Pharmacokinetics of First-Line Antituberculosis Drugs Using WHO Revised Dosage in Children With Tuberculosis With and Without HIV Coinfection
| Autor: | Fizza S. Gillani, Albert Dompreh, Awewura Kwara, Lubbe Wiesner, Sampson Antwi, Sandra Kwarteng Owusu, Jennifer Norman, Daniel Ansong, Lawrence Osei-Tutu, Charles A. Peloquin, Anthony Enimil, Jaclynn Kurpewski, Hongmei Yang, Anima Sarfo, Antoinette Ortsin |
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| Jazyk: | angličtina |
| Rok vydání: | 2015 |
| Předmět: |
0301 basic medicine
Male medicine.medical_specialty Tuberculosis 030106 microbiology Population Cmax Antitubercular Agents HIV Infections Pharmacology World Health Organization Gastroenterology Ghana Mass Spectrometry 03 medical and health sciences Pharmacokinetics Internal medicine Medicine Humans Prospective Studies education Child Ethambutol education.field_of_study AIDS-Related Opportunistic Infections business.industry Coinfection Isoniazid Infant General Medicine Pyrazinamide medicine.disease Infectious Diseases Child Preschool Pediatrics Perinatology and Child Health Practice Guidelines as Topic Female business Original Articles and Commentaries medicine.drug Chromatography Liquid |
| Popis: | Background. Pharmacokinetic data on the first-line antituberculosis drugs using the World Health Organization (WHO) revised dosages for children are limited. We investigated the pharmacokinetics of these drugs in children who were mostly treated with revised dosages. Methods. Children with tuberculosis on first-line therapy for at least 4 weeks had blood samples collected at predose, 1, 2, 4, and 8 hours postdose. Drug concentrations were determined by validated liquid chromatography mass spectrometry methods, and pharmacokinetic parameters were calculated using noncompartmental analysis. Factors associated with plasma peak concentration (Cmax) and the area under the time–concentration curve 0–8 hours (AUC0–8h) of each drug was examined using univariate and multivariate analysis. Results. Of the 62 children, 32 (51.6%) were male, 29 (46.8%) wereyounger than 5 years old, and 28 (45.2%) had human immunodeficiency virus (HIV) coinfection. Three patients had undetectable pyrazinamide and ethambutol concentrations. The median (interquartile range) AUC0–8h for isoniazid was 17.7 (10.2–23.4) µg·h mL –1 , rifampin was 26.0 (15.3–36.1) µg·h mL –1 , pyrazinamide was 144.6 (111.5–201.2) µg·h mL –1 , and ethambutol was 6.7 (3.8–10.4) µg·h mL –1 . Of the children who received recommended weight-band dosages, 44/51 (86.3%), 46/56 (82.1%), 27/56 (48.2%), and 21/51 (41.2%) achieved target Cmax for isoniazid, pyrazinamide, ethambutol, and rifampin, respectively. In multivariate analysis, age, sex, HIV coinfection status, and drug dosage in milligrams per kilogram were associated with the drugs’ plasma drug Cmax or AUC0–8h. Conclusions. The revised dosages appeared to be adequate for isoniazid and pyrazinamide, but not for rifampin or ethambutol in this population. Higher dosages of rifampin and ethambutol than currently recommended may be required in most children. |
| Databáze: | OpenAIRE |
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