Comprehensive treatment of extensively drug-resistant tuberculosis
Massachusetts Supranational TB Reference Laboratory; Center for Health Policy and Research
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.
DOI of Published Version
N Engl J Med. 2008 Aug 7;359(6):563-74. Link to article on publisher's site
The New England journal of medicine 19051373
Mitnick CD, Shin SS, Seung KJ, Rich ML, Atwood SS, Furin JJ, Fitzmaurice GM, Alcantara Viru FA, Appleton SC, Bayona JN, Bonilla CS, Chalco K, Choi S, Franke MF, Fraser HS, Guerra D, Hurtado RM, Jazayeri D, Joseph K, Llaro K, Mestanza L, Mukherjee JS, Munoz M, Palacios E, Sanchez E, Sloutsky A, Becerra MC. (2008). Comprehensive treatment of extensively drug-resistant tuberculosis. Center for Health Policy and Research (CHPR) Publications. https://doi.org/10.1056/NEJMoa0800106. Retrieved from https://escholarship.umassmed.edu/healthpolicy_pp/58