OBJECTIVE/BACKGROUND: Globally, approximately 50% of @entity1 with @entity6371 ( @entity6371 ) experience treatment failure. @entity6371 treatment is hindered by adverse events, @entity137 of the second-line anti- @entity1906 drugs, logistics and costs, especially in low-income countries, and problems with medication adherence. Pharmacokinetic variability is also attributed as one of the reasons contributing to treatment failure. In our reference Tuberculosis Center Beatrixoord (University Medical Center Groningen, Groningen, The Netherlands), we strive to individualize treatment of all @entity6371 @entity1 based on drug-susceptibility testing using minimal inhibitory concentrations and pharmacokinetic parameters. The aim of this work is to give an overview of our efforts to individualize treatment of @entity6371 @entity1 and to provide insights into practical tools that might be implemented in other clinical settings worldwide. METHODS: We critically looked at clinical practice guidelines implemented in our center to give an overview of practically applied tools to individualize treatment of @entity6371 @entity1 . Furthermore, we selected studies carried out in our clinic on treatment individualization of @entity6371 @entity1 and combined their results with recent studies in this area to suggest practical tools for implementation in other clinical settings. RESULTS: We regularly perform therapeutic drug monitoring (TDM) of several second-line anti- @entity1906 drugs, such as @entity4509 , @entity7913 , @entity5136 , and @entity3477 . New analyses of Group D and experimental drugs, such as @entity799 ( @entity207 / @entity206 ), @entity17303 , delamanid, and @entity4581 , have been or are being developed. By implementing TDM methods, variability in pharmacokinetics is often detected and treatment is adjusted, possibly preventing @entity137 in @entity1 with very high drug exposure or treatment failure, or resistance in @entity1 with very low drug exposure. Over the past 10years in the Netherlands, 86% of 104 @entity1 had a successful outcome using a median of six active drugs. Many studies were performed using dried blood spot (DBS) analysis of second-line @entity1906 drugs. These studies may be used to implement TDM worldwide, even in low-income countries. Furthermore, several studies are performed to determine limited sampling strategies (LSSs). By limiting the number samples required for adequate sampling, TDM will become easier to implement. Other examples of LSSs included development of oral fluid sampling methods or development of semiquantitative thin-layer chromatography methods. CONCLUSION: TDM is highly valuable to individualize and optimize treatment of @entity6371 @entity1 . TDM is routinely applied in Tuberculosis Center Beatrixoord, and high success rates for treatment of @entity6371 @entity1 have been achieved. DBS and @entity11542 make implementation of TDM feasible, even in low- and middle-income countries.

Individualized treatment of XXXX using therapeutic drug monitoring.

@entity1 :: ('9606', 'Species') :: ['patients'] @entity6371 :: ('MESH:D018088', 'Disease') :: ['MDR-TB', 'complex MDR-TB', 'multidrug-resistant tuberculosis'] @entity137 :: ('MESH:D064420', 'Disease') :: ['toxicity'] @entity7913 :: ('MESH:D007612', 'Chemical') :: ['kanamycin'] @entity3477 :: ('MESH:C104727', 'Chemical') :: ['moxifloxacin'] @entity799 :: ('MESH:D015662', 'Chemical') :: ['co-trimoxazole'] @entity4581 :: ('MESH:D017291', 'Chemical') :: ['clarithromycin'] @entity4509 :: ('MESH:D000583', 'Chemical') :: ['amikacin'] @entity1906 :: ('MESH:D014390', 'Disease') :: ['TB'] @entity207 :: ('MESH:D013420', 'Chemical') :: ['sulfamethoxazole'] @entity5136 :: ('MESH:C098010', 'Chemical') :: ['linezolid'] @entity11542 :: ('MESH:C535689', 'Disease') :: ['LSS'] @entity206 :: ('MESH:D014295', 'Chemical') :: ['trimethoprim'] @entity17303 :: ('MESH:C493870', 'Chemical') :: ['bedaquiline']
@entity6371 :: (MESH:D018088,Disease) :: ['multidrug-resistant tuberculosis']
