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Int. J. Mol. Sci. 2016, 17(3), 373; doi:10.3390/ijms17030373

Carbapenems to Treat Multidrug and Extensively Drug-Resistant Tuberculosis: A Systematic Review

1
Clinical Epidemiology and Medical Statistics Unit, Department of Biomedical Sciences, University of Sassari—Research, Medical Education and Professional Development Unit, AOU Sassari, Sassari 07100, Italy
2
World Health Organization Collaborating Centre for Tuberculosis and Lung Diseases, Fondazione S. Maugeri, IRCCS (Istituto di Ricovero e Cura a Carattere Sceintifico), Via Roncaccio 16, Tradate 21049, Italy
3
Public Health Consulting Group, Lugano 6900, Switzerland
4
Division of Infection, Royal London Hospital, Barts Health NHS Trust, London E1 2ES, UK
5
Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS (Istituto di Ricovero e Cura a Carattere Sceintifico) Ca’ Granda Ospedale Maggiore Policlinico, Milan 20122, Italy
6
Pneumology Unit, Fondazione Maugeri, IRCCS (Istituto di Ricovero e Cura a Carattere Sceintifico), Tradate 21049, Italy
7
Department of Clinical and Experimental Medicine, University of Insubria, Varese 21100, Italy
These authors contributed equally to this work.
*
Author to whom correspondence should be addressed.
Academic Editor: Brian Wigdahl
Received: 1 February 2016 / Revised: 29 February 2016 / Accepted: 7 March 2016 / Published: 12 March 2016
View Full-Text   |   Download PDF [610 KB, uploaded 12 March 2016]   |  

Abstract

Background: Carbapenems (ertapenem, imipenem, meropenem) are used to treat multidrug-resistant (MDR-) and extensively drug-resistant tuberculosis (XDR-TB), even if the published evidence is limited, particularly when it is otherwise difficult to identify the recommended four active drugs to be included in the regimen. No systematic review to date has ever evaluated the efficacy, safety, and tolerability of carbapenems. Methods: A search of peer-reviewed, scientific evidence was carried out, aimed at evaluating the efficacy/effectiveness, safety, and tolerability of carbapenem-containing regimens in individuals with pulmonary/extra-pulmonary disease which was bacteriologically confirmed as M/XDR-TB. We used PubMed to identify relevant full-text, English manuscripts up to the 20 December 2015, excluding editorials and reviews. Results: Seven out of 160 studies satisfied the inclusion criteria: two on ertapenem, one on imipenem, and four on meropenem, all published between 2005 and 2016. Of seven studies, six were retrospective, four were performed in a single center, two enrolled children, two had a control group, and six reported a proportion of XDR-TB cases higher than 20%. Treatment success was higher than 57% in five studies with culture conversion rates between 60% and 94.8%. Conclusions: The safety and tolerability is very good, with the proportion of adverse events attributable to carbapenems below 15%. View Full-Text
Keywords: MDR-TB; XDR-TB; carbapenems; imipenem; meropenem; ertapenem; effectiveness; safety; tolerability MDR-TB; XDR-TB; carbapenems; imipenem; meropenem; ertapenem; effectiveness; safety; tolerability
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This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).

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MDPI and ACS Style

Sotgiu, G.; D’Ambrosio, L.; Centis, R.; Tiberi, S.; Esposito, S.; Dore, S.; Spanevello, A.; Migliori, G.B. Carbapenems to Treat Multidrug and Extensively Drug-Resistant Tuberculosis: A Systematic Review. Int. J. Mol. Sci. 2016, 17, 373.

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