Treatment of multidrug-resistant tuberculosis with bedaquiline, pretomanid, linezolid, and moxifloxacin following near-total gastrectomy
Abstract
ABSTRACT Background Patients with a history of gastrectomy are at increased risk of developing pulmonary tuberculosis due to nutritional deficiencies and potential immune impairment. Altered gastrointestinal anatomy can affect oral drug absorption and treatment pharmacokinetics, making management of drug-resistant tuberculosis in this population challenging. Case Summary We describe a case of a woman with a history of gastric adenocarcinoma treated with chemotherapy, followed by near-total gastrectomy and Roux-en-Y reconstruction, who subsequently developed multidrug-resistant pulmonary tuberculosis. A biopsy of a pulmonary nodule was sent for culture and grew Mycobacterium tuberculosis complex. Phenotypic drug susceptibility testing could not be performed due to poor growth; however, a line probe assay performed on the isolate identified resistance to rifampin and isoniazid. The patient was treated with the all-oral bedaquiline, pretomanid, linezolid, and moxifloxacin (BPaLM) regimen. Due to concerns regarding impaired drug absorption following gastrectomy, therapeutic drug monitoring was performed to guide dosing. Therapeutic drug levels were ultimately achieved, and sputum culture conversion occurred after 5 weeks of effective therapy. The patient successfully completed the 26-week regimen with sustained microbiologic cure. Conclusion This case demonstrates successful use of the all-oral BPaLM regimen in a patient with prior gastrectomy when supported by therapeutic drug…
How strong is the evidence?
Evidence Hub reads this as a case report, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.
Read the paper
Related studies
- Synthesis, In Vitro and In Silico Molecular Docking Studies of Novel Phthalimide–Pyrimidine Hybrid Analogues to Thalidomide as Potent Antitubercular Agents
- Exploring the inhibitory performance of expired moxifloxacin and norfloxacin on copper corrosion in saline environment
- Molecular investigation of antimicrobial peptides against Helicobacter pylori proteins using a peptide-protein docking approach
- Screening of novel narrow-spectrum benzofuroxan derivatives for the treatment of multidrug-resistant tuberculosis through in silico, in vitro, and in vivo approaches
- Synthesis, Characterization, Anticancer, Antioxidant, and In Silico Evaluation of Semicarbazides and Thiosemicarbazides
- Fast and accurate prediction of drug induced proarrhythmic risk with sex specific cardiac emulators
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.