Ann Lab Med 2017; 37(2): 97-107  
Recommendations for Optimizing Tuberculosis Treatment: Therapeutic Drug Monitoring, Pharmacogenetics, and Nutritional Status Considerations
Rihwa Choi, M.D.1, Byeong-Ho Jeong, M.D.2, Won-Jung Koh, M.D.2, and Soo-Youn Lee, M.D.1,3
Department of Laboratory Medicine and Genetics1; Division of Pulmonary and Critical Care Medicine, Department of Medicine2; Department of Clinical Pharmacology & Therapeutics3, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
Correspondence to: Won-Jung Koh
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea
Tel: +82-2-3410-3429 Fax: +82-2-3410-3849 E-mail: wjkoh@skku.edu
Co-corresponding author: Soo-Youn Lee
Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea
Tel: +82-2-3410-1834 Fax: +82-2-3410-2719 E-mail: suddenbz@skku.edu
Received: June 28, 2016; Revised: August 4, 2016; Accepted: November 22, 2016; Published online: March 1, 2017.
© The Korean Society for Laboratory Medicine. All rights reserved.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Although tuberculosis is largely a curable disease, it remains a major cause of morbidity and mortality worldwide. Although the standard 6-month treatment regimen is highly effective for drug-susceptible tuberculosis, the use of multiple drugs over long periods of time can cause frequent adverse drug reactions. In addition, some patients with drug-susceptible tuberculosis do not respond adequately to treatment and develop treatment failure and drug resistance. Response to tuberculosis treatment could be affected by multiple factors associated with the host-pathogen interaction including genetic factors and the nutritional status of the host. These factors should be considered for effective tuberculosis control. Therefore, therapeutic drug monitoring (TDM), which is individualized drug dosing guided by serum drug concentrations during treatment, and pharmacogenetics-based personalized dosing guidelines of anti-tuberculosis drugs could reduce the incidence of adverse drug reactions and increase the likelihood of successful treatment outcomes. Moreover, assessment and management of comorbid conditions including nutritional status could improve anti-tuberculosis treatment response.
Keywords: Tuberculosis, Therapeutic drug monitoring, Pharmacogenetics, Nutrition, Immunity, Treatment


This Article

e-submission

Archives

Indexed/Covered by