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Effectiveness and safety of meropenem/ clavulanate-containing regimens in the treatment of MDR- and XDR-TB

par Tiberi, Simon;De Lorenzo, Saverio;Gaga, Mina;Gualano, Gina;Roby Arias, Aurora Jazmín;Scardigli, Anna;Skrahina, Alena;Solovic, Ivan;Sulis, Giorgia;Tadolini, Marina;Akkerman, Onno O.W.;Payen, Marie-Christine ;Alarcon Arrascue, Edith;Aleska, Alena;Avchinko, Vera;Bonini, Eduardo Henrique;Chong Marín, Felix Antonio;Collahuazo López, Lorena;De Vries, Gérard;Dore, Simone;Kunst, Heinke;Matteelli, Alberto;Sotgiu, Giovanni;Moschos, Charalampos;Palmieri, Fabrizio;Papavasileiou, Apostolos;Spanevello, Antonio;Vargas Vasquez, Dante;Viggiani, Pietro;White, Veronica;Zumla, Alimuddin;Migliori, Giovanni Battista;D'Ambrosio, Lia;Alarcon Guizado, Valentina;Alffenaar, Jan Willem;Arbex, Marcos Abdo;Caminero, José Antonio;Centis, Rosella
Référence The European respiratory journal, 47, 4, page (1235-1243)
Publication Publié, 2016-04

Article révisé par les pairs

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Résumé :

No large study has ever evaluated the efficacy, safety and tolerability of meropenem/ clavulanate to treat multidrug- and extensively drug-resistant tuberculosis (MDR- and XDR-TB). The aim of this observational study was to evaluate the therapeutic contribution, effectiveness, safety and tolerability profile of meropenem/clavulanate added to a background regimen when treating MDR- and XDR-TB cases. Patients treated with a meropenem/clavulanate-containing regimen (n=96) showed a greater drug resistance profile than those exposed to a meropenem/clavulanate-sparing regimen (n=168): in the former group XDR-TB was more frequent (49% versus 6.0%, p<0.0001) and the median (interquartile range (IQR)) number of antibiotic resistances was higher (8 (6-9) versus 5 (4-6)). Patients were treated with a meropenem/clavulanate-containing regimen for a median (IQR) of 85 (49-156) days. No statistically significant differences were observed in the overall MDR-TB cohort and in the subgroups with and without the XDR-TB patients; in particular, sputum smear and culture conversion rates were similar in XDR-TB patients exposed to meropenem/clavulanate-containing regimens (88.0% versus 100.0%, p=1.00 and 88.0% versus 100.0%, p=1.00, respectively). Only six cases reported adverse events attributable to meropenem/clavulanate (four of them then restarting treatment). The nondifferent outcomes and bacteriological conversion rate observed in cases who were more severe than controls might imply that meropenem/clavulanate could be active in treating MDR- and XDR-TB cases.