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LETTER TO EDITOR
Year : 2016  |  Volume : 4  |  Issue : 1  |  Page : 30

β-lactams against tuberculosis


Department of Microbiology, MIMSR Medical College, Latur, Maharashtra, India

Date of Web Publication31-Mar-2017

Correspondence Address:
Basavraj S Nagoba
Department of Microbiology, MIMSR Medical College, Latur - 413 531, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpsic.jpsic_12_16

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How to cite this article:
Davane M, Nagoba BS. β-lactams against tuberculosis. J Patient Saf Infect Control 2016;4:30

How to cite this URL:
Davane M, Nagoba BS. β-lactams against tuberculosis. J Patient Saf Infect Control [serial online] 2016 [cited 2019 Nov 12];4:30. Available from: http://www.jpsiconline.com/text.asp?2016/4/1/30/203540



Madam,

We read with great interest an article entitled, “β-Lactams against Tuberculosis (TB) - New Trick for an Old Dog?” by Diacon et al. published in New England J Med.[1] We would like to add the followings with respect to use of β-lactams against TB.In vitro susceptibility data show that Mycobacterium tuberculosis is intrinsically resistant to β-lactams.[2] It is because of either β-lactamases inactivating these drugs [3] or lipid-rich outer cell wall that is believed to be a virtually impermeable barrier to these drugs.[4],[5]

The present report shows reduction in bacterial load in sputum after giving meropenem and amoxycillin-clavulanic acid in 15 patients. Successful treatment of multidrug-resistant TB with regimen including amoxycillin-clavulanic acid has also been reported.[6] These reports are anecdotal and do not justify overall efficacy of β-lactams. No single study has shown clear evidence of effect of β-lactams against M. tuberculosis in vivo although some β-lactams are active in-vitro.

Although some β-lactam antibiotics are active in vitro against M. tuberculosis, there is limited evidence of in vivo bactericidal activity.[7] Although they are safe, their efficacy remains unclear.

Although amoxycillin-clavulanic acid has been included as third-line drug with unclear efficacy for the treatment of TB by the World Health Organization, this drug is not registered and recommended for routine use making its use off-label.[8] It seems to yield no successful results. In view of clinical evidence, the use of β-lactams for TB is not justifiable by considering anecdotal reports. We really want a new trick for this old dog.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Diacon AH, van der Merwe L, Barnard M, von Groote-Bidlingmaier F, Lange C, García-Basteiro AL, et al. ß-lactams against tuberculosis – New trick for an old dog? N Engl J Med 2016;375:393-4.  Back to cited text no. 1
    
2.
Finch R. Beta-lactam antibiotics and mycobacteria. J Antimicrob Chemother 1986;18:6-8.  Back to cited text no. 2
    
3.
Hamilton-Miller J, Smith J, editors. β-Lactamases. London: Academic Press; 1979.  Back to cited text no. 3
    
4.
Jarlier V, Gutmann L, Nikaido H. Interplay of cell wall barrier and beta-lactamase activity determines high resistance to beta-lactam antibiotics in Mycobacterium chelonae. Antimicrob Agents Chemother 1991;35:1937-9.  Back to cited text no. 4
    
5.
Trias J, Jarlier V, Benz R. Porins in the cell wall of mycobacteria. Science 1992;258:1479-81.  Back to cited text no. 5
    
6.
Pagliotto AD, Caleffi-Ferracioli KR, Lopes MA, Baldin VP, Leite CQ, Pavan FR, et al. Anti-Mycobacterium tuberculosis activity of antituberculosis drugs and amoxicillin/clavulanate combination. J Microbiol Immunol Infect 2016;49:980-3.  Back to cited text no. 6
    
7.
Donald PR, Diacon AH. The early bactericidal activity of anti-tuberculosis drugs: A literature review. Tuberculosis (Edinb) 2008;88 Suppl 1:S75-83.  Back to cited text no. 7
    
8.
Yew WW, Chan CK, Leung CC, Chau CH, Tam CM, Wong PC, et al. Comparative roles of levofloxacin and ofloxacin in the treatment of multidrug-resistant tuberculosis: Preliminary results of a retrospective study from Hong Kong. Chest 2003;124:1476-81.  Back to cited text no. 8
    




 

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