The Role of Pyridoxine in the Prevention and Treatment of Neuropathy and Neurotoxicity Associated with Rifampicin-Resistant Tuberculosis Treatment Regimens: A Topic Review

Rifampicin-resistant tuberculosis (RR-TB) is a global public health problem caused by mycobacterium tuberculosis resistant to Rifampicin. Drug-induced peripheral neuropathy and neurotoxicity are well-known adverse effects of treatment regimens that cause significant morbidity. Pyridoxine is often added to treatment regimens for the prevention and/or treatment of these side effects. The basis and effectiveness of this practice are unclear. We conducted a systematic review to evaluate the effectiveness of pyridoxine in preventing and/or treating neuropathy and neurotoxicity associated with RR-TB treatment. We included studies with patients with RR-TB who experienced neuropathy or neurotoxicity attributed to RR-TB regimens and were given pyridoxine. Our findings showed contradicting evidence on the use of pyridoxine for preventing or treating neurotoxicity due to cycloserine in the treatment of RR-TB. Moreover, pyridoxine did not have a protective effect against neuropathy and/or neurotoxicity caused by other RR-TB regimens that do not contain isoniazid. In conclusion, we found that withdrawing or withholding medications such as linezolid, cycloserine, thioamides, fluoroquinolones, and ethambutol, implicated in causing neuropathy or neurotoxicity was more effective than using pyridoxine to stop the progression of symptoms, and in some instances, led to their reversal over time.

Characteristics of rifampicin-resistant tuberculosis detection in China,2015–2019

Background The very high burden of rifampicin resistance tuberculosis(RR-TB)and the very low detection of RR-TB cases are a major challenge that China has been facing.This study analyzed the characteristics of RR-TB detection in China after the change of RR-TB detection strategy since 2015,aiming to provide reference and evidence for the development of more precise national drug resistance tuberculosis prevention and control policy.Methods We extracted data related to rifampicin resistance screening from the national Tuberculosis Information Management System(TBIMS)from 2015 to 2019,and used descriptive research methods to analyze the screening rate of presumptive RR-TB,the number and duration of RR-TB patients detected and drug resistance testing methods in each year.Chi-square test was used to compare the differences in component ratio or rate between years,and Kruskal Wallis test was used to compare the differences in median days for detection of RR-TB patients in each year.Results A total of 68,200 RR-TB cases were detected during 2015–2019,of which 48.1%were new cases.The number and detection rate of RR-TB cases increased year by year,from 10019 and 14.3%in 2015 to 18623 and 28.7%in 2019,respectively.Of the bacteriologically confirmed TB cases,81.9%were tested for RR in 2019,a considerable increase from 29.5%in 2015.In 2019,only 41.0%of RR-TB cases had fluoroquinolones(FQs)susceptibility testing performed,and this proportion has been declining year by year since 2016.The proportion of application of rapid molecular tools increased from 24.0%in 2015 to 67.1%in 2019,and the median days to obtain RR results was significantly shortened.In 2019,76.0%of RR-TB cases were diagnosed as presumptive RR-TB in county-level hospitals.Conclusions After China modified the RR-TB detection strategy,the screening rate of RR and the number of RR-TB cases increased significantly.The RR testing methods now predominantly utilize rapid molecular tools.However,comprehensive measures should be implemented to close the gap in the detection of RR-TB cases.It is imperative to take FQs susceptibility testing seriously and effectively strengthen the laboratory capacity of county-level hospitals.