Heysell Scott K, Moore Jane L, Staley Debbie, Dodge Denise, Houpt Eric R
Division of Infectious Diseases and International Health, University of Virginia, P.O. Box 801340, Charlottesville, VA 22908-1340, USA.
Tuberculosis Control and Prevention, Virginia Department of Health, Richmond, VA, USA.
Tuberc Res Treat. 2013;2013:129723. doi: 10.1155/2013/129723. Epub 2013 Nov 17.
Slow responders to tuberculosis (TB) treatment in Virginia have prolonged treatment duration and consume more programmatic resources. Diabetes is an independent risk factor for slow response and low serum anti-TB drug concentrations. Thus, a statewide initiative of early therapeutic drug monitoring (TDM) for isoniazid and rifampin at 2 weeks after TB treatment was piloted for all diabetics with newly diagnosed TB. During the period of early TDM, 12/01/2011-12/31/2012, 21 diabetics had C 2 hr concentrations performed and 16 (76%) had a value below the expected range for isoniazid, rifampin, or both. Fifteen had follow-up concentrations after dose adjustment and 12 (80%) increased to within the expected range (including all for rifampin). Of 16 diabetic patients with pulmonary TB that had early TDM, 14 (88%) converted their sputum culture to negative in <2 months. Early TDM for diabetics was operationally feasible, may speed response to TB therapy, and can be considered for TB programs with high diabetes prevalence.
弗吉尼亚州结核病（TB）治疗反应缓慢者的治疗时间延长，消耗的项目资源更多。糖尿病是治疗反应缓慢和血清抗结核药物浓度低的独立危险因素。因此，针对所有新诊断为结核病的糖尿病患者，在结核病治疗2周后对异烟肼和利福平开展全州范围的早期治疗药物监测（TDM）试点。在早期TDM期间，即2011年12月1日至2012年12月31日，21名糖尿病患者进行了2小时血药浓度检测，其中16名（76%）患者异烟肼、利福平或两者的血药浓度值低于预期范围。15名患者在剂量调整后进行了随访血药浓度检测，12名（80%）患者的血药浓度升至预期范围内（包括所有利福平血药浓度）。在16名接受早期TDM的糖尿病肺结核患者中，14名（88%）在不到2个月的时间内痰培养转阴。糖尿病患者的早期TDM在操作上是可行的，可能会加快对结核病治疗的反应，对于糖尿病患病率高的结核病项目可考虑采用。
