Zuur Marlanka A, Bolhuis Mathieu S, Anthony Richard, den Hertog Alice, van der Laan Tridia, Wilffert Bob, de Lange Wiel, van Soolingen Dick, Alffenaar Jan-Willem C
a Department of Clinical Pharmacy and Pharmacology , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands.
b Royal Tropical Institute (KIT) , KIT Biomedical Research , Amsterdam , The Netherlands.
Expert Opin Drug Metab Toxicol. 2016 May;12(5):509-21. doi: 10.1517/17425255.2016.1162785. Epub 2016 Mar 24.
Tuberculosis remains a global health problem and pharmacokinetic variability has been postulated as one of the causes of treatment failure and acquired drug resistance. New developments enable implementation of therapeutic drug monitoring, a strategy to evaluate drug exposure in order to tailor the dose to the individual patient, in tuberculosis treatment.
Literature on pharmacokinetics and pharmacodynamics of anti-tuberculosis drugs was explored to evaluate the effect of drug exposure in relation to drug susceptibility, toxicity and efficacy. New, down-sized strategies, like dried blood spot analysis and limited sampling strategies are reviewed. In addition, molecular resistance testing of Mycobacteria tuberculosis, combining a short turn-around time with relevant information on drug susceptibility of the causative pathogen was explored. Newly emerging host biomarkers provide information on the response to treatment.
Therapeutic drug monitoring can minimize toxicity and increase efficacy of tuberculosis treatment and prevent the development of resistance. Dried blood spot analysis and limited sampling strategies, can be combined to provide us with a more patient friendly approach. Furthermore, rapid information on drug susceptibility by molecular testing, and information from host biomarkers on the bacteriological response, can be used to further optimize tuberculosis treatment.
结核病仍然是一个全球性的健康问题，药代动力学变异性被认为是治疗失败和获得性耐药的原因之一。新的进展使得治疗药物监测得以实施，这是一种在结核病治疗中评估药物暴露以根据个体患者调整剂量的策略。
探讨了抗结核药物的药代动力学和药效学文献，以评估药物暴露对药物敏感性、毒性和疗效的影响。对新的小型化策略，如干血斑分析和有限采样策略进行了综述。此外，还探讨了结核分枝杆菌的分子耐药性检测，该检测结合了较短的周转时间和有关致病病原体药物敏感性的相关信息。新出现的宿主生物标志物提供了有关治疗反应的信息。
治疗药物监测可以将结核病治疗的毒性降至最低，提高疗效，并防止耐药性的产生。干血斑分析和有限采样策略可以结合起来，为我们提供一种对患者更友好的方法。此外，通过分子检测获得的关于药物敏感性的快速信息，以及来自宿主生物标志物的关于细菌学反应的信息，可用于进一步优化结核病治疗。
