期刊
CLINICAL INFECTIOUS DISEASES
卷 67, 期 -, 页码 S293-S302出版社
OXFORD UNIV PRESS INC
DOI: 10.1093/cid/ciy611
关键词
tuberculous meningitis; hollow fiber system model; artificial intelligence; Monte Carlo experiments; gyrA mutations
资金
- Baylor Research Institute
- Wellcome Trust, UK
- National Institutes of Health
- National Institute of Allergy and Infectious Diseases [U01AI119954]
- Baylor Research Institute, Dallas, TX
Background. Levofloxacin is used for the treatment of multidrug-resistant tuberculosis; however the optimal dose is unknown. Methods. We used the hollow fiber system model of tuberculosis (HFS-TB) to identify 0-24 hour area under the concentration- time curve (AUC (0-24)) to minimum inhibitory concentration (MIC) ratios associated with maximal microbial kill and suppression of acquired drug resistance (ADR) of Mycobacterium tuberculosis (Mtb). Levofloxacin-resistant isolates underwent whole-genome sequencing. Ten thousands patient Monte Carlo experiments (MCEs) were used to identify doses best able to achieve the HFS-TB-derived target exposures in cavitary tuberculosis and tuberculous meningitis. Next, we used an ensemble of artificial intelligence (AI) algorithms to identify the most important predictors of sputum conversion, ADR, and death in Tanzanian patients with pulmonary multidrug-resistant tuberculosis treated with a levofloxacin-containing regimen. We also performed probit regression to identify optimal levofloxacin doses in Vietnamese tuberculous meningitis patients. Results. In the HFS-TB, the AUC (0-24) /MIC associated with maximal Mtb kill was 146, while that associated with suppression of resistance was 360. The most common gyrA mutations in resistant Mtb were Asp94Gly, Asp94Asn, and Asp94Tyr. The minimum dose to achieve target exposures in MCEs was 1500 mg/day. AI algorithms identified an AUC (0-24)/MIC of 160 as predictive of micro-biologic cure, followed by levofloxacin 2-hour peak concentration and body weight. Probit regression identified an optimal dose of 25 mg/kg as associated with > 90% favorable response in adults with pulmonary tuberculosis. Conclusions. The levofloxacin dose of 25 mg/kg or 1500 mg/day was adequate for replacement of high-dose moxifloxacin in treatment of multidrug-resistant tuberculosis.
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