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The TBPod

The TBPod is a podcast for clinicians and policymakers caring for patients with tuberculosis. The podcasts present discussions with expert clinicians, researchers, policymakers and advocates about their work in the field of tuberculosis. Tuberculosis remains one of the leading causes of death worldwide, and is an important contributor to morbidity among migrants arriving in Australia and New Zealand. There are around 1300 reported cases of TB in Australia each year, and a further 300 in New Zealand. Included in these figures are cases of multi-drug resistant (MDR) TB which pose significant barriers to treatment and management of the disease. The Australian government has committed to the global elimination of TB by 2030, but to do so requires the development of innovative new strategies, based on high-quality research, that has national and international reach. These podcasts aim to engage and update those who are interested in the field of tuberculosis through discussions with leaders in the field of tuberculosis.

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Therapeutic Drug Monitoring in TB

February 01, 2023 • Actnet

Today we speak to Professor Jan-Willem Alffenaar from Westmead Hospital and the University of Sydney about Therapeutic Drug Monitoring in Tuberculosis. Professor Alffenaar reviews the PK/PD issues with common TB medications, the strengths and weaknesses of TDM and how best to utilise TDM in the treatment of TB patients.

REFERENCES
1) personalised dosing of TB drugs
Clinical standards for the dosing and management of TB drugs
Alffenaar JW, Stocker SL, Forsman LD, Garcia-Prats A, Heysell SK, Aarnoutse RE, Akkerman OW, Aleksa A, van Altena R, de Onata WA, Bhavani PK. Clinical standards for the dosing and management of TB drugs. The International Journal of Tuberculosis and Lung Disease. 2022 Jun 1;26(6):483-99.

Population Pharmacokinetics and Bayesian Dose Adjustment to Advance TDM of Anti-TB Drugs.
Sturkenboom MG, Märtson AG, Svensson EM, Sloan DJ, Dooley KE, van den Elsen SH, Denti P, Peloquin CA, Aarnoutse RE, Alffenaar JW. Population pharmacokinetics and Bayesian dose adjustment to advance TDM of anti-TB drugs. Clinical pharmacokinetics. 2021 Jun;60:685-710.

2) drug exposure - pathogen susceptibility - treatment outcome
Drug exposure and susceptibility of second-line drugs correlate with treatment response in patients with multidrug-resistant tuberculosis: a multicentre prospective cohort study in China.
Zheng X, Forsman LD, Bao Z, Xie Y, Ning Z, Schön T, Bruchfeld J, Xu B, Alffenaar JW, Hu Y. Drug exposure and susceptibility of second-line drugs correlate with treatment response in patients with multidrug-resistant tuberculosis: a multicentre prospective cohort study in China. European Respiratory Journal. 2022 Mar 1;59(3).

Drug Exposure and Minimum Inhibitory Concentration Predict Pulmonary Tuberculosis Treatment Response.
Zheng X, Bao Z, Forsman LD, Hu Y, Ren W, Gao Y, Li X, Hoffner S, Bruchfeld J, Alffenaar JW. Drug exposure and minimum inhibitory concentration predict pulmonary tuberculosis treatment response. Clinical Infectious Diseases. 2021 Nov 1;73(9):e3520-8.

3) TDM framework
Therapeutic Drug Monitoring of Anti-infective Drugs: Implementation Strategies for 3 Different Scenarios.
Kim HY, Byashalira KC, Heysell SK, Märtson AG, Mpagama SG, Rao P, Sturkenboom MG, Alffenaar JW. Therapeutic drug monitoring of anti-infective drugs: implementation strategies for 3 different scenarios. Therapeutic Drug Monitoring. 2022 Feb 1;44(1):3-10.

4) point of care TDM
A mobile microvolume UV/visible light spectrophotometer for the measurement of levofloxacin in saliva.
Alffenaar JW, Jongedijk EM, van Winkel CA, Sariko M, Heysell SK, Mpagama S, Touw DJ. A mobile microvolume UV/visible light spectrophotometer for the measurement of levofloxacin in saliva. Journal of Antimicrobial Chemotherapy. 2021 Feb;76(2):423-9.

Levofloxacin pharmacokinetics in saliva as measured by a mobile microvolume UV spectrophotometer among people treated for rifampicin-resistant TB in Tanzania.
Mohamed S, Mvungi HC, Sariko M, Rao P, Mbelele P, Jongedijk EM, van Winkel CA, Touw DJ, Stroup S, Alffenaar JW, Mpagama S. Levofloxacin pharmacokinetics in saliva as measured by a mobile microvolume UV spectrophotometer among people treated for rifampicin-resistant TB in Tanzania. Journal of Antimicrobial Chemotherapy. 2021 Jun;76(6):1547-52.