CLINICALLY SIGNIFICANT DRUG-INTERACTIONS WITH ANTITUBERCULOSIS AGENTS

被引:55
作者
GRANGE, JM
WINSTANLEY, PA
DAVIES, PDO
机构
[1] Department of Microbiology, National Heart and Lung Institute, London, SW3 6LY, Dovehouse Street
[2] Department of Pharmacology and Therapeutics, The University of Liverpool, Liverpool
[3] Tuberculosis Research Unit, Cardiothoracic Centre, Liverpool NHS Trust, Liverpool
关键词
D O I
10.2165/00002018-199411040-00003
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
Standard short-course regimens for tuberculosis are used worldwide with very few problems. Unfortunately, the emergence of multiple drug-resistance tuberculosis in many parts of the world is leading to a diversification of drug regimens and to the use of drugs that are more toxic per se and more likely to interact with others. In addition, the treatment of HIV/AIDS patients with tuberculosis or disease due to Mycobacterium avium-intracellulare complex (MAC) infection with new drugs and multidrug regimens has added to the problem of drug interactions, especially as such patients may often be receiving concomitant treatment for a range of bacterial, fungal and viral infections. In general, there are very few clinically significant interactions between the first-line antituberculosis drugs themselves, although problems of bioavailability, notably of rifampicin (rifampin), have been encountered in the manufacture of combination tablets. Of the first-line drugs used to treat tuberculosis, i.e. rifampicin, isoniazid and pyrazinamide, rifampicin is particularly likely to cause clinically significant drug interactions as it is a potent inducer of the cytochrome P450 enzyme group, which is involved in the metabolism of many drugs, in particular oral contraceptives, corticosteroids, oral anticoagulants and cyclosporin. The use of quinolones to treat multiple drug-resistant tuberculosis and AIDS-related MAC disease raises further problems of drug interactions as, in contrast to rifampicin, these drugs inhibit some cytochrome isoenzymes, leading to reduced metabolism of certain drugs.
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页码:242 / 251
页数:10
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共 39 条
[1]  
Schatz A., Waksman S.A., Effect of streptomycin and other antibiotic substances upon Mycobacterium tuberculosis and related organisms, Proc Soc Exp Biol Med, 57, (1944)
[2]  
Stanford J.L., Grange J.M., New concepts for the control of tuberculosis in the twenty first century, J R Coll Physicians Lond, 27, (1993)
[3]  
Mitchison D.A., The action of antituberculosis drugs in short course chemotherapy, Tubercle, 66, (1985)
[4]  
WHO model prescribing information. Drugs used in mycobacterial diseases, (1991)
[5]  
Chan S.L., Chemotherapy of tuberculosis, Clinical tuberculosis, (1994)
[6]  
Bloom B.R., Murray C.J.L., Tuberculosis: commentary on a reemergent killer, Science, 257, (1992)
[7]  
Dooley S.W., Simone P.M., The extent and management of drugresistant tuberculosis: the American experience, Clinical tuberculosis, (1994)
[8]  
Pitchenik A.E., Fertel D., Medical management of AIDS patients: Tuberculosis and nontuberculous mycobacterial disease, Med Clin North Am, 76, (1992)
[9]  
Dautzenberg B., Truffot C., Mignon A., Et al., Rifabutin in combination with clofazimine, isoniazid and ethambutol in the treatment of AIDS patients with infections due to opportunist mycobacteria, Tubercle, 72, (1991)
[10]  
Jacobson M., Yajko D., Northfelt D., Et al., Randomised placebocontrolled trial of rifampin, ethambutol and Ciprofloxacin for AIDS patients with disseminated Mycobacterium avium complex infection, J Infect Dis, 168, (1993)