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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
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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 2023 Jun 7];4:30. Available from: https://www.jpsiconline.com/text.asp?2016/4/1/30/203540


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.

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There are no conflicts of interest.

  References Top

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
Finch R. Beta-lactam antibiotics and mycobacteria. J Antimicrob Chemother 1986;18:6-8.  Back to cited text no. 2
Hamilton-Miller J, Smith J, editors. β-Lactamases. London: Academic Press; 1979.  Back to cited text no. 3
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
Trias J, Jarlier V, Benz R. Porins in the cell wall of mycobacteria. Science 1992;258:1479-81.  Back to cited text no. 5
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
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
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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