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  1. Article ; Online: The association between enteropathogens and antimycobacterial drug pharmacokinetics in children.

    Garcia-Prats, Anthony J

    The Lancet. Microbe

    2022  Volume 3, Issue 6, Page(s) e400–e401

    MeSH term(s) Anti-Bacterial Agents/pharmacology ; Child ; Diarrhea/microbiology ; Humans
    Chemical Substances Anti-Bacterial Agents
    Language English
    Publishing date 2022-04-07
    Publishing country England
    Document type Journal Article ; Comment
    ISSN 2666-5247
    ISSN (online) 2666-5247
    DOI 10.1016/S2666-5247(21)00353-0
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: QT Interval Prolongation and Second-line Antituberculosis Medicines in Children: An Update and Practical Considerations for Noncardiologists.

    Hughes, Jennifer / Nielsen, James / Buck, W Chris / Mutemba, Criménia / Garcia-Prats, Anthony J

    The Pediatric infectious disease journal

    2023  Volume 42, Issue 3, Page(s) e80–e83

    MeSH term(s) Child ; Humans ; Electrocardiography ; Antitubercular Agents/adverse effects ; Long QT Syndrome/chemically induced
    Chemical Substances Antitubercular Agents
    Language English
    Publishing date 2023-02-03
    Publishing country United States
    Document type Journal Article
    ZDB-ID 392481-6
    ISSN 1532-0987 ; 0891-3668
    ISSN (online) 1532-0987
    ISSN 0891-3668
    DOI 10.1097/INF.0000000000003742
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  3. Article ; Online: Tuberculosis in Children Living With HIV: Ongoing Progress and Challenges.

    Vonasek, Bryan J / Rabie, Helena / Hesseling, Anneke C / Garcia-Prats, Anthony J

    Journal of the Pediatric Infectious Diseases Society

    2022  Volume 11, Issue Supplement_3, Page(s) S72–S78

    Abstract: There has been much recent progress on control of the tuberculosis (TB) and human immunodeficiency virus (HIV) epidemics globally. However, advances in children have lagged behind, and TB-HIV coinfection continues to be a major driver of pediatric ... ...

    Abstract There has been much recent progress on control of the tuberculosis (TB) and human immunodeficiency virus (HIV) epidemics globally. However, advances in children have lagged behind, and TB-HIV coinfection continues to be a major driver of pediatric mortality in many settings. This review highlights recent research findings in the areas of prevention, diagnosis, and treatment of HIV-associated childhood TB. Key areas for future research are defined. Current prevention efforts such as vaccination, TB symptom screening, and TB preventive treatment are demonstrated as beneficial but need to be optimized for children living with HIV (CLHIV). Diagnosis of HIV-associated TB in children remains a major challenge, depending heavily on clinicians' ability to judge an array of signs, symptoms, and imaging findings, but there are a growing number of promising diagnostic tools with improved accuracy and feasibility. Treatment of TB-HIV coinfection has also seen recent progress with more evidence demonstrating the safety and effectiveness of shorter regimens for treatment of TB infection and disease and improved understanding of interactions between antiretrovirals and TB medications. However, several evidence gaps on drug-drug interactions persist, especially for young children and those with drug-resistant TB. Accelerated efforts are needed in these areas to build upon current progress and reduce the burden of TB on CLHIV.
    MeSH term(s) Child ; Humans ; Child, Preschool ; Antitubercular Agents/therapeutic use ; Tuberculosis/complications ; Tuberculosis/diagnosis ; Tuberculosis/drug therapy ; HIV Infections/complications ; HIV Infections/drug therapy ; HIV Infections/epidemiology ; Coinfection/drug therapy ; Anti-Retroviral Agents/therapeutic use
    Chemical Substances Antitubercular Agents ; Anti-Retroviral Agents
    Language English
    Publishing date 2022-10-31
    Publishing country England
    Document type Review ; Journal Article
    ZDB-ID 2668791-4
    ISSN 2048-7207 ; 2048-7193
    ISSN (online) 2048-7207
    ISSN 2048-7193
    DOI 10.1093/jpids/piac060
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  4. Article ; Online: New Drugs and Regimens for Tuberculosis Disease Treatment in Children and Adolescents.

    Garcia-Prats, Anthony J / Starke, Jeffrey R / Waning, Brenda / Kaiser, Brian / Seddon, James A

    Journal of the Pediatric Infectious Diseases Society

    2022  Volume 11, Issue Supplement_3, Page(s) S101–S109

    Abstract: After almost 30 years of relative stagnation, research over the past decade has led to remarkable advances in the treatment of both drug-susceptible (DS) and drug-resistant (DR) tuberculosis (TB) disease in children and adolescents. Compared with the ... ...

    Abstract After almost 30 years of relative stagnation, research over the past decade has led to remarkable advances in the treatment of both drug-susceptible (DS) and drug-resistant (DR) tuberculosis (TB) disease in children and adolescents. Compared with the previous standard therapy of at least 6 months, 2 new regimens lasting for only 4 months for the treatment of DS-TB have been studied and are recommended by the World Health Organization (WHO), along with a shortened 6-month regimen for treatment of DS-TB meningitis. In addition, the 18- to 24-month regimens previously used for DR-TB that included painful injectable drugs with high rates of adverse effects have been replaced with shorter, safer all-oral regimens. Advances that have improved treatment include development of new TB drugs (bedaquiline, delamanid, pretomanid), reapplication of older TB drugs (rifampicin and rifapentine), and repurposing of other drugs (clofazimine and linezolid). The development of child-friendly formulations for many of these drugs has further enhanced the ability to safely and effectively treat DS- and DR-TB in children and adolescents. The characteristics and use of these drugs, regimens, and formulations are reviewed.
    MeSH term(s) Adolescent ; Humans ; Antitubercular Agents/therapeutic use ; Tuberculosis/drug therapy ; Tuberculosis, Multidrug-Resistant/drug therapy ; Clofazimine/therapeutic use ; Linezolid
    Chemical Substances Antitubercular Agents ; Clofazimine (D959AE5USF) ; Linezolid (ISQ9I6J12J)
    Language English
    Publishing date 2022-10-31
    Publishing country England
    Document type Journal Article
    ZDB-ID 2668791-4
    ISSN 2048-7207 ; 2048-7193
    ISSN (online) 2048-7207
    ISSN 2048-7193
    DOI 10.1093/jpids/piac047
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  5. Article ; Online: Pharmacokinetics and Optimal Dosing of Levofloxacin in Children for Drug-Resistant Tuberculosis: An Individual Patient Data Meta-Analysis.

    White, Yasmine N / Solans, Belen P / Denti, Paolo / van der Laan, Louvina E / Schaaf, H Simon / Vonasek, Bryan / Malik, Amyn A / Draper, Heather R / Hussain, Hamidah / Hesseling, Anneke C / Garcia-Prats, Anthony J / Savic, Radojka M

    Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

    2024  Volume 78, Issue 3, Page(s) 756–764

    Abstract: Background: Each year 25 000-32 000 children develop rifampicin- or multidrug-resistant tuberculosis (RR/MDR-TB), and many more require preventive treatment. Levofloxacin is a key component of RR/MDR-TB treatment and prevention, but the existing ... ...

    Abstract Background: Each year 25 000-32 000 children develop rifampicin- or multidrug-resistant tuberculosis (RR/MDR-TB), and many more require preventive treatment. Levofloxacin is a key component of RR/MDR-TB treatment and prevention, but the existing pharmacokinetic data in children have not yet been comprehensively summarized. We aimed to characterize levofloxacin pharmacokinetics through an individual patient data meta-analysis of available studies and to determine optimal dosing in children.
    Methods: Levofloxacin concentration and demographic data were pooled from 5 studies and analyzed using nonlinear mixed effects modeling. Simulations were performed using current World Health Organization (WHO)-recommended and model-informed optimized doses. Optimal levofloxacin doses were identified to target median adult area under the time-concentration curve (AUC)24 of 101 mg·h/L given current standard adult doses.
    Results: Data from 242 children (2.8 years [0.2-16.8] was used). Apparent clearance was 3.16 L/h for a 13-kg child. Age affected clearance, reaching 50% maturation at birth and 90% maturation at 8 months. Nondispersible tablets had 29% lower apparent oral bioavailability compared to dispersible tablets. Median exposures at current WHO-recommended doses were below the AUC target for children weighing <24 kg and under <10 years, resulting in approximately half of the exposure in adults. Model-informed doses of 16-33 mg/kg for dispersible tablets or 16-50 mg/kg for nondispersible tablets were required to meet the AUC target without significantly exceeding the median adult Cmax.
    Conclusions: Revised weight-band dosing guidelines with doses of >20 mg/kg are required to ensure adequate exposure. Further studies are needed to determine safety and tolerability of these higher doses.
    MeSH term(s) Child ; Adult ; Infant, Newborn ; Humans ; Infant ; Levofloxacin ; Antitubercular Agents ; Tuberculosis, Multidrug-Resistant/drug therapy ; Tuberculosis, Multidrug-Resistant/prevention & control ; Rifampin/therapeutic use ; Rifampin/pharmacokinetics ; Tablets/therapeutic use
    Chemical Substances Levofloxacin (6GNT3Y5LMF) ; Antitubercular Agents ; Rifampin (VJT6J7R4TR) ; Tablets
    Language English
    Publishing date 2024-02-02
    Publishing country United States
    Document type Meta-Analysis ; Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 1099781-7
    ISSN 1537-6591 ; 1058-4838
    ISSN (online) 1537-6591
    ISSN 1058-4838
    DOI 10.1093/cid/ciae024
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  6. Article: Caregiver-child separation during tuberculosis hospitalisation: a qualitative study in South Africa.

    Meyerson, Kyla A / Hoddinott, Graeme / Garcia-Prats, Anthony J / Tomlinson, Mark

    South African journal of psychology = Suid-Afrikaanse tydskrif vir sielkunde

    2020  Volume 51, Issue 3, Page(s) 409–421

    Abstract: There are an estimated 32,000 incident cases of multidrug-resistant tuberculosis in children globally each year. Extended hospitalisation is often required to ensure optimal adherence to the complex multidrug-resistant tuberculosis treatment regimen. ... ...

    Abstract There are an estimated 32,000 incident cases of multidrug-resistant tuberculosis in children globally each year. Extended hospitalisation is often required to ensure optimal adherence to the complex multidrug-resistant tuberculosis treatment regimen. Hospitalisation usually results in caregiver-child separation which is known to cause psychological difficulties in children. We explored caregivers' and health workers' perceptions of the effects of caregiver-child separation during hospitalisation for tuberculosis in the Western Cape. We conducted semi-structured interviews with health workers (
    Language English
    Publishing date 2020-10-12
    Publishing country England
    Document type Journal Article
    ZDB-ID 2067303-6
    ISSN 2078-208X ; 0081-2463
    ISSN (online) 2078-208X
    ISSN 0081-2463
    DOI 10.1177/0081246320962729
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  7. Article ; Online: Drug-resistant tuberculosis: will grand promises fail children and adolescents?

    Furin, Jennifer / Tommasi, Marcela / Garcia-Prats, Anthony J

    The Lancet. Child & adolescent health

    2018  Volume 2, Issue 4, Page(s) 237–238

    MeSH term(s) Adolescent ; Child ; Disease Eradication ; Humans ; Tuberculosis, Multidrug-Resistant/drug therapy
    Language English
    Publishing date 2018-03-13
    Publishing country England
    Document type Journal Article
    ISSN 2352-4650
    ISSN (online) 2352-4650
    DOI 10.1016/S2352-4642(18)30068-3
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  8. Article: Treatment of Rifampicin-Resistant Tuberculosis Disease and Infection in Children: Key Updates, Challenges and Opportunities.

    Howell, Pauline / Achar, Jay / Huang, G Khai Lin / Mariandyshev, Andrei / Schaaf, H Simon / Garcia-Prats, Anthony J

    Pathogens (Basel, Switzerland)

    2022  Volume 11, Issue 4

    Abstract: Children affected by rifampicin-resistant tuberculosis (RR-TB; TB resistant to at least rifampicin) are a neglected group. Each year an estimated 25,000-30,000 children develop RR-TB disease globally. Improving case detection and treatment initiation is ... ...

    Abstract Children affected by rifampicin-resistant tuberculosis (RR-TB; TB resistant to at least rifampicin) are a neglected group. Each year an estimated 25,000-30,000 children develop RR-TB disease globally. Improving case detection and treatment initiation is a priority since RR-TB disease is underdiagnosed and undertreated. Untreated paediatric TB has particularly high morbidity and mortality. However, children receiving TB treatment, including for RR-TB, respond well. RR-TB treatment remains a challenge for children, their caregivers and TB programmes, requiring treatment regimens of up to 18 months in duration, often associated with severe and long-term adverse effects. Shorter, safer, effective child-friendly regimens for RR-TB are needed. Preventing progression to disease following
    Language English
    Publishing date 2022-03-23
    Publishing country Switzerland
    Document type Journal Article ; Review
    ZDB-ID 2695572-6
    ISSN 2076-0817
    ISSN 2076-0817
    DOI 10.3390/pathogens11040381
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  9. Article ; Online: Relative bioavailability of delamanid 50 mg tablets dispersed in water in healthy adult volunteers.

    Zou, Yuanxi / de Jager, Veronique / Hesseling, Anneke C / Diacon, Andreas H / Wiesner, Lubbe / Mostert, Joni / Svensson, Elin M / Garcia-Prats, Anthony

    British journal of clinical pharmacology

    2023  

    Abstract: Aim: Delamanid is a novel drug for the treatment of drug-resistant tuberculosis, manufactured as 50-mg solid and 25-mg dispersible tablets. We evaluated the effects of dispersing the 50-mg tablet, focusing on the relative bioavailability.: Methods: ... ...

    Abstract Aim: Delamanid is a novel drug for the treatment of drug-resistant tuberculosis, manufactured as 50-mg solid and 25-mg dispersible tablets. We evaluated the effects of dispersing the 50-mg tablet, focusing on the relative bioavailability.
    Methods: Delamanid, 50-mg tablets administered dispersed vs swallowed whole, was investigated in a phase I, four-period, crossover study. Two of three dose strengths of delamanid (25, 50 or 100 mg) were given to healthy adult participants, in both whole and dispersed forms, with a 7-day washout period. Blood samples were collected over 168 h after each dose. Delamanid and its metabolite DM-6705 were analysed with a validated liquid chromatography tandem mass spectrometry assay. The pharmacokinetics of both analytes were analysed using nonlinear mixed-effect modelling. Palatability and acceptability were determined using a standardized questionnaire.
    Results: Twenty-four participants completed the study. The bioavailability of dispersed tablets was estimated to be 107% of whole tablets, with a 90% confidence interval of 99.7-114%, fulfilling bioequivalence criteria. The two formulations were not significantly different regarding either bioavailability or its variability. Bioavailability increased at lower doses, by 34% (26-42%) at 50 mg and by 74% (64-86%) at 25 mg, relative to 100 mg. The majority of participants (93%) found the dispersed formulation acceptable in palatability across all delamanid doses.
    Conclusions: Dispersed 50-mg delamanid tablets have similar bioavailability to tablets swallowed whole in adult volunteers. This can be an option for children and other patients who cannot swallow whole tablets, improving access to treatment.
    Language English
    Publishing date 2023-01-24
    Publishing country England
    Document type Journal Article
    ZDB-ID 188974-6
    ISSN 1365-2125 ; 0306-5251 ; 0264-3774
    ISSN (online) 1365-2125
    ISSN 0306-5251 ; 0264-3774
    DOI 10.1111/bcp.15672
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  10. Article ; Online: Hepatocellular Injury in Children Treated for Rifampicin-resistant Tuberculosis: Incidence, Etiology and Outcome.

    Duvenhage, Joanie / Draper, Heather R / Garcia-Prats, Anthony J / Winckler, Jana / Hesseling, Anneke C / Schaaf, H Simon

    The Pediatric infectious disease journal

    2022  Volume 41, Issue 12, Page(s) 953–958

    Abstract: Background: Hepatocellular injury has been reported commonly in adults on rifampicin-resistant and multidrug-resistant tuberculosis (RR/MDR-TB) treatment. However, there are limited data in children.: Methods: Two pharmacokinetic studies of children ( ...

    Abstract Background: Hepatocellular injury has been reported commonly in adults on rifampicin-resistant and multidrug-resistant tuberculosis (RR/MDR-TB) treatment. However, there are limited data in children.
    Methods: Two pharmacokinetic studies of children (0-17 years) routinely treated for RR/MDR-TB were conducted in Cape Town, South Africa between October 2011 and February 2020. Hepatocellular injury adverse events (AEs; defined as elevated alanine aminotransferase [ALT]) were documented serially. Data were analyzed to determine the incidence, etiology, risk factors, management and outcome of ALT elevation.
    Results: A total of 217 children, median age 3.6 years (interquartile range, 1.7-7.1 years) at enrollment were included. The median follow-up time was 14.0 months (interquartile range, 9.8-17.2 months). Fifty-five (25.3%) patients developed an ALT AE. Of these, 43 of 55 (78%) patients had 54 ALT AEs attributed to their RR/MDR-TB treatment. The incidence rate of ALT AEs related to RR-TB treatment was 22.4 per 100 person-years. Positive HIV status and having an elevated ALT at enrollment were associated with time to ALT AE attributed to RR/MDR-TB treatment, with P values 0.0427 and P < 0.0001, respectively. Hepatitis A IgM was positive in 11 of 14 (78.6%) severe (grade ≥3) cases of ALT AEs. In 8 of 14 (57%) severe ALT AEs, hepatotoxic drugs were stopped or temporarily interrupted. None had a fatal or unresolved outcome.
    Conclusions: Hepatocellular injury in children on RR/MDR-TB treatment is common, although usually mild; having elevated ALT early in treatment and HIV-positive status are possible risk factors. Hepatitis A was a common etiology of severe ALT AE in children treated for RR/MDR-TB.
    MeSH term(s) Adult ; Child ; Humans ; Child, Preschool ; Rifampin/adverse effects ; Incidence ; Antitubercular Agents/adverse effects ; Hepatitis A/complications ; Carcinoma, Hepatocellular/chemically induced ; Carcinoma, Hepatocellular/complications ; Carcinoma, Hepatocellular/drug therapy ; South Africa/epidemiology ; Liver Neoplasms/chemically induced ; Liver Neoplasms/complications ; Liver Neoplasms/drug therapy ; Tuberculosis, Multidrug-Resistant/drug therapy ; Tuberculosis, Multidrug-Resistant/epidemiology ; Tuberculosis, Multidrug-Resistant/complications ; Treatment Outcome
    Chemical Substances Rifampin (VJT6J7R4TR) ; Antitubercular Agents
    Language English
    Publishing date 2022-09-06
    Publishing country United States
    Document type Journal Article
    ZDB-ID 392481-6
    ISSN 1532-0987 ; 0891-3668
    ISSN (online) 1532-0987
    ISSN 0891-3668
    DOI 10.1097/INF.0000000000003690
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