Comprehensive treatment of extensively drug-resistant tuberculosis
Massachusetts Supranational TB Reference Laboratory; Center for Health Policy and Research
Medical Subject Headings
Adult; Ambulatory Care; Antitubercular Agents; Combined Modality Therapy; *Directly Observed Therapy; Drug Therapy, Combination; Extensively Drug-Resistant Tuberculosis; Female; HIV Seronegativity; Humans; Male; Mycobacterium tuberculosis; Peru; Retrospective Studies; Social Support; Sputum; Tuberculosis, Multidrug-Resistant
Health Services Administration | Health Services Research | Public Health
BACKGROUND: Extensively drug-resistant tuberculosis has been reported in 45 countries, including countries with limited resources and a high burden of tuberculosis. We describe the management of extensively drug-resistant tuberculosis and treatment outcomes among patients who were referred for individualized outpatient therapy in Peru.
METHODS: A total of 810 patients were referred for free individualized therapy, including drug treatment, resective surgery, adverse-event management, and nutritional and psychosocial support. We tested isolates from 651 patients for extensively drug-resistant tuberculosis and developed regimens that included five or more drugs to which the infecting isolate was not resistant.
RESULTS: Of the 651 patients tested, 48 (7.4%) had extensively drug-resistant tuberculosis; the remaining 603 patients had multidrug-resistant tuberculosis. The patients with extensively drug-resistant tuberculosis had undergone more treatment than the other patients (mean [+/-SD] number of regimens, 4.2+/-1.9 vs. 3.2+/-1.6; P<0.001) and had isolates that were resistant to more drugs (number of drugs, 8.4+/-1.1 vs. 5.3+/-1.5; P<0.001). None of the patients with extensively drug-resistant tuberculosis were coinfected with the human immunodeficiency virus (HIV). Patients with extensively drug-resistant tuberculosis received daily, supervised therapy with an average of 5.3+/-1.3 drugs, including cycloserine, an injectable drug, and a fluoroquinolone. Twenty-nine of these patients (60.4%) completed treatment or were cured, as compared with 400 patients (66.3%) with multidrug-resistant tuberculosis (P=0.36).
CONCLUSIONS: Extensively drug-resistant tuberculosis can be cured in HIV-negative patients through outpatient treatment, even in those who have received multiple prior courses of therapy for tuberculosis.
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Citation: N Engl J Med. 2008 Aug 7;359(6):563-74. Link to article on publisher's site
Mitnick, Carole D.; Shin, Sonya S.; Seung, Kwonjune J.; Rich, Michael L.; Atwood, Sidney S.; Furin, Jennifer J.; Fitzmaurice, Garrett M.; Alcantara Viru, Felix A.; Appleton, Sasha C.; Bayona, Jaime N.; Bonilla, Cesar S.; Chalco, Katiuska; Choi, Sharon; Franke, Molly F.; Fraser, Hamish S.F.; Guerra, Dalia; Hurtado, Rocio M.; Jazayeri, Darius; Joseph, Keith; Llaro, Karim; Mestanza, Lorena; Mukherjee, Joia S.; Munoz, Maribel; Palacios, Eda; Sanchez, Epifanio; Sloutsky, Alexander; and Becerra, Mercedes C., "Comprehensive treatment of extensively drug-resistant tuberculosis" (2008). Center for Health Policy and Research (CHPR) Publications. Paper 58.