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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 affects half a million people each year. Levofloxacin is advised for preventive treatment based on observational data, however evidence from large scale clinical trial is unavailable. TB CHAMP and V-QUIN, two phase 3 clinical trials have evaluated safety and efficacy of levofloxacin in preventing MDR TB in participants with household exposure to multidrug resistant M. tuberculosis. Levofloxacin was found to reduce the incidence of multidrug-resistance tuberculosis in both the studies but the reduction in incidence was not significant. A meta-analysis of the data from the TB CHAMP and V-QUIN trials has revealed that levofloxacin was associated with a 60% relative reduction in occurrence of tuberculosis in household MDR-TB contacts.){kind=link}