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Wednesday 1 June 2016
Carbapenems to Treat Multidrug and Extensively Drug-Resistant Tuberculosis: A Systematic Review

WAidid suggests a recent article, published this year on the International Journal of Molecular Sciences, on Carbapenems (ertapenem, imipenem, meropenem), that are used to treat multidrug-resistant (MDR-) and extensively drug-resistant tuberculosis (XDR-TB).

With over 480,000 new multidrug-resistant tuberculosis (MDR-TB, i.e. , tuberculosis caused by Mycobacterium tuberculosis  strains resistant, in vitro , to at least isoniazid and rifampicin) cases and 190,000 deaths estimated to have occurred in 2014 by the World Health Organization (WHO), tuberculosis is a global priority.
Our capacity to diagnose MDR-TB cases remains limited (one in three) and that of treating them even lower (one in four).
As clinicians managing MDR- and XDR-TB patients in reference centers perfectly know, treating these cases is long, expensive, and complicated, and a wealth of experience in managing adverse events (which are frequent) is necessary WHO recommends the design of effective background regimens for MDR- and XDR-TB using a stepwise approach: active second-line drugs (based on the drug susceptibility test-DST) need to be introduced according to an order of priority based on their efficacy and safety. To simplify the procedure these drugs are classified into five groups based on a hierarchical order.
Drugs with unknown/limited evidence on efficacy and/or tolerability, linezolid, and carbapenems are often used for this purpose.
Although as of today carbapenems (which include meropenem, imipenem, and ertapenem) are presently prescribed to manage M/XDR-TB cases, the evidence on their efficacy, safety, and tolerability is anecdotal.
Although new drugs are becoming available to support the move towards TB elimination, repurposed drugs, like the carbapenems, exemplified by their tolerability, safety, and activity show a potential role in the TB treatment arena, and could be included in new TB drug combination trials, as better evidence is needed.

AUTHORS: Giovanni Sotgiu, Lia D’Ambrosio, Rosella Centis, Simon Tiberi, Susanna Esposito, Simone Dore, Antonio Spanevello and Giovanni Battista Migliori