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Tuberculosis and trimethoprim-sulfamethoxazole.
Pierre Forgacs1, Nancy L Wengenack, Leslie Hall
1Department of Infectious Diseases and Research, Lahey Clinic, 41 Mall Rd., Burlington, MA 01805, USA. pltcf@verizon.net
Antimicrobial Agents and Chemotherapy
|July 1, 2009
Summary
Trimethoprim-sulfamethoxazole (TMP-SMX) shows high susceptibility in Mycobacterium tuberculosis isolates, challenging previous beliefs. This suggests TMP-SMX could be a valuable treatment option for drug-resistant tuberculosis.
Area of Science:
- Microbiology
- Infectious Diseases
- Pharmacology
Background:
- Sulfonamides were early antitubercular drugs but fell out of favor with streptomycin and isoniazid.
- A common misconception exists that Mycobacterium tuberculosis is resistant to trimethoprim-sulfamethoxazole (TMP-SMX).
- This belief may stem from limited prior testing on suboptimal media.
Purpose of the Study:
- To investigate the susceptibility of Mycobacterium tuberculosis isolates to trimethoprim-sulfamethoxazole (TMP-SMX).
- To re-evaluate the potential of TMP-SMX as a treatment for tuberculosis, particularly drug-resistant forms.
Main Methods:
- Tested 44 Mycobacterium tuberculosis isolates for susceptibility to TMP-SMX.
- Utilized supplemented Middlebrook 7H10 plates for drug susceptibility testing.
- Determined minimum inhibitory concentrations (MICs) for TMP-SMX.
Main Results:
- 98% (43 of 44) of M. tuberculosis isolates were susceptible to TMP-SMX at a concentration of <= 1/19 microg/ml.
- Susceptibility levels were comparable to other mycobacteria successfully treated with TMP-SMX.
- Observed a patient with complex immunocompromised tuberculosis who improved with TMP-SMX monotherapy.
Conclusions:
- The majority of M. tuberculosis isolates demonstrate susceptibility to TMP-SMX.
- TMP-SMX warrants further investigation as a potential therapeutic agent for multidrug-resistant and extensively drug-resistant tuberculosis.
- A clinical trial evaluating TMP-SMX for tuberculosis treatment is recommended.
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