The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease
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Int. J. Tuberc. Lung Dis. · Apr 2011
Alternative approaches to tuberculosis treatment evaluation: the role of pragmatic trials.
Clinical trials are sometimes classified as being explanatory or pragmatic, although they are rarely reported in that way. Explanatory trials may seek to investigate the efficacy of new treatments by imposing strict limitations on many aspects of trial design, including, for example, recruiting only those patients who are most likely to respond. In contrast, the objective of pragmatic trials is to assess whether treatments work in conditions more appropriate to routine practice. ⋯ The PRECIS (pragmatic-explanatory continuum indicator summary) wheel based on 10 domains, which include inclusion criteria, flexibility of delivery of the intervention and intensity of follow-up, has been proposed as a way of enabling researchers to assess the extent to which the trials they are designing could be considered explanatory or pragmatic. In this article, we consider how the PRECIS tool can be applied to trials of tuberculosis treatment. In view of the well-recognised delay in getting results from well-conducted clinical trials into practice, we would suggest that if more pragmatic trials were to be conducted, physicians would better understand the implications of the results for their own practice and be more ready to adopt new treatments.
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Int. J. Tuberc. Lung Dis. · Mar 2011
ReviewHigher-dose rifampin for the treatment of pulmonary tuberculosis: a systematic review.
To provide a descriptive synthesis of the evidence assessing the efficacy and safety of higher doses of rifampin (RMP) for the treatment of pulmonary tuberculosis (TB). ⋯ Historical trials suggest that higher than standard RMP dosing results in improved culture conversion rates. Phase 2 and 3 clinical trials evaluating higher doses of RMP and other rifamycins are needed to confirm efficacy and assure tolerability. Pharmacokinetic studies will be needed to inform the development of such trials.
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Int. J. Tuberc. Lung Dis. · Mar 2011
Comparative StudyWood smoke exposure, poverty and impaired lung function in Malawian adults.
Household air pollution from burning biomass fuel is increasingly recognised as a major global health concern. Biomass smoke is associated with chronic obstructive pulmonary disease (COPD) in Asian and Central American countries, but there are few data from Africa. ⋯ Our data suggest that wood smoke and poverty contribute to reduced lung function in rural Africans and that COPD is common in this population. The use of charcoal in rural populations may be relatively protective, and this idea merits further study. The risk factors for impaired lung function in Malawi are multiple and require more detailed characterisation to plan appropriate health interventions.
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Int. J. Tuberc. Lung Dis. · Mar 2011
Prevalence of vitamin D deficiency in adult tuberculosis patients at a central hospital in Malawi.
Vitamin D deficiency (VDD) is associated with impaired mycobacterial immunity and susceptibility to tuberculosis (TB). We measured 25 hydroxy vitamin D levels in 161 adult TB patients at a central hospital in Malawi, of whom 120 (74.5%) had ≤75 nmol/l (hypovitaminosis D), 68 (42%) had ≤50 nmol/l (VDD) and 13.6% of in-patients and 6.8% of out-patients had ≤25 nmol/l (severe VDD). ⋯ We conclude that VDD is common in adult TB patients in Malawi. In this small sample, it was not possible to identify any independent associations of VDD.
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Int. J. Tuberc. Lung Dis. · Mar 2011
Case ReportsMoxifloxacin and pyrazinamide susceptibility testing in a complex case of multidrug-resistant tuberculosis.
Multidrug-resistant tuberculosis (MDR-TB) is a public health problem of global concern. It is critical that drug susceptibility testing (DST) methods accurately predict clinical response. We present a patient with a challenging case of MDR-TB with additional resistance to quinolones and pyrazinamide. ⋯ This case highlights the possibility of treatment with high-dose fluoroquinolones despite apparent bacterial resistance to these agents. Improved DST methods are necessary for both agents. Development of genotypic approaches may offer a susceptibility profile rapidly, enabling early introduction of individualised treatments.