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| LETTER TO EDITOR |
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| Year : 2016 | Volume
: 4
| Issue : 1 | Page : 30 |
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β-lactams against tuberculosis
Milind Davane, Basavraj S Nagoba
Department of Microbiology, MIMSR Medical College, Latur, Maharashtra, India
| Date of Web Publication | 31-Mar-2017 |
Correspondence Address:
Basavraj S Nagoba
Department of Microbiology, MIMSR Medical College, Latur - 413 531, Maharashtra
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jpsic.jpsic_12_16
How to cite this article:
Davane M, Nagoba BS. β-lactams against tuberculosis. J Patient Saf Infect Control 2016;4:30 |
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 | |  |
| 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.  |
| 2. | Finch R. Beta-lactam antibiotics and mycobacteria. J Antimicrob Chemother 1986;18:6-8. |
| 3. | Hamilton-Miller J, Smith J, editors. β-Lactamases. London: Academic Press; 1979. |
| 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. |
| 5. | Trias J, Jarlier V, Benz R. Porins in the cell wall of mycobacteria. Science 1992;258:1479-81. |
| 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. |
| 7. | Donald PR, Diacon AH. The early bactericidal activity of anti-tuberculosis drugs: A literature review. Tuberculosis (Edinb) 2008;88 Suppl 1:S75-83. |
| 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. |
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