Lung TB: Higher dose of rifampicin safe, can boost recurrence-free survival, says ICMR study
TB is curable but still remains the most common cause of death due to infectious diseases, with an estimated 1.3 million deaths globally in 2022. Rifamycins are a crucial drug group in the anti-TB regimen, which sterilise the lesions and aid in recurrence-free cure.
Currently, rifampicin is administered at 10 mg/kg for six months to all patients with pulmonary TB.
The team reviewed the available evidence from published clinical trials to determine whether higher doses of rifampicin (more than 15 mg/kg) are more efficacious and safer.
'Compared to standard dose, higher doses of rifampicin were found to lead to early sputum conversion in eight weeks and thus faster TB bacteria clearance,' said corresponding author Dr Leeberk Raja Inbaraj, Department of Clinical Research, ICMR- National Institute for Research in Tuberculosis, Chennai.
Early sputum conversion is a valuable tool widely used as a surrogate marker for treatment response and those who are at risk for relapse in pulmonary TB.
'The ability of high-dose rifampicin to achieve early sputum conversion and eliminate the persistent bacteria that cause relapse could potentially lead to recurrence-free survival. Early bacterial clearance is also of public health importance as this could potentially reduce disease transmission in the community,' the researchers said.
Notably, the study showed 20-30mg/kg rifampicin as the best balance.
'This dose range showed better sputum conversion without a significant increase in serious side effects and may be considered in TB treatment,' revealed the study, published in the Indian Journal of Medical Research (IJMR).
On the other hand, doses above 30 mg/kg, although beneficial, came with severe side effects such as serious liver damage (hepatotoxicity) and adverse drug reactions (ADR), leading to treatment discontinuation.
The study showed no reduction in death or treatment failure in people with more than 15 mg/kg doses of rifampicin.
'High doses did not reduce mortality or treatment failure at 6 months compared to standard treatment,' the team said.
'This dose could be administered with close monitoring of adverse events and hepatotoxicity. There is an urgent need for adequately powered trials that assess long-term treatment outcomes, including recurrence,' they added.
Hashtags
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
The Hindu
2 hours ago
- The Hindu
ICMR seeks collaboration for malaria vaccine production through tech transfer
Indian Council of Medical Research (ICMR), Delhi, has invited Expression of Interest (EoI) from eligible organisations, companies and manufacturers for undertaking 'Transfer of Technology' for commercialisation of 'a recombinant chimeric multi-stage malaria vaccine (AdFalciVax) against Plasmodium falciparum' useful in preventing Plasmodium falciparum infection in humans and minimizing its community transmission. The goal is to facilitate the commercialisation of this vaccine to prevent and minimize malaria transmission, and the EoI is open until August 17. The Council noted that it would provide technical support through its team of experienced scientists in study planning, product development, development of study protocol, results/data analysis, outcome assessment, safety and efficacy assessment, product improvement, etc., if deemed fit upon mutual understanding between ICMR and the collaborative company. Additionally, while the Council will have no financial implications unless otherwise specified, its Institutes would provide support and facilitation to conduct the research and development (R&D)/clinical study of new technology/product in India through its affiliates/institutes, in collaboration with the company/institutions. It would also provide technical support in development of technology/product and will also facilitate the validation, if required. 'ICMR-Regional Medical Research Centre, Bhubaneswar (ICMR-RMRCBB) is one of the four constituent institutes that has led the development of the technology and has technical-know-how of the process to produce this recombinant chimeric multi-stage malaria vaccine in Lactococcus lactis. The pre-clinical validation of this technology was conducted in collaboration with ICMR-National Institute of Malaria Research (ICMR-NIMR), another constituent institute of ICMR, and National Institute of Immunology (NII), New Delhi, an autonomous research institute of the Department of Biotechnology,' it added.
The Hindu
4 hours ago
- The Hindu
Cy-TB test introduced by Kerala govt. for detecting and treating tuberculosis
The State health authorities in Kerala have introduced a new intradermal test called Cy-TB for detecting and treating tuberculosis (TB) infection following the prioritisation of latent TB infection treatment under the National TB Elimination Programme (NTEP). TB infection is different from active TB disease. A person with TB infection harbours the organism causing TB infection (Mycobacterium tuberculosis) in the body, having probably acquired it through contact with someone with active disease. But the organism remains dormant or inactive in the body and the person neither has any TB symptoms nor is he contagious. However, if left untreated, 5-10% of them will progress to developing active TB disease when the body's immune system weakens, allowing the TB bacteria to flare up. This could happen within weeks of acquiring the infection or maybe years, depending on the immune system and other factors determining immune regulation. Study A community-based cross-sectional study among adults in Thiruvananthapuram district in 2023 had reported that roughly one-fifth of the adult population in the district – 20.5% of adults – have tuberculosis infection. The study, 'Prevalence of Tuberculosis Infection among Adults of Thiruvananthapuram District of Kerala as Measured by Interferon Gamma Release Assay – A Cross-Sectional Study,' tested whole blood samples of 396 adults in Thiruvananthapuram for TB infection and found that the prevalence of TB infection increased with age, ranging from 11.5% in the 18-35 age group to 30.3% in the 58-years-plus age group. 'Our studies show that about 22% of the State's general population has acquired TB infection from the community. While they pose no immediate threat to the community, once they go into an immuno-compromised state, the bacteria will multiply and produce symptoms of active disease. Given the morbidity profile of Kerala – high prevalence of diabetes, chronic kidney disease, heavy alcohol use and a huge population on dialysis – it is important that we identify and treat these people to reduce the future burden of TB,' says Aparna Mohan, Government of India-WHO consultant for TB. Cy-TB is a third generation test approved by the Central TB Division. Blood test detection Since 2021, Kerala has been using the blood test Interferon Gamma Release Assay (IGRA) for detecting TB infection. However, this test required extensive laboratory support and it had a waiting period too. There were also systemic difficulties in rolling it out. Cy-TB is a highly specific, accurate and user-friendly skin test, wherein 0.1 ml dose of M. tuberculosis-specific antigens (ESAT-6 and CFP-10) are injected into the skin in the inner forearm. An induration (a raised area) of 5 mm or more which develops on the skin within 48-72 hours indicates TB infection (While a trained nurse can administer the injection, the person will have to return to the health centre for checking out the skin reaction.) If tested positive, active TB has to be ruled out before considering TB preventive therapy. TB preventive therapy is optional and not currently recommended for all those who are infected. Only high risk individuals recommended for preventive therapy under the NTEP alone need to take preventive therapy. Risk groups In Kerala, the identified risk groups include individuals on immunosuppressive therapy, those with silicosis (lung disease following the inhalation of silica dust), those on anti-TNF treatment, and those on dialysis and awaiting organ transplantation. Preventive therapy is also offered to health-care workers who test positive in the Cy-TB test. The preventive therapy is a short regimen with less number of drugs. This could be three-month weekly Isoniazid and Rifapentine (3HP) or six-months daily Isoniazid (6H). According to the State TB Division, Cy-TB will be offered in district TB centres, taluk hospitals, at the block level in some districts and in all dialysis centres too. The Health department also intends to use Cy-TB to test inmates in old age homes where pulmonary TB has been reported. The test is currently available in major private hospitals too.
The Hindu
9 hours ago
- The Hindu
India's cholesterol crisis: why dyslipidemia is the next big public health challenge
Changing lifestyle patterns have given rise to a host of non-communicable diseases (NCDs) in India, including diabetes, hypertension and dyslipidemia. A recent cross-sectional study conducted by the Indian Council of Medical Research–India Diabetes (ICMR-INDIAB), assessed a representative sample of individuals aged 20 years and older, drawn from urban and rural areas of 31 States, Union Territories, and the National Capital Territory of India found that dyslipidemia was prevalent in 81.2 % of the total of 1,13,043 individuals (79,506 from rural areas and 33,537 from urban areas) who participated in the survey. This presents a worrying scenario, one where individuals as young as 20 are already showing signs of abnormal lipid profiles, significantly increasing their risk of developing heart disease and other complications later in life. If left unchecked, this can snowball into a major public health challenge for our country. Understanding dyslipidemia To understand dyslipidemia, we need to understand what cholesterol is. Cholesterol is a fat-like substance found in all cells of our body. Cholesterol travels through the body in small packages called lipoproteins. Lipoproteins are of three types: LDL or low-density lipoprotein known as 'bad cholesterol', HDL or high-density lipoprotein known as 'good cholesterol', and triglycerides. LDL is bad because it leads to a buildup of cholesterol in our arteries, which can lead to plaque build-ups and potentially cause blockages, which can eventually cause a heart attack or a stroke. HDL or high-density lipoprotein is good for the body because it carries cholesterol from other parts of the body back to the liver which removes the cholesterol from the blood. Triglycerides are also bad for the body; they are a type of fat stored in your body and used for energy. They increase when you consume more calories (especially sugar and fat) than your body needs. High triglyceride levels can contribute to hardening or thickening of the arteries, increasing the risk of stroke, heart attack, and pancreatitis. To check for dyslipidemia, all three types of lipids are tested: if LDL and triglycerides are more than 100 mg/dl and 150 mg/dl respectively and HDL is lower than 40 mg/dl in men and 50 mg/dl in women, it means your body has high cholesterol levels that need to be brought under control. The South Asian problem The South Asian population in general, is more prone to NCDs such as dyslipidemia and diabetes due to a genetic risk, lack of physical activity, and suboptimal dietary habits. Our population tends to have low HDL (good cholesterol) levels, which puts it at a markedly increased risk for heart disease. HDL is even more important than LDL. Low HDL is three times more common than high LDL in patients with premature heart disease. Thus, there is an urgent need to lower LDL levels and increase HDL levels to protect the heart from diseases, and the best way to do this is through a good diet and active lifestyle. Those with dyslipidemia and increased LDL levels (bad cholesterol) should restrict saturated fat to less than 7% of their total calorie count and cholesterol intake to less than 200 mg/day. They should add more fibre through dietary strategies such as increasing oats or psyllium, as well as fruits and vegetables. This can help decrease bad cholesterol. Indian foods such as rice, puri, naan, white bread and fried items are all high in non-saturated fats and can hike triglyceride levels. Combating obesity Obesity is strongly linked to dyslipidemia and weight management is an essential part of the recovery plan to lower lipid levels. Physical exercise for at least 45 minutes a day, five days a week is a must. For those who are not able to control their cholesterol levels with lifestyle changes such as diet and exercise, effective prescription medications are available and should be strictly adhered to. Discipline can help us avert a health crisis at the national level. (Dr. S. Sadhanandham is consultant & interventional cardiologist, professor - cardiology, Sri Ramachandra Institute of Higher Education and Research, Chennai. cardiosadha@
