Influence of Malnutrition on the Pharmacokinetics of Drugs Used in the Treatment of Poverty-Related Diseases: A Systematic Review

  title={Influence of Malnutrition on the Pharmacokinetics of Drugs Used in the Treatment of Poverty-Related Diseases: A Systematic Review},
  author={Luka Verrest and Erica A. Wilthagen and Jos H. Beijnen and Alwin D. R. Huitema and Thomas P. C. Dorlo},
  journal={Clinical Pharmacokinetics},
  pages={1149 - 1169}
Patients affected by poverty-related infectious diseases (PRDs) are disproportionally affected by malnutrition. To optimize treatment of patients affected by PRDs, we aimed to assess the influence of malnutrition associated with PRDs on drug pharmacokinetics, by way of a systematic review. A systematic review was performed on the effects of malnourishment on the pharmacokinetics of drugs to treat PRDs, including HIV, tuberculosis, malaria, and neglected tropical diseases. In 21/29 PRD drugs… 
2 Citations

Clinical standards for the dosing and management of TB drugs

  • J. AlffenaarS. Stocker G. Migliori
  • Medicine
    The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease
  • 2022
This is the first consensus-based Clinical Standards for the dosing and management of TB drugs to guide clinicians and programme managers in planning and implementation of locally appropriate measures for optimal person-centred treatment to improve patient care.

Antimalarial treatment in infants.

Additional evidence on the efficacy, safety, tolerability, acceptability and effectiveness of ACTs in infants is needed, as well as population pharmacokinetics studies on antimalarials in the infant population.



Exposure to Total and Protein-Unbound Rifampin Is Not Affected by Malnutrition in Indonesian Tuberculosis Patients

The large interindividual variability in the free fraction of rifampin suggests that protein-unbound rather than total rifampsin concentrations should preferably be used to study exposure-response relationships.

Population Pharmacokinetics of Lopinavir in Severely Malnourished HIV-infected Children and the Effect on Treatment Outcomes

LPV pharmacokinetics was found to be highly variable and bioavailability greatly reduced, resulting in a high CL estimate in this population of severely malnourished HIV-infected children initiating ART.

Metabolism of Quinine in Children with Global Malnutrition

As metabolism of quinine is increased in children with global malnutrition, it is suggested that the administration interval should be reduced in these children to obtain the same plasma concentrations ofQuinine found in normally nurished children.

A systematic review of pharmacokinetics studies in children with protein-energy malnutrition

Considering the proportion of children affected with PEM world-wide, there have been relatively few pharmacokinetic studies of drugs frequently used for their treatment, and more studies are therefore required to establish the appropriate dose and safety of these drugs for PEM children.

Pathophysiological changes that affect drug disposition in protein-energy malnourished children

There are no good indications for drug dosage modification in PEM; but for drug safety purposes, further studies are required to accurately determine dosages of drugs frequently used for children with PEM.

Drug Metabolism and Pharmacokinetics in Malnourished Children

There is at present enough evidence to support monitoring plasma drug concentrations in malnourished children, particularly for those drugs which have dose-dependent kinetics and narrow margins of safety.

The Effect of Malnutrition on the Pharmacokinetics and Virologic Outcomes of Lopinavir, Efavirenz and Nevirapine in Food Insecure HIV-infected Children in Tororo, Uganda

Ugandan children demonstrated lower EFV and LPV and higher NVP exposure compared to children in RRC, perhaps reflecting the consequence of malnutrition on bioavailability, and the relation between exposure, malnutrition and outcome turned out to be marginally significant.

Low Levels of Pyrazinamide and Ethambutol in Children with Tuberculosis and Impact of Age, Nutritional Status, and Human Immunodeficiency Virus Infection

Serum drug levels were low in all children for both pyrazinamide and ethambutol and in almost all cases, the maximum concentration of the drug in serum failed to reach the MIC for Mycobacterium tuberculosis.

Pharmacokinetics of nevirapine in HIV-infected children with and without malnutrition receiving divided adult fixed-dose combination tablets.

The data support the use of bespoke paediatric antiretroviral formulations by comparing the pharmacokinetics of nevirapine in HIV-infected children of different ages with and without malnutrition receiving divided tablets of Triomune 30.

Pharmacokinetics of isoniazid, rifampicin, pyrazinamide and ethambutol in Indian children

The aim of determining the plasma concentrations of isoniazid, rifampicin, pyrazinamide and ethambutol achieved with different dosage of the anti-tubercular drugs so as to provide supportive evidence to the revised dosages and to evaluate the effects of malnutrition on the pharmacokinetics of these drugs in children was successful.