title: Early Therapeutic Drug Monitoring for Isoniazid and Rifampin among Diabetics with Newly Diagnosed Tuberculosis in Virginia, USA.
abstract: Slow responders to tuberculosis (TB) treatment in Virginia have prolonged treatment duration and consume more programmatic resources. Diabetes is an independent risk factor for slow response and low serum anti-TB drug concentrations. Thus, a statewide initiative of early therapeutic drug monitoring (TDM) for isoniazid and rifampin at 2 weeks after TB treatment was piloted for all diabetics with newly diagnosed TB. During the period of early TDM, 12/01/2011-12/31/2012, 21 diabetics had C 2 hr concentrations performed and 16 (76%) had a value below the expected range for isoniazid, rifampin, or both. Fifteen had follow-up concentrations after dose adjustment and 12 (80%) increased to within the expected range (including all for rifampin). Of 16 diabetic patients with pulmonary TB that had early TDM, 14 (88%) converted their sputum culture to negative in <2 months. Early TDM for diabetics was operationally feasible, may speed response to TB therapy, and can be considered for TB programs with high diabetes prevalence.
authors.affiliation: Division of Infectious Diseases and International Health, University of Virginia, P.O. Box 801340, Charlottesville, VA 22908-1340, USA.
authors.forename: Scott K
authors.initials: SK
authors.lastname: Heysell
authors.affiliation: Tuberculosis Control and Prevention, Virginia Department of Health, Richmond, VA, USA.
authors.forename: Jane L
authors.initials: JL
authors.lastname: Moore
authors.affiliation: Tuberculosis Control and Prevention, Virginia Department of Health, Richmond, VA, USA.
authors.forename: Debbie
authors.initials: D
authors.lastname: Staley
authors.affiliation: Tuberculosis Control and Prevention, Virginia Department of Health, Richmond, VA, USA.
authors.forename: Denise
authors.initials: D
authors.lastname: Dodge
authors.affiliation: Division of Infectious Diseases and International Health, University of Virginia, P.O. Box 801340, Charlottesville, VA 22908-1340, USA.
authors.forename: Eric R
authors.initials: ER
authors.lastname: Houpt