{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,1]],"date-time":"2025-11-01T13:50:37Z","timestamp":1762005037751,"version":"3.41.0"},"reference-count":49,"publisher":"Oxford University Press (OUP)","issue":"suppl_3","license":[{"start":{"date-parts":[[2018,11,28]],"date-time":"2018-11-28T00:00:00Z","timestamp":1543363200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"Baylor Research Institute"},{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,11,28]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Gatifloxacin is used for the treatment of multidrug-resistant tuberculosis (MDR-TB). The optimal dose is unknown.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We performed a 28-day gatifloxacin hollow-fiber system model of tuberculosis (HFS-TB) study in order to identify the target exposures associated with optimal kill rates and resistance suppression. Monte Carlo experiments (MCE) were used to identify the dose that would achieve the target exposure in 10000 adult patients with meningeal or pulmonary MDR-TB. The optimal doses identified were validated using probit analyses of clinical data from 2 prospective clinical trials of patients with pulmonary and meningeal tuberculosis. Classification and regression-tree (CART) analyses were used to identify the gatifloxacin minimum inhibitory concentration (MIC) below which patients failed or relapsed on combination therapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The target exposure associated with optimal microbial kill rates and resistance suppression in the HFS-TB was a 0\u201324 hour area under the concentration-time curve-to-MIC of 184. MCE identified an optimal gatifloxacin dose of 800 mg\/day for pulmonary and 1200 mg\/day for meningeal MDR-TB, and a clinical susceptibility breakpoint of MIC \u2264 0.5 mg\/L. In clinical trials, CART identified that 79% patients failed therapy if MIC was &amp;gt;2 mg\/L, but 98% were cured if MIC was \u22640.5 mg\/L. Probit analysis of clinical data demonstrated a &amp;gt;90% probability of a cure in patients if treated with 800 mg\/day for pulmonary tuberculosis and 1200 mg\/day for meningeal tuberculosis. Doses \u2264400 mg\/day were suboptimal.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Gatifloxacin doses of 800 mg\/day and 1200 mg\/day are recommended for pulmonary and meningeal MDR-TB treatment, respectively. Gatifloxacin has a susceptible dose-dependent zone at MICs 0.5\u20132 mg\/L.<\/jats:p><\/jats:sec>","DOI":"10.1093\/cid\/ciy618","type":"journal-article","created":{"date-parts":[[2018,7,30]],"date-time":"2018-07-30T19:20:38Z","timestamp":1532978438000},"page":"S274-S283","source":"Crossref","is-referenced-by-count":19,"title":["Gatifloxacin Pharmacokinetics\/Pharmacodynamics\u2013based Optimal Dosing for Pulmonary and Meningeal Multidrug-resistant Tuberculosis"],"prefix":"10.1093","volume":"67","author":[{"given":"Devyani","family":"Deshpande","sequence":"first","affiliation":[{"name":"Center for Infectious Diseases Research and Experimental Therapeutics, Baylor Research Institute, Baylor University Medical Center, Dallas, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jotam G","family":"Pasipanodya","sequence":"additional","affiliation":[{"name":"Center for Infectious Diseases Research and Experimental Therapeutics, Baylor Research Institute, Baylor University 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