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New drugs to treat difficult tuberculous and nontuberculous mycobacterial pulmonary disease

Lee, SFK; Laughon, BE; McHugh, TD; Lipman, M; (2019) New drugs to treat difficult tuberculous and nontuberculous mycobacterial pulmonary disease. Current Opinion in Pulmonary Medicine , 25 (3) pp. 21-280. 10.1097/MCP.0000000000000570. Green open access

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Abstract

Purpose of review Treatment of drug-sensitive tuberculosis (TB) is effective, whereas that of multidrug-resistant and extensively drug-resistant TB as well as nontuberculous mycobacterial (NTM) disease are less so. Therapy in general requires good adherence to potentially toxic drug regimens over prolonged periods. Poor adherence is associated with resistance development and poor outcome. This review will present promising new treatments, both new drugs and regimens, for difficult mycobacterial pulmonary infections. Recent findings A number of new and repurposed drugs including bedaquiline, delamanid, pretomanid, linezolid and clofazimine, and drug regimens, such as the The Evaluation of a Standard Treatment Regimen of Anti-tuberculosis Drugs for Patients With MDR-TB (STREAM) trial regimens, are currently progressing from basic research through clinical trials. Summary The role of bedaquiline and delamanid in TB and NTM treatment is still not clearly defined. New and repurposed drugs such as pretomanid, linezolid and clofazimine have the potential to advance TB and NTM treatment. Inhaled liposomal amikacin shows promise in pulmonary NTM disease. Patients with multidrug-resistant TB, extensively drug-resistant TB and NTM disease should be offered the choice to participate in drug trials that may shorten or otherwise improve their experience of treatment. The use of an effective regimen based on appropriate NTM-specific drug susceptibility testing should be a cornerstone of treatment for NTM as much as it is for Mycobacterium tuberculosis treatment. All new drugs identified for Mycobacterium tuberculosis should also be tested for activity against NTM, though robust tools for NTM drug susceptibility testing are required.

Type: Article
Title: New drugs to treat difficult tuberculous and nontuberculous mycobacterial pulmonary disease
Location: United States
Open access status: An open access version is available from UCL Discovery
DOI: 10.1097/MCP.0000000000000570
Publisher version: https://doi.org/10.1097/MCP.0000000000000570
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Tuberculosis, NTM, non-tuberculous, MDR-TB, mycobacteria, regimen
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Infection and Immunity
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine > Respiratory Medicine
URI: https://discovery.ucl.ac.uk/id/eprint/10070469
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