The effectiveness of the main course of chemotherapy for drug-resistant tuberculosis

Abstract

SummaryThe article is devoted to the effectiveness of treatment of tuberculosis with MDR-TB and XDR-TB mycobacteria after the main course of chemotherapy. The treatment of tuberculosis with multiple and broad MD MBT is a com-plex and urgent task. Prescribing the latest generation of drugs (thioureidoiminomethylpyridinium perchlorate, bedaquiline, linezolid) in the complex composition of tu-berculosis therapy with MDR and XDR-MBT significantly increases the effectiveness of the main course of treat-ment, compared with the control group, respectively (85.0% and 65.8%). Мaterials and methods. The main course of chemotherapy was completed by 119 patients with pulmonary tuberculosis with drug-resistant patho-gen, who were diagnosed for the first time, treated in anti-tuberculosis hospitals in St. Petersburg and on an outpatient basis in St. Petersburg “Inter-district Petro-grad-Primorsky TB dispensary No 3”. Clinical, radiological, and laboratory data are presented. All patients were iden-tified with Mycobacterium tuberculosis with multiple and broad drug resistance MBT. The patients were divided into 2 groups: the main group (OG) — 40 people, received the latest generation drugs; 79 patients (KG) — received standard therapy without the inclusion of the latest gen-eration of drugs. Half of the patients in all age groups were identified during a preventive examination (50.4%), a third when applying for complaints (31.9%), and one — when examining for contact with a patient with tubercu-losis. Infiltrative tuberculosis was most often diagnosed in 75 (63.0%), disseminated tuberculosis was detected in 20 (16.8%), and fibrocavernous pulmonary tuberculo-sis — in 24 (20.2%). The decay phase was diagnosed in 88 (73.9%) patients. Three-quarters of the studied patients had 90 comorbidities (75.6%). Results and discussion. The groups are comparable in terms of clinical, radiologi-cal, and bacteriological parameters. By the fourth month of the therapy, the cessation of bacterial excretion was significantly more often determined in patients taking bedaquiline, thioureidoiminomethylpyridinium perchlo-rate, linezolid as part of HT, compared with the group not receiving the above drugs 47.5% and 35.4%, respectively, (p<0.05); by the end of the intensive phase of treatment, the cessation of bacterial excretion occurred in OG in 92.0%, KG — 57.0% (p<0.001). Conclusions. The inclu-sion of drugs thioureidoiminomethylpyridinium perchlo-rate, bedaquiline, linezolid in the complex chemotherapy of tuberculosis with multi-resistant tuberculosis increases the effectiveness of the main course of treatment com-pared to the KG.