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Antimicrobial Susceptibility Testing of Mycobacterium Tuberculosis Complex for First and Second Line Drugs by Broth Dilution in a Microtiter Plate Format
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How can oral second-line anti-tuberculosis medications be administered to an extremely preterm neonate?

Tien Thuy Ngo1, Charis Lau2

  • 1Pharmacy Department, Sunshine Hospital, St Albans, Victoria, Australia tien.ngo2@wh.org.au.

European Journal of Hospital Pharmacy : Science and Practice
|July 13, 2024
PubMed

Insights

Treating congenital extensively drug-resistant tuberculosis in premature infants is difficult due to dosing and formulation challenges. This case study shows successful treatment using carefully prepared second-line medications.

Area of Science:

  • Neonatal Medicine
  • Infectious Diseases
  • Pharmacology

Background:

  • Congenital extensively drug-resistant tuberculosis (XDR-TB) is a rare and severe condition in newborns.
  • Administering second-line anti-TB drugs to neonates presents significant challenges, including precise dosing and formulation suitability.
  • Limited availability of pediatric formulations and the need for frequent dose adjustments complicate treatment in extremely preterm and low birth weight infants.

Purpose of the Study:

  • To describe the challenges and considerations in treating a neonate with congenital pre-XDR-TB.
  • To report the successful outcome of using second-line anti-TB medications in an extremely premature infant.
  • To highlight the importance of pharmaceutical formulation and extemporaneous compounding for neonatal TB treatment.

Main Methods:

  • A case report of an extremely premature neonate diagnosed with congenital pre-XDR-TB.
  • Procurement of available child-friendly formulations of second-line anti-TB drugs.
  • Extemporaneous compounding of oral suspensions for clofazimine, moxifloxacin, and prothionamide to achieve accurate neonatal dosing.
  • Administration via enteral feeding tube with frequent dose adjustments based on infant's growth.

Main Results:

  • Successful treatment of congenital pre-XDR-TB in an extremely premature neonate.
  • Demonstrated feasibility of administering precise doses of second-line anti-TB drugs through extemporaneous compounding.
  • The infant tolerated the treatment regimen, indicating the safety and efficacy of the approach.

Conclusions:

  • Congenital pre-XDR-TB in extremely premature neonates can be successfully treated with second-line anti-TB medications.
  • Extemporaneous compounding is a crucial method for enabling accurate and safe drug administration in this vulnerable population.
  • Addressing formulation and dosing challenges is essential for improving outcomes in neonatal tuberculosis.

Keywords:
COMMUNICABLE DISEASESDrug Administration RoutesNEONATOLOGYPEDIATRICSPHARMACEUTICAL PREPARATIONSTROPICAL MEDICINE

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