Optimal treatment with 15 mg/kg levofloxacin daily is effective for active or latent MDR TB in children in the Federated States of Micronesia and Republic of the Marshall Islands
This study was carried out during outbreaks of multidrug-resistant tuberculosis (MDR TB) in Chuuk, Federated States of Micronesia (FSM) and then in Majuro, the Republic of the Marshall Islands (RMI) in 50 children who were given levofloxacin-based regimens for MDR TB or LTBI presumed to be MDR. In FSM, plasma concentrations were measured at the end of a 1-year regimen of levofloxacin as monotherapy or in combination with ethambutol (based on the drug susceptibility results for index patients) for LTBI or with multiple medication for MDR TB. The results of these analyses were used to adjust the levofloxacin dosage in RMI children who were being treated with levofloxacin and ethambutol for LTBI after being exposed to MDR TB. Pharmacokinetic data on levofloxacin for both groups of children were used to support further paediatric dosing strategies. The investigators included experts in various aspects of respiratory disease across the USA, including the Centers for Disease Control and Prevention, Atlanta, Georgia, and the TB/Leprosy Program, Federated States of Micronesia.
The levofloxacin-based regimens were given for 18 months for MDR TB and 12 months for MDR LTBI, and all those taking part completed their treatment without experiencing any side effects that required interruption or discontinuation of treatment. Analysis of the results showed that, in order to achieve a Cmax target of 8 mcg/ml levofloxacin, a revision of current dosage regimens needs to be considered: 15 -20mg/kg levofloxacin once daily appears to be optimal at least in children 2 years of age or over and a high target attainment was achieved with 15 mg/kg daily.
Pediatr Infect Dis J. 2015 Dec 10. [Epub ahead of print]
Source : http://www.ncbi.nlm.nih.gov/pubmed/26658531?dopt=Abstract