Abstract
Tuberculosis is a leading killer of young adults worldwide and the global scourge of multi-drug resistant tuberculosis is reaching epidemic proportions. It is endemic in most developing countries and resurgent in developed and developing countries with high rates of human immunodeficiency virus infection. This article reviews the current situation in terms of drug delivery approaches for tuberculosis chemotherapy. A number of novel implant-, microparticulate-, and various other carrier-based drug delivery systems incorporating the principal anti-tuberculosis agents have been fabricated that either target the site of tuberculosis infection or reduce the dosing frequency with the aim of improving patient outcomes. These developments in drug delivery represent attractive options with significant merit, however, there is a requisite to manufacture an oral system, which directly addresses issues of unacceptable rifampicin bioavailability in fixed-dose combinations. This is fostered by the need to deliver medications to patients more efficiently and with fewer side effects, especially in developing countries. The fabrication of a polymeric once-daily oral multiparticulate fixed-dose combination of the principal anti-tuberculosis drugs, which attains segregated delivery of rifampicin and isoniazid for improved rifampicin bioavailability, could be a step in the right direction in addressing issues of treatment failure due to patient non-compliance.
Highlights
Tuberculosis (TB), a ubiquitous, highly contagious chronic granulomatous bacterial infection, is still a leading killer of young adults worldwide
TB has returned with a new face and the global scourge of multi-drug resistant TB (MDR TB) is reaching epidemic proportions
With particular reference to Africa, the increase in TB incidence is strongly associated with the prevalence of human immunodeficiency virus (HIV) infection: rates of HIV infection among TB patients are correspondingly high, exceeding 60% in South Africa, Botswana, Zambia, and Zimbabwe [2]
Summary
Tuberculosis (TB), a ubiquitous, highly contagious chronic granulomatous bacterial infection, is still a leading killer of young adults worldwide. Prabakaran [41] developed an osmotically regulated capsular multi-drug oral delivery system comprising asymmetric membrane coating- and dense semipermeable membrane coating-capsular systems for the simultaneous controlled administration of RIF and INH for the treatment of TB This was in an attempt to reduce the problems associated with multidrug therapy. The once daily system is optimal, and could potentially enhance patient compliance In addition to these combinations, the past several years have seen the development of a number of RIF-only controlled release formulations for the improvement of the clinical efficacy of the drug and patient compliance [5362]. Liposomes coated with alveolar macrophage-specific ligands demonstrated preferential accumulation in alveolar macrophages, maintaining high concentrations of RIF in the lungs even after 24 hours In another approach to solve the predicament of poor patient compliance, depot-delivery of anti-TB drugs has been investigated. RIF is known to undergo hydrolysis in acidic medium to the insoluble 3-formyl rifamycin SV
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