Use of Drug-Susceptibility Testing for Management of Drug-Resistant Tuberculosis, Thailand, 2004–2008

Eugene Lam,Laura Jean Podewils,Sriprapa Nateniyom,Saiyud Moolphate,Junya Danyutapolchai,Apiratee Kanphukiew,Wanlaya Sitti,Pranom Limsomboon,Sara Whitehead,Amornrat Anuwatnonthakate,Navarat Chiengsorn,Jiraphan Inyaphong,Chalinthorn Sinthuwattanawibool,Suporn Kavinum,Narin Suriyon,Patama Monkongdee

doi:10.3201/eid2003.130951

Abstract

In 2004, routine use of culture and drug-susceptibility testing (DST) was implemented for persons in 5 Thailand provinces with a diagnosis of tuberculosis (TB). To determine if DST results were being used to guide treatment, we conducted a retrospective chart review for patients with rifampin-resistant or multidrug-resistant (MDR) TB during 2004–2008. A total of 208 patients were identified. Median time from clinical sample collection to physician review of DST results was 114 days. Only 5.8% of patients with MDR TB were empirically prescribed an appropriate regimen; an additional 31.3% received an appropriate regimen after DST results were reviewed. Most patients with rifampin -resistant or MDR TB had successful treatment outcomes. Patients with HIV co-infection and patients who were unmarried or had received category II treatment before DST results were reviewed had less successful outcomes. Overall, review of available DST results was delayed, and results were rarely used to improve treatment.

Highlights

This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Medscape, LLC and Emerging Infectious Diseases
Patient and Clinical Characteristics We identified a total of 490 patients as having TB that was RIF-resistant (n = 121) or MDR (n = 369) (Figure 1)
Patients with RIF-resistant TB who were excluded from analysis were substantially younger than those who were included in the analysis, and a substantially larger proportion of patients with HIV infection plus extrapulmonary or pulmonary and extrapulmonary disease were excluded from the RIF-resistant and MDR TB patient groups (Tables 1 and 2)

Summary

Introduction

This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Medscape, LLC and Emerging Infectious Diseases. LLC is accredited by the ACCME to provide continuing medical education for physicians. All other clinicians completing this activity will be issued a certificate of participation. To participate in this journal CME activity: [1] review the learning objectives and author disclosures; [2] study the education content; [3] take the post-test with a 70% minimum passing score and complete the evaluation at www.medscape.org/journal/eid; [4] view/print certificate. CME Editor Claudia Chesley, Technical Writer/Editor, Emerging Infectious Diseases.

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Conclusion