Clinical Pharmacokinetics and Pharmacodynamics of Anti-Tubercular Drugs in Pregnancy
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REVIEW ARTICLE
Clinical Pharmacokinetics and Pharmacodynamics of Anti‑Tubercular Drugs in Pregnancy Jennifer R. Shiu1 · Alan Min2 · Tony K. L. Kiang2,3
© Springer Nature Switzerland AG 2020
Abstract The objectives of this qualitative review were to critically evaluate and summarize the currently available data on the use of anti-tuberculosis (TB) drugs during pregnancy, with a focus on treatment outcomes, safety, and pharmacokinetics. This qualitative, narrative review was based on literature searches in Medline, Pubmed, Embase, and Google Scholar (from their inception to 13 August 2020). Our search identified 22 papers related to treatment outcomes and 14 papers related to pharmacokinetic exposures and fetal distributions. While it is challenging to study this patient population, current evidence supports treatment of drug-susceptible TB, multidrug-resistant TB and latent TB infections. However, decisions regarding initiating, continuing, or discontinuing anti-tubercular medications while pregnant should be individualized and discussed with a specialist. Similarly, the pharmacokinetic data of anti-TB agents were mainly derived from small scale, observational studies many of which lacked high quality controls. Based on these data, it does not appear that pregnancy has an extensive impact on the pharmacokinetics of the majority of first-line and second-line agents, although caution (discussed in the review) should be exercised in data interpretation. Fetal drug exposure can also be significant and should be considered when selecting an anti-TB agent for longer term treatment. Overall, it is generally difficult to predict pregnancy-associated pharmacokinetic changes based only on drug’s physiochemical characteristics.
1 Introduction Tuberculosis (TB) is a serious infectious disease caused by Mycobacterium tuberculosis [1]. It is highly communicable via aerosolization (i.e., coughing) and it is estimated that approximately 25% of the global population has already been infected with the bacterium. Infected individuals are susceptible to developing active disease which is associated with significant morbidity and mortality [1]. Current recommended therapies for TB involve the obligatory utilization of antimicrobials that have activities toward M. tuberculosis. * Tony K. L. Kiang [email protected] 1
Clinical Practice Leader North, Internal Medicine, University of Alberta Hospital, Clinical Academic Colleague, Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada
2
Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada
3
Faculty of Pharmacy and Pharmaceutical Sciences, Katz Group Centre for Pharmacy and Health Research, Room 3‑142D, 11361‑81 Ave, Edmonton, AB T6G 2E1, Canada
Key Points Current evidence supports the treatment of drug-susceptible TB, multidrug-resistant TB and latent TB infections. Further research on pregnancy treatment outcomes is required to support the limited amount of data identified in the literature. P
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