Fixed-dose combination associated with faster time to smear conversion compared to separate tablets of anti-tuberculosis drugs in patients with poorly controlled diabetes and pulmonary tuberculosis in Qatar.
Fixed-dose combination associated with faster time to smear conversion compared to separate tablets of anti-tuberculosis drugs in patients with poorly controlled diabetes and pulmonary tuberculosis in Qatar.
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DOI：
10.1186/s12879-018-3309-0
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发表时间：
2018-08-08
影响因子：
3.7
通讯作者：
Heysell SK
中科院分区：
文献类型：
--
作者：
Al-Shaer MH;Elewa H;Alkabab Y;Nazer LH;Heysell SK
与非糖尿病患者相比，糖尿病与结核病（TB）治疗失败、死亡和复发的风险增加有关。目前的结核病治疗方案有固定剂量联合治疗（FDC）和单独片剂治疗（ST）两种，使用前者据称更容易坚持和完成治疗。到目前为止，还没有研究评估FDC与ST在糖尿病合并肺结核患者中的疗效。进行了一项回顾性队列研究，包括卡塔尔的8家医院，其中诊断为肺结核的患者接受利福平、异烟肼、吡嗪酰胺和乙胺丁醇（作为FDC或ST）作为直接观察治疗。每周一次痰涂片检测抗酸杆菌。我们纳入了2012年12月至2015年12月入院的患者，年龄≥18岁，痰涂片预处理阳性诊断为结核病，并患有糖尿病。排除对任何一线药物耐药的结核分枝杆菌患者。密切监测血糖，并使用口服降糖药和/或胰岛素控制在< 180 md/dL。我们通过比较接受FDC或ST治疗的患者到确诊阴性涂片的时间以及添加二甲双胍的影响来评估结核病治疗方案的有效性。103例患者符合纳入标准。平均年龄为45.6±9.1岁，体重指数为22.1±3.6 kg/m2。54例（52%）患者接受了FDC治疗。两组之间的基线特征和痰杆菌载量没有差异。处方FDC的患者到痰涂片转换时间较ST更快（32±19天比46±31天，p = 0.01）。预处理细菌负荷为3+的患者差异更大（FDC 36.6±19.5 vs. ST 56.1±28.8,p = 0.008）。二甲双胍≥2000 mg/天改变了涂片转化时间的差异（FDC 30.7±13.4 vs. ST 62±35.5,p = 0.016），其中预处理细菌负荷3+组和二甲双胍≥2000 mg/天组差异最大（FDC 36±12.1 vs. ST 92.2±26,p = 0.001）。与ST相比，糖尿病患者和处方FDC在治疗肺结核期间显示更快的涂片转换，这在3+细菌负荷预处理中更为明显，并且似乎被高剂量二甲双胍改变。
Diabetes is associated with increased risk of tuberculosis (TB) treatment failure, death, and relapse compared to patients without diabetes. Current TB regimens are available as fixed dose combination (FDC) and separate tablets (ST), in which using the former is purported to make it easier to adhere and complete treatment. So far there are no studies assessing the performance of FDC compared to ST in diabetic patients with pulmonary TB. A retrospective cohort study was conducted, and included eight hospitals in Qatar in which patients diagnosed with pulmonary TB received rifampin, isoniazid, pyrazinamide, and ethambutol (as FDC or ST) given as directly observed therapy. Sputum smears for acid fast bacilli were tested weekly. We included patients admitted between December 2012 and December 2015, ≥18 years old, diagnosed with TB with pretreatment positive sputum smears, and having diabetes. Patients with Mycobacterium tuberculosis that was resistant to any first-line drug were excluded. Blood glucose was monitored closely and controlled to < 180 md/dL using oral hypoglycemic agents and/or insulin. We assessed the effectiveness of TB regimens by comparing time to confirmed negative smears between those treated with FDC or ST, and the impact of adding metformin. 103 patients met inclusion criteria. Mean age and body mass index were 45.6 ± 9.1 years and 22.1 ± 3.6 kg/m2, respectively. Fifty-four (52%) patients received the FDC. There was no difference between groups in baseline characteristics and sputum bacillary loads. Patients prescribed FDC showed faster times to sputum smear conversion compared to ST (32 ± 19 vs. 46 ± 31 days, p = 0.01). The difference was greater among patients with pretreatment bacillary load of 3+ (FDC 36.6 ± 19.5 vs. ST 56.1 ± 28.8, p = 0.008). Receipt of metformin≥2000 mg/day altered the difference in time to smear conversion (FDC 30.7 ± 13.4 vs. ST 62 ± 35.5, p = 0.016), which was of greatest difference in those with pretreatment bacillary load 3+ and who received metformin≥2000 mg/day (FDC 36 ± 12.1 vs. ST 92.2 ± 26 days, p = 0.001). Patients with diabetes and prescribed FDC showed faster smear conversion during treatment for pulmonary TB compared to ST which was more pronounced in those with 3+ bacillary load pretreatment and which appeared to be modified by higher dose metformin.
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影响因子：
11.8
作者：
Nijland, Hanneke M. J.;Ruslami, Rovina;van Crevel, Reinout
通讯作者：
van Crevel, Reinout
影响因子：
9.4
作者：
MORGAN, MA;HORSTMEIER, CD;ROBERTS, GD
通讯作者：
ROBERTS, GD
影响因子：
56.3
作者：
Dooley, Kelly E.;Chaisson, Richard E.
通讯作者：
Chaisson, Richard E.
影响因子：
4.9
作者：
Medelln-Garibay, S. E.;Cortez-Espinosa, N.;Romano-Moreno, S.
通讯作者：
Romano-Moreno, S.
影响因子：
11.5
作者：
Blomberg, B;Fourie, B
通讯作者：
Fourie, B