Multidrug resistant tuberculosis (MDR TB) cuam tshuam txog ib nrab lab tus tib neeg txhua xyoo. Levofloxacin tau qhia rau kev tiv thaiv kev kho mob raws li kev soj ntsuam cov ntaub ntawv, txawm li cas los xij cov pov thawj los ntawm kev sim tshuaj loj loj tsis muaj. TB CHAMP thiab V-QUIN, ob theem 3 kev sim tshuaj ntsuam xyuas tau soj ntsuam kev nyab xeeb thiab kev ua tau zoo ntawm levofloxacin hauv kev tiv thaiv MDR TB hauv cov neeg koom nrog tsev neeg raug rau ntau yam tshuaj tiv thaiv M. tuberculosis. Levofloxacin tau pom tias txo qis qhov tshwm sim ntawm ntau cov tshuaj tiv thaiv tuberculosis hauv ob qhov kev tshawb fawb tab sis qhov txo qis ntawm qhov tshwm sim tsis tseem ceeb. Ib qho kev tshuaj ntsuam meta-kev soj ntsuam ntawm cov ntaub ntawv los ntawm TB CHAMP thiab V-QUIN kev sim tau qhia tias levofloxacin tau cuam tshuam nrog 60% txheeb ze txo qhov tshwm sim ntawm tuberculosis hauv tsev neeg MDR-TB.
Mycobacterium tuberculosis tiv taus isoniazid thiab rifampin cuam tshuam ze li ib nrab lab tus tib neeg txhua xyoo thoob ntiaj teb. Nws yog lub luag haujlwm rau kev tiv thaiv kab mob ntau yam tshuaj tiv thaiv kab mob (MDR) uas nyuaj rau cov kev tswj xyuas tuberculosis. Tshwj xeeb tshaj yog, cov menyuam yaus uas muaj tsev neeg raug rau ntau yam tshuaj tiv thaiv kab mob (MDR) tuberculosis ua rau muaj kev pheej hmoo ntau dua. Kwv yees li 2 lab tus menyuam yaus hnub nyoog qis dua 15 xyoos tau kis tus kabmob MDR M. tuberculosis.
Levofloxacin, tus thib peb tiam fluoroquinolone tshuaj tua kab mob noj qhov ncauj, uas yog ib feem ntawm cov qauv kev kho mob rau rifampicin-resistant los yog MDR tuberculosis yog qhia raws li cov ntaub ntawv soj ntsuam rau kev tiv thaiv kev kho mob tom qab raug rau multidrug-resistant (MDR) tuberculosis, txawm li cas los xij cov pov thawj los ntawm kev sim loj. ntawm nws cov kev ua tau zoo yog tsis muaj.
Ob qhov loj-scale 3 kev sim tshuaj - TB CHAMP thiab V-QUIN tau tshawb xyuas kev nyab xeeb thiab kev ua tau zoo ntawm levofloxacin hauv kev tiv thaiv kev kho mob ntawm MDR TB tom qab kis tus kab mob ntau yam tshuaj tiv thaiv. Qhov kev tshawb pom thiab cov lus xaus ntawm ob txoj kev tshawb fawb tau luam tawm rau 18 Kaum Ob Hlis 2024.
cov TB CHAMP (Tuberculosis Child Multidrug-Resistant Preventive Therapy Trial) tau soj ntsuam qhov ua tau zoo thiab kev nyab xeeb ntawm kev tiv thaiv kev kho mob nrog levofloxacin hauv cov menyuam yaus thiab cov tub ntxhais hluas nrog tsev neeg raug rau cov kab mob ntau yam tshuaj tiv thaiv kab mob. Nws tau ua rau 922 tus menyuam yaus thiab cov tub ntxhais hluas uas muaj tsev neeg raug tus kab mob ntau yam tshuaj tiv thaiv kab mob thaum 6 lub hlis dhau los (tab sis tsis muaj pov thawj ntawm tuberculosis) los ntawm 497 tsev neeg ntawm ntau qhov chaw hauv South Africa. Cov neeg koom nrog tau txais levofloxacin lossis placebo txhua hnub rau 24 lub lis piam. 453 tus neeg koom tau txais levofloxacin thiab tus so 469 tau muab cov placebo. Los ntawm lub lim tiam 48, tuberculosis tsim nyob rau hauv 5 tus neeg koom (1.1%) hauv pawg levofloxacin thiab hauv 12 tus neeg koom (2.6%) hauv pawg placebo. Yog li, kev tiv thaiv kev kho mob nrog levofloxacin txo qis qhov tshwm sim ntawm tuberculosis ntawm cov menyuam yaus thiab cov tub ntxhais hluas nrog tsev neeg raug MDR TB tab sis qhov txo qis ntawm qhov tshwm sim tsis qis dua li cov placebo.
Lwm txoj kev kawm (hu ua V-QUIN trial) soj ntsuam kev ua tau zoo thiab kev nyab xeeb ntawm 6-hli kev tswj hwm ntawm levofloxacin rau kev tiv thaiv kab mob ua haujlwm ntawm cov neeg hauv tsev neeg uas paub tseeb tias rifampicin resistant lossis multidrug-resistant (MDR) tuberculosis. Qhov kev sim no tau ua nyob rau ntau qhov chaw hauv Nyab Laj ntawm 2041 cov neeg koom nrog uas yog cov neeg nyob hauv tsev ntawm cov neeg uas muaj rifampicin resistant lossis MDR tuberculosis. Cov neeg koom nrog muaj kab mob M. tuberculosis tab sis tsis muaj kab mob tshwm sim thiab tau pib kho hauv 3 lub hlis dhau los. Cov neeg koom nrog tau raug muab tso tseg kom tau txais 6 lub hlis ntawm levofloxacin txhua hnub lossis cov placebo. 1023 cov neeg koom tau txais levofloxacin thaum 1018 Cov neeg koom nrog cov placebo. Thaum 30 lub hlis, 6 tus neeg koom (0.6%) hauv pawg levofloxacin tau kuaj pom tias muaj kab mob ntsws thaum muaj 11 tus neeg koom (1.1%) hauv cov placebo pab pawg tau kuaj pom tias muaj kab mob ntsws. Tsis tas li ntawd, 1 tus neeg koom nrog hauv pawg levofloxacin thiab 2 hauv pawg placebo tau kuaj pom tias muaj tuberculosis. Yog li, qhov tshwm sim ntawm tus kab mob yog qis dua rau cov pab pawg levofloxacin dua li cov placebo, tab sis qhov sib txawv tsis tseem ceeb.
Ob qho tib si saum toj no-loj theem loj 3 kev sim tshuaj ntsuam xyuas kev ua tau zoo thiab kev nyab xeeb ntawm levofloxacin hauv kev tiv thaiv kab mob ntawm cov neeg koom nrog tsev neeg raug rau ntau yam tshuaj tiv thaiv tuberculosis. Hauv TB CHAMP, cov neeg tuaj koom tsis muaj pov thawj ntawm tuberculosis, thaum nyob rau hauv kev sim V-QUIN, cov neeg koom tau muaj tus kab mob M. tuberculosis tab sis tsis muaj kab mob. Hauv ob qho xwm txheej, levofloxacin tau pom los txo qhov tshwm sim ntawm tus kab mob, tab sis qhov txo qis tsis tseem ceeb.
Txawm li cas los xij, ib qho kev soj ntsuam ntawm cov ntaub ntawv los ntawm TB CHAMP thiab V-QUIN kev sim tau qhia tias levofloxacin tau cuam tshuam nrog 60% txheeb ze txo qhov tshwm sim ntawm tuberculosis hauv tsev neeg MDR-TB.
Thaum lub Cuaj Hlis 2024, tus LEEJ TWG tau pom zoo levofloxacin rau kev kho mob tiv thaiv MDR-TB raws li kev tshuaj xyuas ntawm cov pov thawj kev sim no.
Delamanid tam sim no tau raug tshuaj xyuas hauv kev sim tshuaj rau kev tiv thaiv kev kho mob ntawm MDR TB. Nws yog ib qho tshuaj tiv thaiv kab mob uas inhibits mycobacterial cell phab ntsa synthesis thiab tau pom zoo rau kev kho mob ntawm ntau yam kab mob resistant tuberculosis.
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References:
- Hesseling AC et al 2024. Levofloxacin Kev Tiv Thaiv Kev Kho Mob hauv Menyuam Yaus raug MDR Tuberculosis. Luam tawm 18 Kaum Ob Hlis 2024. N Engl J Med 2024; 391: 2315-2326. Vol. 391, nr 24. https://www.nejm.org/doi/full/10.1056/NEJMoa2314318
- Fox GJ, thiab al 2024. Levofloxacin rau kev tiv thaiv ntawm Multidrug-Resistant Tuberculosis hauv Nyab Laj. Luam tawm 18 Kaum Ob Hlis 2024. N Engl J Med 2024; 391: 2304-2314 . Vol. 391 Nr. 24. DOI: https://www.nejm.org/doi/full/10.1056/NEJMoa2314325
- Duong T., et al 2024. Ib qho Meta-Kev tshuaj ntsuam ntawm Levofloxacin rau kev sib cuag ntawm Multidrug-Resistant Tuberculosis. Published 18 December 2024. NEJM Evidence. DOI: https://evidence.nejm.org/doi/full/10.1056/EVIDoa2400190
- Dorman SE 2024. Levofloxacin Tiv Thaiv Kev Kho Mob rau cov neeg raug MDR Tuberculosis. Luam tawm 18 Kaum Ob Hlis 2024. N Engl J Med 2024; 391: 2376-2378. Vol. 391, nr 24. https://www.nejm.org/doi/full/10.1056/NEJMe2413531
- MRC-UCL. TB-CHAMP kev sim nrhiav pom thawj zaug uas muaj kev nyab xeeb thiab muaj txiaj ntsig zoo los tiv thaiv kab mob TB hauv cov menyuam yaus. 19 Kaum Ob Hlis 2024. Muaj nyob ntawm https://www.mrcctu.ucl.ac.uk/news/news-stories/2024/december/tb-champ-trial-finds-first-ever-safe-and-effective-treatment-to-prevent-multidrug-resistant-tb-in-children/
- WHO. Cov ntsiab lus ntawm TB CHAMP thiab V-QUIN kev sim tshuaj. https://tbksp.who.int/en/node/2745
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 affects half a million people each year. Levofloxacin is advised for preventive treatment based on observational data, however evidence from large scale clinical trial is unavailable. TB CHAMP and V-QUIN, two phase 3 clinical trials have evaluated safety and efficacy of levofloxacin in preventing MDR TB in participants with household exposure to multidrug resistant M. tuberculosis. Levofloxacin was found to reduce the incidence of multidrug-resistance tuberculosis in both the studies but the reduction in incidence was not significant. A meta-analysis of the data from the TB CHAMP and V-QUIN trials has revealed that levofloxacin was associated with a 60% relative reduction in occurrence of tuberculosis in household MDR-TB contacts.){kind=link}