Principles and rationale of infusion therapy in tuberculosis

Abstract

Background. In 2018 7 million new cases of tuberculosis (TB) were registered, which is more than in previous years. Undoubtedly, TB is one of the most important threats to the public health globally. In developing countries, where there are no new TB drugs (TBD) and modern medical services, this threat is even more serious. Intravenous administration is an option to optimize the existing drug regimens, as it is accompanied by increased bioavailability. Objective. To substantiate the rationality of infusion therapy in TB. Materials and methods. Analysis of literature data on this topic; own study involving 106 patients with newly diagnosed infiltrative and disseminated pulmonary TB with bacterial excretion. Results and discussion. The medical community is concerned not only about the increase in the TB incidence, but also about the increase in the number of drug resistance (DR) cases. Improper treatment is one of the causes of DR. In case of oral administration absorption disorders of the drug are possible in people with digestive system diseases, in addition, part of the drug is metabolized by passing through the liver. In contrast, intravenous drugs enter the superior vena cava system, right ventricle, and pulmonary arteries. In a number of patients’ subgroups, it is not possible to achieve a sufficient concentration of drugs in serum when taken orally for various reasons. In particular, these reasons include host organism factors (features of drug metabolism (fast acetylators are more likely to have DR than slow ones), malabsorption, drug clearance, inability of the drug to reach lung tissue) and mycobacteria factors (biofilm formation, drug resistance due to efflux pumps, metabolic status of the bacterium – division phase or sleep phase). These factors are considered to be the consequences of continuous oral administration of TBD. Achieving a high concentration of TBD in the source of infection due to intravenous administration allows to overcome the DR of mycobacteria. In the own study, oral (n=33) and intravenous (n=73) modes of TBD administration were compared. The groups were identical in age, sex, and TB stage. In the intravenous treatment group there was a significantly higher proportion of complete closure of the decay cavities (90.5 % vs. 60.4 % in the oral treatment group; p=0.04), as well as the significantly lower number of toxic reactions (14.3 % vs. 57.9 %; p=0.001) and poor tolerability of treatment (31 % vs. 57.9 %; p=0.04). On the background of intravenous therapy less fluoroquinolone DR was observed. Conclusions. 1. Intravenous therapy in patients with pulmonary TB is more effective than standard in terms of closure of the decay cavities. 2. Intravenous therapy is accompanied by significantly less toxicity and better tolerability. 3. Intravenous TB therapy is less likely to provoke the development of DR.