Multidrug resistant tuberculosis (MDR TB) inobata hafu yemiriyoni yevanhu gore negore. Levofloxacin inorayirirwa kurapwa kwekudzivirira kunoenderana neruzivo rwekutarisa, zvisinei humbowo kubva kune yakakura kuyedzwa kwekiriniki haupo. TB CHAMP neV-QUIN, makiriniki maviri echikamu che3 akaongorora kuchengetedzwa uye kushanda kwe levofloxacin mukudzivirira MDR TB kune vatori vechikamu vane hutachiona hwemhuri kuhutachiona hweM. Levofloxacin yakawanikwa kuderedza chiitiko chemishonga yakawanda-resistance tuberculosis mune zvose zvidzidzo asi kuderedzwa kwechiitiko kwakanga kusina kukosha. Ongororo yedata kubva muongororo yeTB CHAMP neV-QUIN yakaratidza kuti levofloxacin yakabatana nekudzikira kwechikamu che60% chekuitika kwechirwere cherurindi mudzimba dzeMDR-TB.
Mycobacterium tuberculosis inoshingirira kuisoniazid uye rifampin inobata vanhu vanosvika hafu yemiriyoni gore rega rega pasi rose. Inoona nezvechirwere cherurindi chisingachinjiki (MDR) icho chinodenha zvirongwa zvekurwisa chirwere cherurindi. Kunyanya, vana vadiki vane hutachiona hwemumba kune multidrug-resistant (MDR) tuberculosis vane njodzi huru yezvirwere. Vana vanosvika mamiriyoni maviri vari pasi pemakore gumi nemashanu ekuberekwa vanobatwa neMDR M. tuberculosis.
Levofloxacin, yechitatu-chizvarwa fluoroquinolone mishonga inorwisa mabhakitiriya inotorwa nemuromo, inova chikamu chekurapa kwakajairwa kwerifampicin-resistant kana MDR tuberculosis inorairwa zvichibva pane yekutarisa data yekudzivirira kurapwa mushure mekufumurwa kune multidrug-resistant (MDR) tuberculosis, zvisinei humbowo kubva mumiyedzo mikuru. pakushanda kwayo kwanga kusipo.
Makiriniki maviri makuru-chikamu chechitatu - TB CHAMP neV-QUIN vakaongorora kuchengetedzwa uye kushanda kwelevofloxacin mukudzivirira kurapwa kweMDR TB mushure mekusangana nechirwere chisingarapiki zvinodhaka. Zvakawanikwa uye mhedzisiro yezvidzidzo zviviri izvi zvakaburitswa muna Zvita 3 18.
The TB CHAMP (Tuberculosis Child Multidrug-Resistant Preventive Therapy Trial) yakaongorora kushanda uye kuchengetedzwa kwekudzivirira kwekudzivirira ne levofloxacin muvana nevechiri kuyaruka vane hutachiona hwemhuri kune multidrug-resistant tuberculosis. Yakaitwa pavana 922 nevechiri kuyaruka vane hukama hwemhuri kune multidrug-resistant tuberculosis mukati memwedzi mitanhatu yapfuura (asi pasina humbowo hwechirwere chetachiona) kubva kudzimba dze6 munzvimbo dzakawanda muSouth Africa. Vatori vechikamu vakagamuchira levofloxacin kana placebo zuva nezuva kwemavhiki makumi maviri nemana. Vatori vechikamu 497 vakagamuchira levofloxacin uye vamwe mazana mana nemakumi matanhatu nevapfumbamwe vakapihwa placebo. Pakupera kwevhiki 24, tuberculosis yakatanga muvashanu vatori vechikamu (453%) muboka re levofloxacin uye mune gumi nevaviri (469%) muboka re placebo. Nokudaro, kurapa kwekudzivirira ne levofloxacin kwakaderedza kuitika kwechirwere chetachiona pakati pevana nevechiri kuyaruka vane mhuri yeMDR TB asi kuderedzwa kwechiitiko kwakanga kusiri kuderera zvakanyanya pane placebo.
Imwe fundo (yakadanwa V-QUIN muyedzo) yakaongorora kushanda uye kuchengeteka kwemwedzi mitanhatu yerejimeni ye levofloxacin yekudzivirira kwechirwere chetachiona pakati pemhuri dzevanhu vane rifampicin inopikisa kana kuti multidrug-resistant (MDR) tuberculosis yakasimbiswa. Muyedzo uyu wakaitwa munzvimbo dzakawanda muVietnam pa6 vatori vechikamu vaive vedzimba dzevanhu vane rifampicin isingaite kana MDR tuberculosis. Vatori vechikamu vaiva neM. tuberculosis chirwere asi pasina chirwere chinoshanda uye vakanga vatanga kurapwa mukati memwedzi yapfuura ye2041. Vatori vechikamu vakagoverwa kuti vagamuchire 3 mwedzi yezuva nezuva levofloxacin kana placebo. 6 vatori vechikamu vakagamuchira levofloxacin nepo 1023 Vatori vechikamu placebo. Pamwedzi makumi matatu, vatori vechikamu vatanhatu (1018%) muboka relevofloxacin vakasimbiswa nebhakitiriya kuti vakaita tibhii ukuwo vatori vechikamu 30 (6%) muboka replacebo vakasimbiswa nebhakitiriya kuti vakaita tuberculosis. Kupfuurirazve, 0.6 anotora chikamu muboka re levofloxacin uye 11 muboka re placebo vakaonekwa vaine kiriniki kuti vane tuberculosis. Nokudaro, chiitiko chechirwere chakanga chakaderera kune boka re levofloxacin pane ye placebo, asi mutsauko wakanga usina kukosha.
Zvose zvataurwa pamusoro apa zvakakura-chikamu chechitatu miedzo yakatsvaga kushanda uye kuchengeteka kwe levofloxacin mukudzivirira zvirwere pakati pevatori vechikamu vane hutachiona hwemhuri kune multidrug-resistant tuberculosis. MuTB CHAMP, vatori vechikamu vakanga vasina humbowo hwechirwere chetachiona, nepo mukuedza kweV-QUIN, vatori vechikamu vaiva neM. tuberculosis chirwere asi pasina chirwere chinoshanda. Muzviitiko zvese izvi, levofloxacin yakawanikwa ichideredza chiitiko chechirwere, asi kuderedzwa kwaive kusingakoshi.
Zvakadaro, ongororo yedata kubva kuTB CHAMP neV-QUIN miedzo yakaratidza kuti levofloxacin yakabatana nekudzikira kwe60% kwekuitika kwechirwere cherurindi mudzimba dzeMDR-TB.
MunaGunyana 2024, iyo WHO akanga akurudzira levofloxacin yeMDR-TB yekudzivirira kurapwa zvichienderana nekuongorora kwehumbowo hwekuedza uhwu.
Delamanid parizvino iri kuongororwa mukuedzwa kwekudzivirira kurapwa kweMDR TB. Iyo antimicrobial agent iyo inhibits mycobacterial cell wall synthesis uye inotenderwa kurapwa kwemultidrug resistant tuberculosis.
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References:
- Hesseling AC et al 2024. Levofloxacin Kudzivirira Kurapa muvana Vanoratidzwa kune MDR Tuberculosis. Rakabudiswa 18 Zvita 2024. N Engl J Med 2024;391:2315-2326. Vol. 391 Nhamba 24. https://www.nejm.org/doi/full/10.1056/NEJMoa2314318
- Fox GJ, et al 2024. Levofloxacin yeDziviriro yeMultidrug-Resistant Tuberculosis muVietnam. Rakabudiswa 18 Zvita 2024. N Engl J Med 2024; 391: 2304-2314. Vol. 391 Nhamba 24. DOI: https://www.nejm.org/doi/full/10.1056/NEJMoa2314325
- Duong T., et al 2024. Meta-Ongororo yeLevofloxacin yeKusangana kweMultidrug-Resistant Tuberculosis. Rakabudiswa 18 December 2024. NEJM Evidence. DOI: https://evidence.nejm.org/doi/full/10.1056/EVIDoa2400190
- Dorman SE 2024. Levofloxacin Preventive Therapy for Persons Exposed to MDR Tuberculosis. Rakabudiswa 18 Zvita 2024. N Engl J Med 2024; 391:2376-2378. Vol. 391 Nhamba 24. https://www.nejm.org/doi/full/10.1056/NEJMe2413531
- MRC-UCL. Chiyedzo cheTB-CHAMP chinowana kurapwa kwakachengeteka uye kunoshanda kudzivirira TB isingaite zvinodhaka muvana. 19 Zvita 2024. Inowanikwa pa https://www.mrcctu.ucl.ac.uk/news/news-stories/2024/december/tb-champ-trial-finds-first-ever-safe-and-effective-treatment-to-prevent-multidrug-resistant-tb-in-children/
- WHO. Pfupiso yeTB CHAMP uye V-QUIN miedzo yekiriniki. https://tbksp.who.int/en/node/2745
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