Chest
Chronic Tuberculous Empyema with Bronchopleural Fistula Resulting in Treatment Failure and Progressive Drug Resistance
Section snippets
Discussion
Exposure of populations of tubercle bacilli to sublethal concentrations of a drug is a proven means to select for mutant bacilli resistant to that drug.2 Modern drugs such as isoniazid or rifampin, taken in appropriate doses, generally result in tissue concentrations sufficiently high to kill strains of drug-susceptible tubercle bacilli. We report here five patients who acquired drug resistance despite receiving appropriate drug regimens, presumably through the mechanism of partial exclusion of
References (3)
A study of 200 cases of tuberculous pleurisy with effusion
Am Rev Tuberc
(1960)
Cited by (51)
Pleural Tuberculosis
2021, Clinics in Chest MedicineCitation Excerpt :In general, patients with complex effusions, patients with frank TB empyema, and PLHIV who are not on antiretroviral treatment (ART) are likely to need extended anti-TB treatment, although the optimal duration and regimen are not known.32,112 Where the pleura is thickened and diseased, anti-TB drug penetration into the pleural space is variable and may be subtherapeutic.113–116 Although there is a concern that this may drive the emergence of drug resistance, there is very little direct evidence of this as yet.116
Surgery for thoracic tuberculosis
2015, Revue de Pneumologie CliniqueInfections and Diseases of the Lungs, Pleura, and Mediastinum
2012, Pediatric Surgery, 2-Volume Set: Expert Consult - Online and PrintInfections and Diseases of the Lungs, Pleura, and Mediastinum
2012, Pediatric SurgeryDesign, synthesis and antimycobacterial activity of some novel imidazo[1,2-c]pyrimidines
2009, European Journal of Medicinal ChemistryCitation Excerpt :The organism has a long generation time and a capacity for dormancy, when its low metabolic activity makes it a difficult therapeutic target [5–7]. In addition, M. tuberculosis may be located in pulmonary cavities, empyema pus, or solid caseous material, where penetration of antibiotics is difficult or the pH is sufficiently low to inhibit the activity of most antibiotics [8,9]. Although TB can be cured by an optimized regimen comprising of various first line and second line drugs [10,11], the emergence of MDR-TB and extremely drug resistant TB (XDR-TB, first reported in November 2005 [12]) has created new challenges to control and defeat the disease.
Manuscript received July 5; revision accepted November 19.