{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T17:18:10Z","timestamp":1789579090404,"version":"build-2803163510"},"reference-count":27,"publisher":"American Society for Microbiology","issue":"12","license":[{"start":{"date-parts":[[2025,12,2]],"date-time":"2025-12-02T00:00:00Z","timestamp":1764633600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,12,2]],"date-time":"2025-12-02T00:00:00Z","timestamp":1764633600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"funder":[{"name":"Hangzhou Agriculture and Social Development Scientific Research Project","award":["20220919Y034"],"award-info":[{"award-number":["20220919Y034"]}]},{"name":"Hangzhou Biomedicine and Health Industry Development Project","award":["2022WJC116"],"award-info":[{"award-number":["2022WJC116"]}]},{"name":"Hangzhou Pharmaceutical Association Hospital Pharmaceutical Innovation Research Funding Project","award":["2023HZ4617"],"award-info":[{"award-number":["2023HZ4617"]}]},{"name":"Zhejiang Pharmaceutical Association Hospital Pharmacy Special Research Funding Project","award":["2023ZYY29"],"award-info":[{"award-number":["2023ZYY29"]}]},{"name":"Hangzhou Health Science and Technology Project","award":["A20230289"],"award-info":[{"award-number":["A20230289"]}]},{"name":"Hangzhou Health Science and Technology Project","award":["A20250256"],"award-info":[{"award-number":["A20250256"]}]},{"name":"Zhejiang Natural Science Foundation Project","award":["LTGY23H260003"],"award-info":[{"award-number":["LTGY23H260003"]}]},{"name":"Hangzhou Health Science and Technology Project","award":["ZD20220103"],"award-info":[{"award-number":["ZD20220103"]}]}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["Microbiol Spectr"],"published-print":{"date-parts":[[2025,12,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title\/>\n                    <jats:p>\n                      Cycloserine (Cs) is a crucial anti-multidrug-resistant tuberculosis medication with significant clinical efficacy. However, its clinical application is limited by neuropsychiatric-related adverse drug reactions (ADRs). This study retrospectively evaluated the peak plasma concentration (\n                      <jats:italic toggle=\"yes\">C<\/jats:italic>\n                      <jats:sub>max<\/jats:sub>\n                      ) of Cs and Cs-related neuropsychiatric ADRs and analyzed the risk factors of developing neuropsychiatric ADRs. A multivariable ordinal logistic regression model was built to predict the incidence of neuropsychiatric ADRs. This study enrolled a total of 136 participants, with a cumulative incidence of neuropsychiatric ADRs of 12.5%. Patients experiencing ADRs had significantly higher Cs\n                      <jats:italic toggle=\"yes\">C<\/jats:italic>\n                      <jats:sub>max<\/jats:sub>\n                      compared to those without ADRs. The risk of ADRs rose with increasing Cs exposure, especially when\n                      <jats:italic toggle=\"yes\">C<\/jats:italic>\n                      <jats:sub>max<\/jats:sub>\n                      exceeded 30 mg\/L. Receiver operating characteristic analysis demonstrated the strong predictive value of\n                      <jats:italic toggle=\"yes\">C<\/jats:italic>\n                      <jats:sub>max<\/jats:sub>\n                      for neuropsychiatric ADRs. Notably, the predictive efficacy of the logistic regression model significantly improved after incorporating drinking history as a covariate, achieving a final predictive accuracy of 87.6%. Cs\n                      <jats:italic toggle=\"yes\">C<\/jats:italic>\n                      <jats:sub>max<\/jats:sub>\n                      serves as a critical indicator for predicting Cs-related neuropsychiatric ADRs. Dynamic monitoring of Cs\n                      <jats:italic toggle=\"yes\">C<\/jats:italic>\n                      <jats:sub>max<\/jats:sub>\n                      combined with alcohol history assessment can enable accurate identification of high-risk populations for neuropsychiatric ADRs, thereby providing a scientific basis for developing individualized medication regimens and implementation of early interventions.\n                    <\/jats:p>\n                    <jats:sec>\n                      <jats:title>IMPORTANCE<\/jats:title>\n                      <jats:p>\n                        Cycloserine (Cs) is a vital medication for treating multidrug-resistant tuberculosis (MDR-TB), but its use is often limited by severe neuropsychiatric side effects such as depression, anxiety, and seizures. This study highlights the critical role of monitoring Cs peak plasma concentration (\n                        <jats:italic toggle=\"yes\">C<\/jats:italic>\n                        <jats:sub>max<\/jats:sub>\n                        ) to predict and mitigate these adverse reactions. By analyzing data from 136 patients, the researchers found that higher Cs\n                        <jats:italic toggle=\"yes\">C<\/jats:italic>\n                        <jats:sub>max<\/jats:sub>\n                        levels significantly increase the risk of neuropsychiatric toxicity, particularly when concentrations exceed 30 mg\/L. Additionally, a history of alcohol consumption further elevates this risk. These findings provide a practical approach for clinicians: regular monitoring of Cs levels and assessing alcohol use can help identify high-risk patients early, enabling timely adjustments to treatment plans. This work not only enhances patient safety but also supports the broader goal of improving MDR-TB treatment outcomes by minimizing harmful side effects.\n                      <\/jats:p>\n                    <\/jats:sec>\n                  <\/jats:sec>","DOI":"10.1128\/spectrum.01437-25","type":"journal-article","created":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T14:12:16Z","timestamp":1762351936000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":3,"title":["Cycloserine-induced neuropsychiatric toxicity in multidrug-resistant tuberculosis: association with peak plasma concentration"],"prefix":"10.1128","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-6455-975X","authenticated-orcid":true,"given":"Junjie","family":"Cheng","sequence":"first","affiliation":[{"name":"Department of Pharmacy, Zhejiang Hospital of Integrated Traditional Chinese and Western Medicine","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6589-3610","authenticated-orcid":true,"given":"Jinmeng","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Zhejiang Hospital of Integrated Traditional Chinese and Western Medicine","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6928-525X","authenticated-orcid":true,"given":"Ren","family":"Zheng","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Zhejiang Hospital of Integrated Traditional Chinese and Western Medicine","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kan","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Tuberculosis, Zhejiang Hospital of Integrated Traditional Chinese and Western Medicine","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoqing","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Tuberculosis, Zhejiang Hospital of Integrated Traditional Chinese and Western Medicine","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junke","family":"Qiu","sequence":"additional","affiliation":[{"name":"Department of Tuberculosis, Zhejiang Hospital of Integrated Traditional Chinese and Western Medicine","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6695-5051","authenticated-orcid":false,"given":"Ruoying","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Zhejiang Hospital of Integrated Traditional Chinese and Western Medicine","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-1841-6994","authenticated-orcid":true,"given":"Xinjun","family":"Cai","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Zhejiang Hospital of Integrated Traditional Chinese and Western Medicine","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"235","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41572-024-00504-2"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41579-024-01025-1"},{"key":"e_1_3_3_4_2","volume-title":"WHO consolidated guidelines on drug-resistant tuberculosis treatment Geneva","author":"World Health Organization","year":"2019","unstructured":"World Health Organization. 2019. 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