name: 4 Division of Infection, Royal London Hospital, Barts Health NHS Trust, London E1 2ES, UK; simon.tiberi@bartshealth.nhs.uk
Author_xml	– sequence: 1 givenname: Giovanni orcidid: 0000-0002-1600-4474 surname: Sotgiu fullname: Sotgiu, Giovanni – sequence: 2 givenname: Lia surname: D’Ambrosio fullname: D’Ambrosio, Lia – sequence: 3 givenname: Rosella surname: Centis fullname: Centis, Rosella – sequence: 4 givenname: Simon surname: Tiberi fullname: Tiberi, Simon – sequence: 5 givenname: Susanna orcidid: 0000-0003-4103-2837 surname: Esposito fullname: Esposito, Susanna – sequence: 6 givenname: Simone surname: Dore fullname: Dore, Simone – sequence: 7 givenname: Antonio surname: Spanevello fullname: Spanevello, Antonio – sequence: 8 givenname: Giovanni surname: Migliori fullname: Migliori, Giovanni
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Snippet	Background: Carbapenems (ertapenem, imipenem, meropenem) are used to treat multidrug-resistant (MDR-) and extensively drug-resistant tuberculosis (XDR-TB),... Carbapenems (ertapenem, imipenem, meropenem) are used to treat multidrug-resistant (MDR-) and extensively drug-resistant tuberculosis (XDR-TB), even if the...
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SubjectTerms	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
Title	Carbapenems to Treat Multidrug and Extensively Drug-Resistant Tuberculosis: A Systematic Review
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