CORRESPONDENCE • CID 2007:45 (15 August) • 521 5. Mandell DL, Wald ER, Michaels MG, Dohar JE. Management of nontuberculous mycobac- terial cervical lymphadenitis. Arch Otolaryngol Head Neck Surg 2003; 129:341–4. 6. Gerrits JA, Wolfs TF, Geelen SP. Threetoddlers with a swelling in the neck [in Dutch]. Ned Tijdschr Geneeskd 2003; 147:225–9. 7. Lindeboom JA, Kuijper EJ, Bruijnesteijn van Coppenraet ES, R. Lindeboom, Prins JM. Sur- gical excision versus antibiotic treatment for nontuberculous mycobacterial cervicofacial lymphadenitis in children: a multicenter, ran- domized, controlled trial. Clin Infect Dis 2007; 44:1057–64. Reprints or correspondence: Dr. Jerome Lindeboom, Dept. of Oral and Maxillofacial Surgery, A1-1, Academic Medical Cen- ter, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ, Netherlands (j.a.lindeboom@amc.uva.nl). Clinical Infectious Diseases 2007; 45:520–1  2007 by the Infectious Diseases Society of America. All rights reserved. 1058-4838/2007/4504-0023$15.00 DOI: 10.1086/521444 Stability of Antituberculosis Drugs Mixed in Food To the Editor—Tablet or capsule ad- ministration is difficult in young children or patients with dysphagia, and most an- tituberculosis drugs are not available in liquid formulations. Pharmacies can pre- pare extemporaneous dosage forms, but stability data are limited for such prepa- rations [1]. Therefore, we tested the sta- bility of tuberculosis drugs in common foods that might be palatable for children. Tablets (or capsules) of isoniazid, rif- ampin, rifapentine, pyrazinamide, etham- butol, ethionamide, and cycloserine were individually crushed (or opened) and transferred to beakers containing 30 g of chocolate pudding (Hunt’s Snackpack, no sugar added), grape jelly (Safeway Con- cord), or peanut butter (Safeway Creamy) or to a beaker containing a 1:1 concen- tration of methanol and water as the con- trol. In addition, isoniazid and rifapentine were tested in 7-Up soda and orange juice. Each drug-food mixture was blended thoroughly. Paired samples for each mix- ture were frozen at 0, 1, 2, and 4 h after preparation. Final dilutions were extracted and assayed according to standard oper- ating procedures at the National Jewish Medical and Research Center (Denver, CO). For each drug, the median percent- age recovery for each pair of samples at each time point was calculated, and the median and range of recovery for all pairs and time points were calculated. Drug sta- bility over time was assessed by plotting median recovery versus time. For all drugs and time points, there was 93% recovery from pudding, 89% re- covery from jelly, and 80% recovery from peanut butter. Recoveries of !90% were seen for pyrazinamide mixed with jelly or peanut butter and for either rif- ampin or ethambutol mixed with peanut butter. Recovery was close to 100% for isoniazid and rifapentine mixed with or- ange juice or 7-Up soda, although isoni- azid recovery was as low as 85% in the latter. Recovery over 4 h trended down- ward for isoniazid, pyrazinamide, and cy- closerine mixed in grape jelly and for pyr- azinamide and rifapentine mixed in peanut butter. In clinical practice, tablets are crushed (or capsules are opened), and their con- tents are mixed with several different types of foods to improve acceptability to se- lected patients. We tested oral antituber- culosis drugs in a variety of mixtures that might be acceptable to children. These tu- berculosis drugs proved to be stable for up to 4 h in sugar-free chocolate pudding and, in most cases, remained stable in the other mixtures tested. These data suggest that mixtures should be administered as soon as possible after preparation to avoid decay. We did not test the oral bioavail- ability of these mixtures in healthy vol- unteers. Our previous studies suggest that high-fat meals reduce the peak concentra- tions and, to a lesser extent, the area under the curve for isoniazid, rifampin, and cy- closerine [2–4]. Because of their lower fat content, the vehicles studied here, with the exception of peanut butter, would not be expected to produce the same reductions in bioavailability. These data suggest that tuberculosis drugs may be mixed in sugar- free chocolate pudding or grape jelly and, if necessary, in peanut butter prior to administration. Acknowledgments Financial support. The Centers for Disease Control and Prevention Tuberculosis Trials Consortium. Potential conflicts of interest. All authors: no conflicts. Charles A. Peloquin, 1,2 David Durbin, 1 James Childs, 1 Timothy R. Sterling, 3 and Marc Weiner 4 1 National Jewish Medical and Research Center and 2 University of Colorado Schools of Pharmacy and Medicine, Denver, Colorado; 3 Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee; and 4 Veteran’s Affairs Medical Center, San Antonio, Texas References 1. Nahata MC, Hipple TF. Pediatric drug for- mulations. Cincinnati, OH: Harvey Whitney Books Company, 2000. 2. Peloquin CA, Namdar R, Dodge AA, Nix DE. Pharmacokinetics of isoniazid under fasting conditions, with food, and with antacids. Int J Tuberc Lung Dis 1999; 3:703–10. 3. Peloquin CA, Namdar R, Singleton MD, Nix DE. Pharmacokinetics of rifampin under fast- ing conditions, with food, and with antacids. Chest 1999; 115:12–8. 4. Zhu M, Nix DE, Adam RD, Childs JM, Pelo- quin CA. Pharmacokinetics of cycloserine un- der fasting conditions, with orange juice, food, and antacids. Pharmacotherapy 2001; 21:891–7. Reprints or correspondence: Dr. Charles Peloquin, Director, Infectious Disease, Pharmacokinetics Lab., Rm. K-424a, Na- tional Jewish Medical and Research Center, 1400 Jackson St., Denver, CO 80206 (peloquinc@njc.org). Clinical Infectious Diseases 2007; 45:521  2007 by the Infectious Diseases Society of America. All rights reserved. 1058-4838/2007/4504-0024$15.00 DOI: 10.1086/521444 Addition of Trimethoprim- Sulfamethoxazole to Ceftazidime during Parenteral Treatment of Melioidosis Is Not Associated with a Long-Term Outcome Benefit To the Editor—In October 2005, we published an article in Clinical Infectious Diseases about the comparative efficacy of ceftazidime alone versus ceftazidime plus trimethoprim-sulfamethoxazole (TMP- SMX) for the treatment of severe melioi- dosis [1]. The primary end point of this meta-analysis of 2 independent prospec- tive randomized trials in Ubon Ratchath- Downloaded from https://academic.oup.com/cid/article/45/4/521/428248 by guest on 24 December 2021