Abstract
OBJECTIVE:To assess the clinical outcomes of patients prescribed the World Health Organization (WHO) Category II retreatment regimen for tuberculosis (TB).DESIGN:A systematic review of the literature was performed by searching Medscape, Embase and Scopus databases for cohort studies and clinical trials reporting outcomes in adult patients on the Category II retreatment regimen.RESULTS:The proportion of patients successfully completing the retreatment regimen varied from 27% to 92% in the 39 studies included in this review. In only 2/39 (5%) studies was the treatment success rate > 85%. There are very few data concerning outcomes in patients categorised as ‘other’, and outcomes in this subgroup are variable. Of the five studies reporting disaggregated outcomes in human immunodeficiency virus (HIV) positive people, four demonstrated worse outcomes than in HIV-negative people on the retreatment regimen. Only four studies reported disaggregated outcomes in patients with isoniazid (INH) resistance, and treatment success rates varied from 11% to 78%.CONCLUSION:Clinical outcomes on the Category II retreatment regimen are poor across various populations. Improvements in management should consider the holistic treatment of comorbidity and comprehensive approaches to drug resistance in patients with recurrent TB, including a standardised approach for the management of INH resistance in patients who develop recurrent TB in settings without reliable access to comprehensive drug susceptibility testing.
Highlights
Positive people, four demonstrated worse outcomes than in human immunodeficiency virus (HIV)-negative people on the retreatment regimen
We performed a protocol-driven systematic review of the literature7 to examine clinical outcomes on a TB retreatment regimen in both microbiologically confirmed and unconfirmed cases, including those registered as ‘other.’ We examined outcomes in different groups of patients to consider possible factors that may be associated with the poor outcomes seen in patients with recurrent TB
Summary measures and synthesis of results The specific endpoint of interest was the proportion of patients in whom an outcome of ‘treatment success’ was recorded
Summary
Positive people, four demonstrated worse outcomes than in HIV-negative people on the retreatment regimen. Four studies reported disaggregated outcomes in patients with isoniazid (INH) resistance, and treatment success rates varied from 11% to 78%. CONCLUSION : Clinical outcomes on the Category II retreatment regimen are poor across various populations. Improvements in management should consider the holistic treatment of comorbidity and comprehensive approaches to drug resistance in patients with recurrent TB, including a standardised approach for the management of INH resistance in patients who develop recurrent TB in settings without reliable access to comprehensive drug susceptibility testing. KEYWORDS : relapse; recurrent; streptomycin; cure; isoniazid
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