Therapeutic Drug Monitoring in Non-Tuberculosis Mycobacteria Infections

Jan-Willem Alffenaar, Anne-Grete Märtson, Scott K Heysell, Jin-Gun Cho, Asad Patanwala, Gina Burch, Hannah Y Kim, Marieke G G Sturkenboom, Anthony Byrne, Debbie Marriott, Indy Sandaradura, Simon Tiberi, Vitali Sintchencko, Shashikant Srivastava, Charles A Peloquin, Jan-Willem Alffenaar, Anne-Grete Märtson, Scott K Heysell, Jin-Gun Cho, Asad Patanwala, Gina Burch, Hannah Y Kim, Marieke G G Sturkenboom, Anthony Byrne, Debbie Marriott, Indy Sandaradura, Simon Tiberi, Vitali Sintchencko, Shashikant Srivastava, Charles A Peloquin

Abstract

Nontuberculous mycobacteria can cause minimally symptomatic self-limiting infections to progressive and life-threatening disease of multiple organs. Several factors such as increased testing and prevalence have made this an emerging infectious disease. Multiple guidelines have been published to guide therapy, which remains difficult owing to the complexity of therapy, the potential for acquired resistance, the toxicity of treatment, and a high treatment failure rate. Given the long duration of therapy, complex multi-drug treatment regimens, and the risk of drug toxicity, therapeutic drug monitoring is an excellent method to optimize treatment. However, currently, there is little available guidance on therapeutic drug monitoring for this condition. The aim of this review is to provide information on the pharmacokinetic/pharmacodynamic targets for individual drugs used in the treatment of nontuberculous mycobacteria disease. Lacking data from randomized controlled trials, in vitro, in vivo, and clinical data were aggregated to facilitate recommendations for therapeutic drug monitoring to improve efficacy and reduce toxicity.

Conflict of interest statement

Anne-Grete Märtson was funded by Marie Skłodowska-Curie Actions (grant agreement no. 713660-PRONKJEWAIL-H2020-MSCA-COFUND-2015). Scott K Heysell was supported by NIH R01 AI137080. Shashikant Srivastava received supported by the ATS Foundation/Insmed Research Award in Non-Tuberculous Mycobacteria Lung Disease and NIH 1 R21 AI148096-01. Jan-Willem Alffenaar, Jin-Gun Cho, Asad Patanwalla, Gina Burch, Hannah Y Kim, Marieke GG Sturkenboom, Anthony Byrne, Debbie Marriott, Indy Sandaradura, Simon Tiberi, Vitali Sintchencko, and Charles A Peloquin have no conflicts of interest that are directly relevant to the content of this article.

Figures

Fig. 1
Fig. 1
In vitro infection models (created with BioRender.com). a Time-kill kinetic models study the bactericidal effect of static drug concentrations in time. The dashed line shows the decline in concentration as a function of chemical degradation due to instability of the compound. b The response of in vitro models is reflected by the number of colony-forming units (CFUs). An increase is observed for inactive compounds and a control situation (growth in medium). c Hollow fiber infection models study the bactericidal effect of dynamic drug concentrations (mimicking human pharmacokinetics) in time. The hollow fiber infection model (HF) can facilitate experiments with extracellular bacteria, intracellular bacteria, and immune cells, thereby accounting for the different conditions of nontuberculous mycobacteria infections

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Source: PubMed

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