ʻO ka maʻi maʻi maʻi kūʻokoʻa multidrug (MDR TB) pili i ka hapalua miliona mau kānaka i kēlā me kēia makahiki. Hoʻomaopopo ʻia ʻo Levofloxacin no ka mālama pale ʻana ma muli o ka ʻikepili nānā, akā naʻe, ʻaʻole i loaʻa nā hōʻike mai nā hoʻokolohua lapaʻau nui. ʻO TB CHAMP a me V-QUIN, ua loiloi nā hoʻokolohua lapaʻau ʻelua pae 3 i ka palekana a me ka pono o ka levofloxacin i ka pale ʻana i ka MDR TB i nā poʻe i komo me ka ʻike ʻana i ka home i ka multidrug resistant M. tuberculosis. Ua ʻike ʻia ʻo Levofloxacin e hōʻemi i ka nui o ka maʻi maʻi multidrug-resistance ma nā haʻawina ʻelua akā ʻaʻole i koʻikoʻi ka emi ʻana o ka maʻi. Ua hōʻike ʻia kahi meta-analysis o ka ʻikepili mai ka TB CHAMP a me V-QUIN hoʻāʻo i pili i ka levofloxacin me ka 60% o ka emi ʻana o ka loaʻa ʻana o ka maʻi maʻi maʻi i nā pilina MDR-TB home.
ʻO ka Mycobacterium tuberculosis kū'ē i ka isoniazid a me ka rifampin pili i ka hapalua miliona kānaka i kēlā me kēia makahiki ma ka honua holoʻokoʻa. ʻO ia ke kuleana no ka maʻi maʻi multidrug-resistant (MDR) e hoʻokūkū nei i nā papahana hoʻomalu maʻi maʻi. ʻO ka mea nui, ʻoi aku ka nui o nā keiki liʻiliʻi me ka ʻike ʻana i ka home i ka maʻi maʻi multidrug-resistant (MDR). Ma kahi o 2 miliona mau keiki ma lalo o 15 makahiki i loaʻa i ka maʻi MDR M. tuberculosis.
ʻO Levofloxacin, kahi lāʻau lapaʻau fluoroquinolone ʻekolu o ka hanauna i lawe waha ʻia, ʻo ia kahi ʻāpana o ka mālama maʻamau no ka rifampicin-resistant a i ʻole MDR tuberculosis e aʻo ʻia ma muli o ka ʻikepili nānā no ka mālama pale ʻana ma hope o ka loaʻa ʻana i ka maʻi maʻi multidrug-resistant (MDR), akā naʻe nā hōʻike mai nā hoʻokolohua nui. ʻAʻole i loaʻa i kona pono.
ʻElua mau ho'āʻo hoʻokolohua hoʻokolohua hoʻokolohua 3 nui - TB CHAMP a me V-QUIN i ka palekana a me ka maikaʻi o ka levofloxacin i ka mālama pale ʻana i ka MDR TB ma hope o ka ʻike ʻana i ka maʻi multidrug-resistant. Ua paʻi ʻia nā ʻike a me nā hopena o nā haʻawina ʻelua ma 18 Dekemaba 2024.
ka TB CHAMP (Tuberculosis Child Multidrug-Resistant Preventive Therapy Trial) i loiloi i ka pono a me ka palekana o ka lapaʻau pale me ka levofloxacin i nā keiki a me nā ʻōpio me ka ʻike ʻana o ka hale i ka maʻi maʻi multidrug-resistant. Ua mālama ʻia ma luna o 922 mau keiki a me nā ʻōpio me ka ʻike ʻana i ka home i ka maʻi maʻi multidrug-resistant ma mua o 6 mahina (akā ʻaʻohe hōʻike o ka maʻi maʻi) mai 497 home ma nā wahi he nui ma ʻApelika Hema. Ua loaʻa i ka poʻe i komo ka levofloxacin a i ʻole placebo i kēlā me kēia lā no 24 mau pule. Ua loaʻa iā 453 mau mea komo levofloxacin a ʻo ke koena 469 i hāʻawi ʻia i kahi placebo. Ma ka pule 48, ua ulu ka maʻi maʻi i 5 mau mea komo (1.1%) ma ka hui levofloxacin a ma 12 mau mea komo (2.6%) i ka hui placebo. No laila, ʻo ka mālama ʻana me ka levofloxacin i hōʻemi i ka nui o ka maʻi maʻi i waena o nā keiki a me nā ʻōpio me ka ʻike ʻana o ka home i ka MDR TB akā ʻaʻole i emi iki ka emi ʻana o ka maʻi ma mua o ka placebo.
ʻO ka haʻawina ʻē aʻe (kapa ʻia V-QUIN hoao) ua loiloi i ka maikaʻi a me ka palekana o ka regimen 6-mahina o levofloxacin no ka pale ʻana i ka maʻi maʻi maʻi ma waena o nā pilina o ka hale o nā poʻe me ka rifampicin resistant a multidrug-resistant (MDR) tuberculosis. Ua mālama ʻia kēia hoʻāʻo ʻana ma nā wahi he nui ma Vietnam ma 2041 i hui pū ʻia me nā poʻe me ka rifampicin resistant a i ʻole MDR tuberculosis. Ua loaʻa i ka poʻe i komo i ka maʻi M. tuberculosis akā ʻaʻohe maʻi ikaika a ua hoʻomaka ka mālama ʻana i loko o nā mahina 3 i hala. Ua hoʻokaʻawale ʻia nā mea komo e loaʻa i nā mahina 6 o kēlā me kēia lā levofloxacin a i ʻole placebo. Ua loaʻa i nā poʻe 1023 ka levofloxacin aʻo 1018 nā mea komo placebo. Ma 30 mau mahina, 6 mau mea komo (0.6%) i ka hui levofloxacin i hoʻopaʻa ʻia ma ka bacteriologically ua loaʻa i ka maʻi maʻi maʻi aʻo 11 mau mea komo (1.1%) i ka hui placebo i hōʻoia ʻia ma ka bacteriologically ua hoʻomohala i ka maʻi maʻi. Eia kekahi, 1 ka mea i komo i ka hui levofloxacin a me 2 i ka hui placebo i ʻike ʻia me ka maʻi maʻi maʻi. No laila, ʻoi aku ka haʻahaʻa o ka maʻi no ka hui levofloxacin ma mua o ka placebo, akā ʻaʻole nui ka ʻokoʻa.
Ua noiʻi nā hoʻokolohua ʻelua i ʻōlelo ʻia ma luna nei i ka maikaʻi a me ka palekana o ka levofloxacin i ka pale ʻana i ka maʻi ma waena o nā poʻe me ka ʻike ʻana i ka home i ka maʻi maʻi multidrug-resistant. I loko o ka TB CHAMP, ʻaʻohe hōʻike o ka poʻe i komo i ka maʻi maʻi, ʻoiai i ka hoʻokolokolo V-QUIN, ua loaʻa i ka poʻe i komo ka maʻi M. tuberculosis akā ʻaʻohe maʻi ikaika. Ma nā hiʻohiʻona ʻelua, ua ʻike ʻia ka levofloxacin e hōʻemi i ka nui o ka maʻi, akā ʻaʻole nui ka emi ʻana.
Eia nō naʻe, ua hōʻike ʻia kahi meta-analysis o ka ʻikepili mai ka TB CHAMP a me V-QUIN hoʻāʻo i pili i ka levofloxacin me ka 60% o ka emi ʻana o ka maʻi maʻi maʻi i nā pilina MDR-TB home.
I Kepakemapa 2024, nā WHO ua ʻōlelo ʻo ia i ka levofloxacin no ka mālama ʻana i ka MDR-TB ma muli o ka loiloi o kēia hōʻike hoʻokolokolo.
Ke loiloi ʻia nei ʻo Delamanid i kahi hoʻokolohua lapaʻau no ka mālama pale ʻana i ka MDR TB. He lāʻau antimicrobial ia e kāohi ai i ka synthesis o ka paia cell mycobacterial a ua ʻae ʻia no ka mālama ʻana i ka maʻi maʻi multidrug resistant tuberculosis.
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E hoʻomaopopo ':
- Hesseling AC et al 2024. ʻO ka Levofloxacin Preventive Treatment i nā keiki i hōʻike ʻia i ka MDR Tuberculosis. Paʻi ʻia 18 Dekemaba 2024. N Engl J Med 2024;391:2315-2326. Vol. 391 Helu 24. https://www.nejm.org/doi/full/10.1056/NEJMoa2314318
- ʻO Fox GJ, et al 2024. Levofloxacin no ka pale ʻana i ka maʻi maʻi multidrug-resistant ma Vietnam. Hoʻopuka ʻia 18 Dekemaba 2024. N Engl J Med 2024; 391: 2304-2314. Vol. 391 Helu 24. DOI: https://www.nejm.org/doi/full/10.1056/NEJMoa2314325
- Duong T., et al 2024. He Meta-Analysis o Levofloxacin no nā Hoʻopili o Multidrug-Resistant Tuberculosis. Published 18 December 2024. NEJM Hōʻike. DOI: https://evidence.nejm.org/doi/full/10.1056/EVIDoa2400190
- Dorman SE 2024. ʻO Levofloxacin Preventive Therapy no nā poʻe i loaʻa i ka MDR Tuberculosis. Hoʻopuka ʻia 18 Dekemaba 2024. N Engl J Med 2024; 391:2376-2378. Vol. 391 Helu 24. https://www.nejm.org/doi/full/10.1056/NEJMe2413531
- MRC-UCL. ʻIke ʻia ka hoʻāʻo ʻana ʻo TB-CHAMP i ka mālama palekana a me ka maikaʻi no ka pale ʻana i ka TB multidrug-resistant i nā keiki. 19 Kekemapa 2024. Loaʻa ma https://www.mrcctu.ucl.ac.uk/news/news-stories/2024/december/tb-champ-trial-finds-first-ever-safe-and-effective-treatment-to-prevent-multidrug-resistant-tb-in-children/
- WHO. Hōʻuluʻulu manaʻo o TB CHAMP a me V-QUIN hoʻokolohua hoʻokolohua. https://tbksp.who.int/en/node/2745
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