ПРИМЕНЕНИЕ УКОРОЧЕННЫХ РЕЖИМОВ ХИМИОТЕРАПИИ В КОМПЛЕКСНОМ ЛЕЧЕНИИ ТУБЕРКУЛЕЗА С МЛУ/ШЛУ МБТ У ПОДРОСТКОВ

Abstract

We conducted a cohort prospective non-comparative study enrolling 37 pulmonary TB patients with multiple/extensive drug resistance (MDR/XDR) aged 13–17 years in order to improve TB chemotherapy based on shortened regimens. The patients were hospitalized to the Central TB Research Institute in 2017–2021. The indications for shortened chemotherapy regimens were determined based on dynamic observation of TB course (clinical dynamics, sputum conversion, X-ray dynamics) in each patient. Considering the elaborated criteria, shortened chemotherapy regimens were administered in three variants:variant 1 – chemotherapy without surgery, variant 2 – surgery during chemotherapy, variant 3 – MDR/XDR was detected in resection samples. The evaluation of immediate effectiveness of shortened chemotherapy regimens was based on “key points”. For variant 1 the “key points” were: sputum conversion – before 3 months, cavity closure – before 6 months of treatment. For variant 2: sputum conversion – before 3 months, indications for surgery during chemotherapy, lack of exacerbation during 2 months after surgery according to chest CT data. For variant 3 the “key point” was lack of exacerbation during 2 months after surgery according to chest CT data. Eleven out of 27 patients (29.7%) received shortened chemotherapy course as per variant 1, 15 out of 37 patients (40.6%) received treatment as per variant 2, and 11 out of 37 patients (29.7%) received treatment as per variant 3. The ultimate “key point” for treatment effectiveness and safety evaluation for each variant of shortened chemotherapy was lack of relapse according to chest CT data 12 months after treatment completion: 97% of the patients did not develop relapse of pulmonary TB.