Skip to main content
Top
Published in: BMC Infectious Diseases 1/2017

Open Access 01-12-2017 | Study protocol

Efficacy of ultra-short course chemotherapy for new smear positive drug susceptible pulmonary tuberculosis: study protocol of a multicenter randomized controlled clinical trial

Authors: Mengqiu Gao, Jingtao Gao, Jian Du, Yuhong Liu, Yao Zhang, Liping Ma, Fengling Mi, Liang Li, Shenjie Tang, on behalf of the Trial Team

Published in: BMC Infectious Diseases | Issue 1/2017

Login to get access

Abstract

Background

Shortening the standard 6-month treatment for drug-susceptible pulmonary tuberculosis (DS-PTB) would be a major improvement for TB case management and disease control.

Methods

We are conducting a randomized, open-label, controlled, non-inferiority trial involving patients with smear-positive, newly diagnosed DS-PTB cases nationwide to assess the efficacy and safety of two 4.5- month regimens in comparison to the standard 6-month WHO recommended regimen. The regimen used in one experiment group is a 4.5-month fluoroquinolone-containing regimen, which consists of full course of levofloxacin, isoniazid (H), rifampin (R), parazinamid (Z) and ethambutol (E). Regimen used in the second experiment group includes 4.5-month full course of H, R, Z, E with levofloxacin removed. Patients in the control group, receive H, R, Z and E for 2 months, followed by 4 months of H and R. The primary endpoint is treatment failure or relapse within 24 month after treatment completion.

Discussion

Results from this trial along with other studies will contribute to the science of constructing a shorter, effective and safe regiment for TB patients.

Trial registration

The protocol has been registered on ClinicalTrials.gov on 2 September,2016 with identifier NCT02901288.
Literature
1.
go back to reference World Health Organization. Global tuberculosis report 2016. Geneva: WHO; 2016. WHO/HTM/TB/2016.13 World Health Organization. Global tuberculosis report 2016. Geneva: WHO; 2016. WHO/HTM/TB/2016.13
2.
go back to reference Tiemersma EW, van der Werf MJ, Borgdorff MW, Williams BG, Nagelkerke NJ. Natural history of tuberculosis: duration and fatality of untreated pulmonary tuberculosis in HIV negative patients: a systematic review. PLoS One. 2011;6(4):e17601.CrossRefPubMedPubMedCentral Tiemersma EW, van der Werf MJ, Borgdorff MW, Williams BG, Nagelkerke NJ. Natural history of tuberculosis: duration and fatality of untreated pulmonary tuberculosis in HIV negative patients: a systematic review. PLoS One. 2011;6(4):e17601.CrossRefPubMedPubMedCentral
3.
go back to reference Peloquin CA, Hadad DJ, Molino LP, Palaci M, Boom WH, Dietze R, et al. Population pharmacokinetics of levofloxacin, gatifloxacin, and moxifloxacin in adults with pulmonary tuberculosis. Antimicrob Agents Chemother. 2008;52(3):852–7.CrossRefPubMed Peloquin CA, Hadad DJ, Molino LP, Palaci M, Boom WH, Dietze R, et al. Population pharmacokinetics of levofloxacin, gatifloxacin, and moxifloxacin in adults with pulmonary tuberculosis. Antimicrob Agents Chemother. 2008;52(3):852–7.CrossRefPubMed
4.
go back to reference Drlica K, Malik M, Kerns RJ, Zhao X. Quinolone-mediated bacterial death. Antimicrob Agents Chemother. 2008;52(2):385–92.CrossRefPubMed Drlica K, Malik M, Kerns RJ, Zhao X. Quinolone-mediated bacterial death. Antimicrob Agents Chemother. 2008;52(2):385–92.CrossRefPubMed
5.
go back to reference Johnson JL, Hadad DJ, Boom WH, Daley CL, Peloguin CA, Elsenach KD, et al. Early and extended early bactericidal activity of levofloxacin, gatifloxacin and moxifloxacin in pulmonary tuberculosis. Int J Tuberc Lung Dis. 2006;10(6):605–12.PubMed Johnson JL, Hadad DJ, Boom WH, Daley CL, Peloguin CA, Elsenach KD, et al. Early and extended early bactericidal activity of levofloxacin, gatifloxacin and moxifloxacin in pulmonary tuberculosis. Int J Tuberc Lung Dis. 2006;10(6):605–12.PubMed
6.
go back to reference Rodriguez JC, Ruiz M, Lopez M, Royo G. In vitro activity of moxifloxacin, levofloxacin, gatifloxacin and linezolid against Mycobacterium tuberculosis. Int J Antimicrob Agents. 2002;20(6):464–7.CrossRefPubMed Rodriguez JC, Ruiz M, Lopez M, Royo G. In vitro activity of moxifloxacin, levofloxacin, gatifloxacin and linezolid against Mycobacterium tuberculosis. Int J Antimicrob Agents. 2002;20(6):464–7.CrossRefPubMed
7.
go back to reference Gillespie SH, Crook AM, McHugh TD, Mendel CM, Meredith SK, Murray SR, et al. Four-month moxifloxacin-based regimens for drug-sensitive tuberculosis. N Engl J Med. 2014;371(17):1577–87.CrossRefPubMedPubMedCentral Gillespie SH, Crook AM, McHugh TD, Mendel CM, Meredith SK, Murray SR, et al. Four-month moxifloxacin-based regimens for drug-sensitive tuberculosis. N Engl J Med. 2014;371(17):1577–87.CrossRefPubMedPubMedCentral
8.
go back to reference Merle CS, Fielding K, Sow OB, Gninafon M, Lo MB, Mthiyane T, et al. A four-month gatifloxacin-containing regimen for treating tuberculosis. N Engl J Med. 2014;371(17):1588–98.CrossRefPubMed Merle CS, Fielding K, Sow OB, Gninafon M, Lo MB, Mthiyane T, et al. A four-month gatifloxacin-containing regimen for treating tuberculosis. N Engl J Med. 2014;371(17):1588–98.CrossRefPubMed
9.
go back to reference Jindani A, Harrison TS, Nunn AJ, Phillips PP, Churchyard GJ, Charalambous S, et al. High-dose rifapentine with moxifloxacin for pulmonary tuberculosis. N Engl J Med. 2014;371(17):1599–608.CrossRefPubMedPubMedCentral Jindani A, Harrison TS, Nunn AJ, Phillips PP, Churchyard GJ, Charalambous S, et al. High-dose rifapentine with moxifloxacin for pulmonary tuberculosis. N Engl J Med. 2014;371(17):1599–608.CrossRefPubMedPubMedCentral
10.
go back to reference Takiff H, Guerrero E. Current prospects for the fluoroquinolones as first-line tuberculosis therapy. Antimicrob Agents Chemother. 2011;55(12):5421–9.CrossRefPubMedPubMedCentral Takiff H, Guerrero E. Current prospects for the fluoroquinolones as first-line tuberculosis therapy. Antimicrob Agents Chemother. 2011;55(12):5421–9.CrossRefPubMedPubMedCentral
11.
go back to reference Rustomjee R, Lienhardt C, Kanyok T, Davies GR, Levin J, Mthiyane T, et al. A phase II study of the sterilising activities of ofloxacin, gatifloxacin and moxifloxacin in pulmonary tuberculosis. Int J Tuberc Lung Dis. 2008;12(2):128–38.PubMed Rustomjee R, Lienhardt C, Kanyok T, Davies GR, Levin J, Mthiyane T, et al. A phase II study of the sterilising activities of ofloxacin, gatifloxacin and moxifloxacin in pulmonary tuberculosis. Int J Tuberc Lung Dis. 2008;12(2):128–38.PubMed
12.
go back to reference Shi W, Zhang X, Jiang X, Yuan H, Lee JS, Barry CE 3rd, et al. Pyrazinamade inhibits trans-translation in Mycobacterium tuberculosis. Science. 2011;333(6049):1630–2.CrossRefPubMedPubMedCentral Shi W, Zhang X, Jiang X, Yuan H, Lee JS, Barry CE 3rd, et al. Pyrazinamade inhibits trans-translation in Mycobacterium tuberculosis. Science. 2011;333(6049):1630–2.CrossRefPubMedPubMedCentral
13.
go back to reference Fox W, Ellard GA, Mitchison DA. Studies on the treatment of tuberculosis undertaken by the British Medical Research Council tuberculosis units, 1946–1986, with relevant subsequent publications. Int J Tuberc Lung Dis. 1999;3(10):S231–79.PubMed Fox W, Ellard GA, Mitchison DA. Studies on the treatment of tuberculosis undertaken by the British Medical Research Council tuberculosis units, 1946–1986, with relevant subsequent publications. Int J Tuberc Lung Dis. 1999;3(10):S231–79.PubMed
14.
go back to reference Nunn AJ, Rusen ID, Van Deun A, Torrea G, Phillips PP, Chiang CY, et al. Evaluation of a standardized treatment regimen of anti-tuberculosis drugs for patients with multi-drug-resistant tuberculosis (STREAM): study protocol for a randomized controlled trial. Trials. 2014;15:353.CrossRefPubMedPubMedCentral Nunn AJ, Rusen ID, Van Deun A, Torrea G, Phillips PP, Chiang CY, et al. Evaluation of a standardized treatment regimen of anti-tuberculosis drugs for patients with multi-drug-resistant tuberculosis (STREAM): study protocol for a randomized controlled trial. Trials. 2014;15:353.CrossRefPubMedPubMedCentral
15.
go back to reference Van Denu A, Maug AK, Salim MA, Das PK, Sarker MR, Daru P, et al. Short, highly effective, and inexpensive standardized treatment of multidrug-resistant tuberculosis. Am J Respir Crit Care Med. 2010;182(5):684–92.CrossRef Van Denu A, Maug AK, Salim MA, Das PK, Sarker MR, Daru P, et al. Short, highly effective, and inexpensive standardized treatment of multidrug-resistant tuberculosis. Am J Respir Crit Care Med. 2010;182(5):684–92.CrossRef
16.
go back to reference Aung KJ, Van Deun A, Declercq E, Sarker MR, Das PK, Hossain MA, et al. Successful “9-month Bangladesh regimen” for multidrug-resistant tuberculosis among over 500 consecutive patients. Int J Tuberc Lung Dis. 2014;18(10):1180–7.CrossRefPubMed Aung KJ, Van Deun A, Declercq E, Sarker MR, Das PK, Hossain MA, et al. Successful “9-month Bangladesh regimen” for multidrug-resistant tuberculosis among over 500 consecutive patients. Int J Tuberc Lung Dis. 2014;18(10):1180–7.CrossRefPubMed
17.
go back to reference East African/British Medical Research Council. Controlled clinical trial of short-course (6-month) regimens of chemotherapy for treatment of pulmonary tuberculosis. Lancet. 1972;1(7760):1079–85. East African/British Medical Research Council. Controlled clinical trial of short-course (6-month) regimens of chemotherapy for treatment of pulmonary tuberculosis. Lancet. 1972;1(7760):1079–85.
18.
go back to reference East African/British Medical Research Council. Controlled clinical trial of four short-course (6-month) regimens of chemotherapy for the treatment of pulmonary tuberculosis. Lancet. 1974;2(7889):1100–6. East African/British Medical Research Council. Controlled clinical trial of four short-course (6-month) regimens of chemotherapy for the treatment of pulmonary tuberculosis. Lancet. 1974;2(7889):1100–6.
19.
go back to reference East African/British Medical Research Council. Results at 5 years of a controlled comparison of a 6-month and a standard 18-month regimen of chemotherapy for pulmonary tuberculosis. Am Rev Respir Dis. 1977;116(1):3–8. East African/British Medical Research Council. Results at 5 years of a controlled comparison of a 6-month and a standard 18-month regimen of chemotherapy for pulmonary tuberculosis. Am Rev Respir Dis. 1977;116(1):3–8.
20.
go back to reference East African/British Medical Research Council. Controlled clinical trial of four short-course regimens of chemotherapy for two durations in the treatment of pulmonary tuberculosis. First report. Am Rev Respir Dis. 1978;118(1):39–48. East African/British Medical Research Council. Controlled clinical trial of four short-course regimens of chemotherapy for two durations in the treatment of pulmonary tuberculosis. First report. Am Rev Respir Dis. 1978;118(1):39–48.
21.
go back to reference East African/British Medical Research Councils. Controlled clinical trial of five short-course (4-month) chemotherapy regimens in pulmonary tuberculosis: Second report of the 4th study. Am Rev Respir Dis. 1981;123(2):165–70. East African/British Medical Research Councils. Controlled clinical trial of five short-course (4-month) chemotherapy regimens in pulmonary tuberculosis: Second report of the 4th study. Am Rev Respir Dis. 1981;123(2):165–70.
22.
go back to reference East African/British Medical Research Council. Controlled clinical trial of five short-course (4-month) chemotherapy regimens in pulmonary tuberculosis. First report. Lancet. 1978;2(8085):334–8. East African/British Medical Research Council. Controlled clinical trial of five short-course (4-month) chemotherapy regimens in pulmonary tuberculosis. First report. Lancet. 1978;2(8085):334–8.
23.
go back to reference Ginsburg AS, Hooper N, Parrish N, Dooley KE, Doman SE, Booth J, et al. Fluoroquinolone resistance in patients with newly diagnosed tuberculosis. Clin Infect Dis. 2003;37(11):1448–52.CrossRefPubMed Ginsburg AS, Hooper N, Parrish N, Dooley KE, Doman SE, Booth J, et al. Fluoroquinolone resistance in patients with newly diagnosed tuberculosis. Clin Infect Dis. 2003;37(11):1448–52.CrossRefPubMed
24.
go back to reference Park IN, Hong SB, Oh YM, Lim CM, Lee SD, Lew WJ, et al. Impact of short-term exposure to fluoroquinolones on ofloxacin resistance in HIV-negative patients with tuberculosis. Int J Tuberc Lung Dis. 2007;11(3):319–24.PubMed Park IN, Hong SB, Oh YM, Lim CM, Lee SD, Lew WJ, et al. Impact of short-term exposure to fluoroquinolones on ofloxacin resistance in HIV-negative patients with tuberculosis. Int J Tuberc Lung Dis. 2007;11(3):319–24.PubMed
25.
go back to reference Wang JY, Lee LN, Lai HC, Wang SK, Jan IS, Yu CJ, et al. Fluoroquinolone resistance in Mycobacterium tuberculosis isolates: associated genetic mutations and relationship to antimicrobial exposure. J Antimicrob Chemother. 2007;59(5):860–5.CrossRefPubMed Wang JY, Lee LN, Lai HC, Wang SK, Jan IS, Yu CJ, et al. Fluoroquinolone resistance in Mycobacterium tuberculosis isolates: associated genetic mutations and relationship to antimicrobial exposure. J Antimicrob Chemother. 2007;59(5):860–5.CrossRefPubMed
26.
go back to reference Wang JY, Hsueh PR, Jan IS, Lee LN, Liaw YS, Yang PC, et al. Empirical treatment with a fluoroquinolone delays the treatment for tuberculosis and is associated with a poor prognosis in endemic areas. Thorax. 2006;61(10):903–8.CrossRefPubMedPubMedCentral Wang JY, Hsueh PR, Jan IS, Lee LN, Liaw YS, Yang PC, et al. Empirical treatment with a fluoroquinolone delays the treatment for tuberculosis and is associated with a poor prognosis in endemic areas. Thorax. 2006;61(10):903–8.CrossRefPubMedPubMedCentral
27.
go back to reference Wang Y, Xiao DL, Wang WJ, Liu X, Wang LX, Xu SF, et al. The fifth national epidemiological survey across China 2010. Beijing: Press of Military Medical Sciences; 2011. p. 169401. Chinese Wang Y, Xiao DL, Wang WJ, Liu X, Wang LX, Xu SF, et al. The fifth national epidemiological survey across China 2010. Beijing: Press of Military Medical Sciences; 2011. p. 169401. Chinese
Metadata
Title
Efficacy of ultra-short course chemotherapy for new smear positive drug susceptible pulmonary tuberculosis: study protocol of a multicenter randomized controlled clinical trial
Authors
Mengqiu Gao
Jingtao Gao
Jian Du
Yuhong Liu
Yao Zhang
Liping Ma
Fengling Mi
Liang Li
Shenjie Tang
on behalf of the Trial Team
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Infectious Diseases / Issue 1/2017
Electronic ISSN: 1471-2334
DOI
https://doi.org/10.1186/s12879-017-2505-7

Other articles of this Issue 1/2017

BMC Infectious Diseases 1/2017 Go to the issue