Therapeutic drug monitoring in patients with cystic fibrosis and mycobacterial disease.

• Cystic fibrosis (CF) patients require higher dosages of many antibiotics. The relapse of tuberculosis in one CF patient, and the repeated growth of Mycobacterium avium-intracellulare in another, despite conventional therapy, raised the question of whether the serum levels of the antimycobacterial drugs were adequate. Antimycobacterial drug serum concentrations were assayed in 10 CF patients with pulmonary mycobacterial disease. Serum levels below the proposed target range were seen 2 h after drug intake in the initial four patients treated: for rifampicin in 2/3, ethambutol in 3/4 and for clarithromycin in 2/3 patients, despite standard dosages. Reassays after dose adjustment and assays in six other patients showed that adequate levels were not achieved 4 h after clarithromycin in 3/5, ethambutol in 1/5, ciproflaxacin in 1/2 and ofloxacin in 2/2 patients. The patient with relapse of tuberculosis and the patient with continuous growth of M. avium-intracellulare improved and became culture negative after dose adjustment. Low drug serum levels is one reason for therapy failure in cystic fibrosis patients with mycobacterial disease. Therapeutic drug monitoring is recommended.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Lungmedicin och allergi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Respiratory Medicine and Allergy (hsv//eng)

Nyckelord

Adolescent

Adult

Antitubercular Agents

administration & dosage

adverse effects

pharmacokinetics

Biological Availability

Clarithromycin

administration & dosage

adverse effects

pharmacokinetics

Cystic Fibrosis

blood

drug therapy

Dose-Response Relationship

Drug

Drug Monitoring

Drug Therapy

Combination

Ethambutol

administration & dosage

adverse effects

pharmacokinetics

Female

Follow-Up Studies

Forced Expiratory Volume

drug effects

Humans

Male

Mycobacterium avium-intracellulare Infection

blood

drug therapy

Pregnancy

Rifampin

administration & dosage

adverse effects

pharmacokinetics

Tuberculosis

Pulmonary

blood

drug therapy

Publikations- och innehållstyp

ref (ämneskategori)

art (ämneskategori)