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Managing malaria in tuberculosis patients on fluoroquinolone-containing regimens: assessing the risk of QT prolongation.

Research output: Contribution to journalReview article

DOI

Standard

Managing malaria in tuberculosis patients on fluoroquinolone-containing regimens: assessing the risk of QT prolongation. / Singh, Kasha; laurenzi, Martino; Brown, Mike; Gillespie, Stephen Henry.

In: International Journal of Tuberculosis and Lung Disease, Vol. 16, No. 2, 02.2012, p. 144-149.

Research output: Contribution to journalReview article

Harvard

Singh, K, laurenzi, M, Brown, M & Gillespie, SH 2012, 'Managing malaria in tuberculosis patients on fluoroquinolone-containing regimens: assessing the risk of QT prolongation.', International Journal of Tuberculosis and Lung Disease, vol. 16, no. 2, pp. 144-149. https://doi.org/10.5588/ijtld.11.0074

APA

Singh, K., laurenzi, M., Brown, M., & Gillespie, S. H. (2012). Managing malaria in tuberculosis patients on fluoroquinolone-containing regimens: assessing the risk of QT prolongation. International Journal of Tuberculosis and Lung Disease, 16(2), 144-149. https://doi.org/10.5588/ijtld.11.0074

Vancouver

Singh K, laurenzi M, Brown M, Gillespie SH. Managing malaria in tuberculosis patients on fluoroquinolone-containing regimens: assessing the risk of QT prolongation. International Journal of Tuberculosis and Lung Disease. 2012 Feb;16(2):144-149. https://doi.org/10.5588/ijtld.11.0074

Author

Singh, Kasha ; laurenzi, Martino ; Brown, Mike ; Gillespie, Stephen Henry. / Managing malaria in tuberculosis patients on fluoroquinolone-containing regimens: assessing the risk of QT prolongation. In: International Journal of Tuberculosis and Lung Disease. 2012 ; Vol. 16, No. 2. pp. 144-149.

Bibtex - Download

@article{84e9f3226e0c4082afcb92a0de54851e,
title = "Managing malaria in tuberculosis patients on fluoroquinolone-containing regimens: assessing the risk of QT prolongation.",
abstract = "The role of fluoroquinolones (FQs) in the management of drug-susceptible and drug-resistant tuberculosis (TB) is under investigation. They are currently being used off-licence to treat TB patients who develop hepatotoxicity on standard therapy, and in patients with drug-resistant disease. Prolongation of ventricular repolarisation, recorded as lengthening of the QT interval on an electrocardiogram, is a recognised adverse effect associated with FQs. Significant prolongation of the QT interval may precipitate torsades de pointe, a potentially fatal tachyarrhythmia. Currently licensed FQs are considered safe, and there are very few reports of associated arrhythmias, but most labels contraindicate concomitant administration of other agents that prolong QT. In many high TB burden countries, malaria is also endemic. Many antimalarials, and possibly malaria infection itself, may prolong QT; under current licence, co-administration of FQs with these antimalarials is contraindicated due to potential risk of additive QT prolongation. This poses significant challenges in planning future policy on FQ use for first-line anti-tuberculosis treatment; the duration of TB treatment makes concomitant malaria treatment inevitable, and options without FQ contraindications are limited. Furthermore, malaria diagnosis is often poor and access to treatment uncontrolled, with many patients buying 'over-the-counter' and/or 'traditional' remedies; concomitant use with anti-tuberculosis treatment is thus likely to be unregulated. Drug interaction studies are urgently required to assess the safety of managing patients with TB and malaria within endemic, resource-poor settings where programmatic management and low-cost monitoring are essential for effective implementation of public health strategies.",
keywords = "tuberculosis, malaria, qt interval, drug toxicity, clinical trials, therapeutics",
author = "Kasha Singh and Martino laurenzi and Mike Brown and Gillespie, {Stephen Henry}",
note = "The first review that links the risk of fluroquinolones in the treatment of tuberculosis and concomittant antimalarials providing practical advice to manage the challenge.",
year = "2012",
month = "2",
doi = "10.5588/ijtld.11.0074",
language = "English",
volume = "16",
pages = "144--149",
journal = "International Journal of Tuberculosis and Lung Disease",
issn = "1027-3719",
publisher = "International Union against Tubercul. and Lung Dis.",
number = "2",

}

RIS (suitable for import to EndNote) - Download

TY - JOUR

T1 - Managing malaria in tuberculosis patients on fluoroquinolone-containing regimens: assessing the risk of QT prolongation.

AU - Singh, Kasha

AU - laurenzi, Martino

AU - Brown, Mike

AU - Gillespie, Stephen Henry

N1 - The first review that links the risk of fluroquinolones in the treatment of tuberculosis and concomittant antimalarials providing practical advice to manage the challenge.

PY - 2012/2

Y1 - 2012/2

N2 - The role of fluoroquinolones (FQs) in the management of drug-susceptible and drug-resistant tuberculosis (TB) is under investigation. They are currently being used off-licence to treat TB patients who develop hepatotoxicity on standard therapy, and in patients with drug-resistant disease. Prolongation of ventricular repolarisation, recorded as lengthening of the QT interval on an electrocardiogram, is a recognised adverse effect associated with FQs. Significant prolongation of the QT interval may precipitate torsades de pointe, a potentially fatal tachyarrhythmia. Currently licensed FQs are considered safe, and there are very few reports of associated arrhythmias, but most labels contraindicate concomitant administration of other agents that prolong QT. In many high TB burden countries, malaria is also endemic. Many antimalarials, and possibly malaria infection itself, may prolong QT; under current licence, co-administration of FQs with these antimalarials is contraindicated due to potential risk of additive QT prolongation. This poses significant challenges in planning future policy on FQ use for first-line anti-tuberculosis treatment; the duration of TB treatment makes concomitant malaria treatment inevitable, and options without FQ contraindications are limited. Furthermore, malaria diagnosis is often poor and access to treatment uncontrolled, with many patients buying 'over-the-counter' and/or 'traditional' remedies; concomitant use with anti-tuberculosis treatment is thus likely to be unregulated. Drug interaction studies are urgently required to assess the safety of managing patients with TB and malaria within endemic, resource-poor settings where programmatic management and low-cost monitoring are essential for effective implementation of public health strategies.

AB - The role of fluoroquinolones (FQs) in the management of drug-susceptible and drug-resistant tuberculosis (TB) is under investigation. They are currently being used off-licence to treat TB patients who develop hepatotoxicity on standard therapy, and in patients with drug-resistant disease. Prolongation of ventricular repolarisation, recorded as lengthening of the QT interval on an electrocardiogram, is a recognised adverse effect associated with FQs. Significant prolongation of the QT interval may precipitate torsades de pointe, a potentially fatal tachyarrhythmia. Currently licensed FQs are considered safe, and there are very few reports of associated arrhythmias, but most labels contraindicate concomitant administration of other agents that prolong QT. In many high TB burden countries, malaria is also endemic. Many antimalarials, and possibly malaria infection itself, may prolong QT; under current licence, co-administration of FQs with these antimalarials is contraindicated due to potential risk of additive QT prolongation. This poses significant challenges in planning future policy on FQ use for first-line anti-tuberculosis treatment; the duration of TB treatment makes concomitant malaria treatment inevitable, and options without FQ contraindications are limited. Furthermore, malaria diagnosis is often poor and access to treatment uncontrolled, with many patients buying 'over-the-counter' and/or 'traditional' remedies; concomitant use with anti-tuberculosis treatment is thus likely to be unregulated. Drug interaction studies are urgently required to assess the safety of managing patients with TB and malaria within endemic, resource-poor settings where programmatic management and low-cost monitoring are essential for effective implementation of public health strategies.

KW - tuberculosis

KW - malaria

KW - qt interval

KW - drug toxicity

KW - clinical trials

KW - therapeutics

U2 - 10.5588/ijtld.11.0074

DO - 10.5588/ijtld.11.0074

M3 - Review article

VL - 16

SP - 144

EP - 149

JO - International Journal of Tuberculosis and Lung Disease

JF - International Journal of Tuberculosis and Lung Disease

SN - 1027-3719

IS - 2

ER -

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ID: 16659079

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