title: Inadequate therapeutic response to a recommended antituberculosis fixed-dose combination regimen in an overweight patient with Mycobacterium bovis infection.
abstract: OBJECTIVE
  To report a case of an overweight man with lymph node tuberculosis due to Mycobacterium bovis, a part of the Mycobacterium tuberculosis complex, treated with fixed-dose combination (FDC) chemotherapy.
  
  
  METHODS
  Following guidelines, according to the patient's weight (92 kg), we prescribed the maximum recommended doses of isoniazid-rifampin-pyrazinamide FDC. It led initially to underdosing, with a poor clinical outcome, justifying increased doses and a complex regimen using separate drugs (isoniazid 600 mg, rifampin 1200 mg, and levofloxacin 1000 mg) to achieve therapeutic drug concentrations and clinical response.
  
  
  CONCLUSIONS
  Usually recommended doses of FDC chemotherapies may be inappropriate in overweight patients. We discuss here the different factors that may be involved in poor clinical outcomes, particularly the consequences of excess weight on drug metabolism: drug-drug interaction, FDC use, generic formulation use, intestinal malabsorption, and acetylation profile.
  
  
  CONCLUSIONS
  Therapeutic drug monitoring in overweight patients may be useful in the clinical setting to help clinicians individualize drug therapeutic regimens and optimize drug response, adherence, and safety.
authors: Department of Internal Medicine A, Lariboisière Hospital, Paris,  France.
authors: Célia
authors: C
authors: Lloret-Linares
authors: Stéphane
authors: S
authors: Mouly
authors: Dan-Tranh
authors: DT
authors: Hoang-Nguyen
authors: John
authors: J
authors: Evans
authors: Laurent
authors: L
authors: Raskine
authors: Amanda
authors: A
authors: Lopes
authors: Emmanuelle
authors: E
authors: Cambau
authors: Jean-François
authors: JF
authors: Bergmann
authors: Pierre
authors: P
authors: Sellier
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D004338:Drug Combinations; D016903:Drug Monitoring; D004359:Drug Therapy, Combination; D006801:Humans; D007538:Isoniazid / Q000008:administration & dosage / Q000627:therapeutic use; D064704:Levofloxacin; D008297:Male; D009163:Mycobacterium bovis / Q000302:isolation & purification*; D015242:Ofloxacin / Q000008:administration & dosage / Q000627:therapeutic use; D050177:Overweight; D017410:Practice Guidelines as Topic; D011718:Pyrazinamide / Q000008:administration & dosage / Q000627:therapeutic use; D012293:Rifampin / Q000008:administration & dosage / Q000627:therapeutic use; D016896:Treatment Outcome; D014388:Tuberculosis, Lymph Node / Q000188:drug therapy* / Q000382:microbiology
chemical_list: D000995:Antitubercular Agents; D004338:Drug Combinations; D011718:Pyrazinamide; D064704:Levofloxacin; D015242:Ofloxacin; D007538:Isoniazid; D012293:Rifampin