Division of Clinical Pharmacology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University , Cape Town, South Africa.
Division of Pulmonology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University , Cape Town, South Africa.
Microbiol Spectr. 2024 Jan 11;12(1):e0287623. doi: 10.1128/spectrum.02876-23. Epub 2023 Nov 22.
The incidence of tuberculosis (TB) in intensive care units (ICUs) can be as high as 3% in high-burden settings, translating to more than 7,500 patients admitted to the ICU annually. In resource-limited settings, the lack or absence of intravenous formulations of drug-sensitive antituberculosis medications necessitates healthcare practitioners to crush, dissolve, and administer the drugs to critically ill patients via a nasogastric tube (NGT). This off-label practice has been linked to plasma concentrations below the recommended target concentrations, particularly of rifampicin and isoniazid, leading to clinical failure and the development of drug resistance. Optimizing the delivery of crushed drug-sensitive antituberculosis medication via the NGT to critically ill patients is of utmost importance.
在高负担地区,重症监护病房(ICU)中的结核病(TB)发病率可高达 3%,这意味着每年有超过 7500 名患者入住 ICU。在资源有限的地区,由于缺乏或不存在药物敏感抗结核药物的静脉制剂,医护人员不得不将药物压碎、溶解后通过鼻胃管(NGT)给重症患者用药。这种超说明书的做法导致了血药浓度低于推荐目标浓度,尤其是利福平利福平和异烟肼,从而导致临床治疗失败和耐药性的产生。通过 NGT 为重症患者提供优化的粉碎药物敏感抗结核药物至关重要。