Multidrug-resistant Tuberculosis Treatment Outcomes Research Articles

Ambulatory Multi-Drug Resistant Tuberculosis Treatment Outcomes in a Cohort of HIV-Infected Patients in a Slum Setting in Mumbai, India

BackgroundIndia carries one quarter of the global burden of multi-drug resistant TB (MDR-TB) and has an estimated 2.5 million people living with HIV. Despite this reality, provision of treatment for MDR-TB is extremely limited, particularly for HIV-infected individuals. Médecins Sans Frontières (MSF) has been treating HIV-infected MDR-TB patients in Mumbai since May 2007. This is the first report of treatment outcomes among HIV-infected MDR-TB patients in India.MethodsHIV-infected patients with suspected MDR-TB were referred to the MSF-clinic by public Antiretroviral Therapy (ART) Centers or by a network of community non-governmental organizations. Patients were initiated on either empiric or individualized second-line TB-treatment as per WHO recommendations. MDR-TB treatment was given on an ambulatory basis and under directly observed therapy using a decentralized network of providers. Patients not already receiving ART were started on treatment within two months of initiating MDR-TB treatment.ResultsBetween May 2007 and May 2011, 71 HIV-infected patients were suspected to have MDR-TB, and 58 were initiated on treatment. MDR-TB was confirmed in 45 (78%), of which 18 (40%) were resistant to ofloxacin. Final treatment outcomes were available for 23 patients; 11 (48%) were successfully treated, 4 (17%) died, 6 (26%) defaulted, and 2 (9%) failed treatment. Overall, among 58 patients on treatment, 13 (22%) were successfully treated, 13 (22%) died, 7 (12%) defaulted, two (3%) failed treatment, and 23 (40%) were alive and still on treatment at the end of the observation period. Twenty-six patients (45%) experienced moderate to severe adverse events, requiring modification of the regimen in 12 (20%). Overall, 20 (28%) of the 71 patients with MDR-TB died, including 7 not initiated on treatment.ConclusionsDespite high fluoroquinolone resistance and extensive prior second-line treatment, encouraging results are being achieved in an ambulatory MDR-T- program in a slum setting in India. Rapid scale-up of both ART and second-line treatment for MDR-TB is needed to ensure survival of co-infected patients and mitigate this growing epidemic.

Countrywide management of pulmonary tuberculosis reverses increasing incidence

To evaluate the impact of countrywide management of tuberculosis (TB) and the availability of second-line drugs (SLDs) on the notification rates of pulmonary TB (PTB) overall and of multidrug-resistant TB (MDR-TB), taking into account human immunodeficiency virus (HIV) co-infection and the national economy in Estonia. Retrospective analysis of notification rates and treatment outcomes of PTB and MDR-TB during 1998-2006. The annual notification rates of both PTB and MDR-TB decreased significantly, by on average 3.3 (P = 0.007) and 1.7 (P = 0.008) cases per 100,000 population, respectively. The accelerating impact of SLD availability on the annual decline was significant for both PTB overall and MDR-TB (P = 0.003 and P = 0.025, respectively). During 1998-2006, an increase in TB-HIV co-infection (P = 0.009) significantly affected the notification rates of both PTB overall and MDR-TB (P < 0.001 and P < 0.001, respectively). The negative impact of TB-HIV co-infection was counterbalanced by the availability of SLDs, the decrease in the MDR-TB rate and the increase in gross domestic product (GDP) per capita, as confirmed by multivariate analysis. Countrywide access to SLDs and the coordinated effect of programmatic conditions can, in parallel with increasing GDP, reverse the increasing notification rates of PTB and MDR-TB in the context of an HIV epidemic.

Retrospective Comparison of Levofloxacin and Moxifloxacin on Multidrug-Resistant Tuberculosis Treatment Outcomes

Background/AimsTo compare the effect of levofloxacin and moxifloxacin on treatment outcomes among patients with multidrug-resistant tuberculosis (MDR-TB).MethodsA retrospective analysis of 171 patients with MDR-TB receiving either levofloxacin or moxifloxacin was performed. Treatment responses were categorized into treatment success (cured and treatment completed) or adverse treatment outcome (death, failure, and relapsed).ResultsThe median age of the patients was 42.0 years. Approximately 56% of the patients were male. Seventeen patients had extensively drug-resistant tuberculosis, and 20 had a surgical resection. A total of 123 patients (71.9%) received levofloxacin for a median 594 days, and 48 patients (28.1%) received moxifloxacin for a median 673 days. Other baseline demographic, clinical, and radiographic characteristics were similar between the two groups. The moxifloxacin group had a significantly higher number of resistant drugs (p < 0.001) and a higher incidence of resistance to ofloxacin (p = 0.005) in the drug sensitivity test. The treatment success rate was 78.9% in the levofloxacin group and 83.3% in the moxifloxacin group (p = 0.42). Adverse reactions occurred at similar rates in the groups (p = 0.44). Patients in the moxifloxacin group were not more likely to have treatment success than those in the levofloxacin group (adjusted odds ratio, 0.76; 95% confidence interval, 0.24 to 2.43; p = 0.65).ConclusionsBoth levofloxacin and moxifloxacin showed equivalent efficacy for treating MDR-TB.

Treatment Outcomes of Multidrug-Resistant Tuberculosis (MDR-TB) and Extensively Drug-Resistant Tuberculosis (XDR-TB) in Hong Kong

Treatment Outcomes of Multidrug-Resistant Tuberculosis (MDR-TB) and Extensively Drug-Resistant Tuberculosis (XDR-TB) in Hong Kong

Standardized Second-line Anti-TB Treatment of Multidrug-Resistant Tuberculosis During Pregnancy: Maternal and Neonatal Safety and Outcome

PURPOSE: To study the efficacy, safety, and outcome of standardized second-line anti-TB treatment of multidrug-resistant tuberculosis (MDR-TB) during pregnancy focusing on maternal and perinatal outcomes. METHODS: Prospective study conducted to evaluate the outcomes of standardized MDR-TB treatment during pregnancy in patients referred to NRITLD from 2003 to 2008. Outcomes are investigated in two categories, namely, maternal and neonatal. RESULTS: Five MDR-TB patients whilst receiving standardized anti-TB regimen became pregnant. We did not change the regimen and all of them did not reveal any adverse effects throughout pregnancy and delivery. No adverse effect occurred for the mothers and the neonates, either. CONCLUSION: Treatment of MDR-TB in pregnancy with standardized second-line regimen could be safe and the rate of successful outcome is acceptable. CLINICAL IMPLICATIONS: Although recommendations for the treatment of pregnant women with pulmonary TB are available, there is no unique guideline for treatment of MDR-TB during pregnancy. The response to treatment is not clear and it has not been yet elucidated which drugs are safe during pregnancy in these patients. In this study all patients received the same standardized regimen of medications. Accordingly, evaluation of patients’ response to treatment and side effects of the treatment could be readily evaluated and compared in a uniform format. DISCLOSURE: Ahmadreza Moradi, No Financial Disclosure Information; No Product/Research Disclosure Information 12:45 PM 2:00 PM Copyright © 2014 American College of Chest Physicians Standardized Second-line Anti-TB Treatment of Multidrug-Resistant Tuberculosis During Pregnancy: Maternal and Neonatal Safety and Outcome Chest. 2010;138(4_MeetingAbstracts):678A. doi:10.1378/chest.9319 FREE TO VIEW Page 1 of 1 7/13/2014 http://journal.publications.chestnet.org/article.aspx?articleid=1086711&resultClick=1

Analysis of tuberculosis treatment outcomes in the European Union and European Economic Area: efforts needed towards optimal case management and control

An analysis of surveillance data was performed to assess treatment outcomes of patients belonging to selected calendar year cohorts. Twenty-two countries in the European Union (EU) and European Economic Area (EEA) reported treatment outcome monitoring data for culture-confirmed pulmonary tuberculosis (TB) cases reported in 2007. The overall treatment success rate was 73.8% for all culture-confirmed pulmonary cases and 79.5% for new culture-confirmed pulmonary cases. For the cohort of new culture-confirmed TB cases, only three countries achieved the target of 85% success rate. This underachievement appears to be a result of relative high defaulting and unknown outcome information. Case fatality remains high particularly among cases of national origin. This factor appears attributable to advanced age of the national cohort. Treatment outcomes for multidrug-resistant tuberculosis were reported by 15 countries, with a range of 19.8% to 100% treatment success at 24 months. The data underline the urgent need for strengthening treatment outcome monitoring in the EU and EEA in order to ensure an effective programme implementation and case management that will ultimately contribute to TB elimination.

Multidrug-Resistant Tuberculosis of the Spine—Is it the Beginning of the End?

Prospective cohort study. We report the first study of multidrug-resistant tuberculosis (MDR-TB) in the spine. The aim was to determine the clinical, radiologic, and drug resistance profile as well as the factors associated with treatment outcome of MDR-TB in the spine. Tuberculosis of the spine is the most common extrapulmonary form of tuberculosis in the Asian subcontinent. The disease in few cases is resistant to the primary anti-Koch's medications and the number of cases detected is on the rise. Multidrug resistant form of tuberculosis of the spine is ill reported in the literature. The diagnosis, management thus remains a challenge to the treating surgeon. This study tries to assess these critical issues of this "new" disease. Described here are the clinical characteristics of 25 MDR-TB spine patients identified in the study and their drug susceptibility patterns. They were followed up clinically, radiologically after a biopsy, culture, and Drug Susceptibility Testing. According to their Drug Susceptibility Testing pattern and previous history of Anti-Tubercular Treatment (ATT), individualized treatment regimens were tailored for each patient by an expert physician. Majority of the patients seen in the present study were in the productive years of their life. (Males (9) mean age: 38.5 years and females (16) mean age: 34.3 years. Four patients were defaulters of the ATT. The average number of drugs used was 6, including 4 second line drugs. Average treatment duration was 24 months. Almost 50% of the patients had adverse drug effects. Of the 25 patients, 19 achieved healed status and 6 are still on treatment. Four patients required surgery for mechanical instability of the spine. Radiologic improvement was observed in all the cases after a mean treatment of 6 months. Five predictors were identified for successful outcome of MDR-TB. They include progressive clinical improvement at 6 months, radiologic improvement during treatment and disease with Mycobacterium tuberculosis strains exhibiting resistance to less than or up to 3 antitubercular drugs, use of less than or up to 4 second-line drugs in treatment, and no change of regimen during treatment. MDR-TB of the spine is a different disease and is here to stay. There is an urgent need to include culture and drug susceptibility testing in the protocol for the treatment of tuberculosis of the spine.

Early Outcomes of MDR-TB Treatment in a High HIV-Prevalence Setting in Southern Africa

BackgroundLittle is known about treatment of multidrug-resistant tuberculosis (MDR-TB) in high HIV-prevalence settings such as sub-Saharan Africa.Methodology/Principal FindingsWe did a retrospective analysis of early outcomes of the first cohort of patients registered in the Lesotho national MDR-TB program between July 21, 2007 and April 21, 2008. Seventy-six patients were included for analysis. Patient follow-up ended when an outcome was recorded, or on October 21, 2008 for those still on treatment. Fifty-six patients (74%) were infected with HIV; the median CD4 cell count was 184 cells/μl (range 5–824 cells/μl). By the end of the follow-up period, study patients had been followed for a median of 252 days (range 12–451 days). Twenty-two patients (29%) had died, and 52 patients (68%) were alive and in treatment. In patients who did not die, culture conversion was documented in 52/54 patients (96%). One patient had defaulted, and one patient had transferred out. Death occurred after a median of 66 days in treatment (range 12–374 days).Conclusions/SignificanceIn a region where clinicians and program managers are increasingly confronted by drug-resistant tuberculosis, this report provides sobering evidence of the difficulty of MDR-TB treatment in high HIV-prevalence settings. In Lesotho, an innovative community-based treatment model that involved social and nutritional support, twice-daily directly observed treatment and early empiric use of second-line TB drugs was successful in reducing mortality of MDR-TB patients. Further research is urgently needed to improve MDR-TB treatment outcomes in high HIV-prevalence settings.

Tuberculosis into the 2010s: Is the Glass Half Full?

During the 16 years since the World Health Organization declared tuberculosis (TB) a global emergency, major new challenges have emerged-in particular the spread of extensively drug-resistant (XDR)-TB and its overlap with human immunodeficiency virus infection. However, during this period, we have also witnessed the creation of-and major commitments from-agencies dedicated to TB control, research, and funding, and tangible positive achievements have occurred; these include improvements in both new and existing TB diagnostics, a developmental pipeline of new candidate TB drugs, better treatment outcomes for multidrug-resistant TB and XDR-TB, heightened recognition of the importance of nosocomial transmission, and improved strategies to reduce mortality associated with concurrent human immunodeficiency virus infection and TB. We suggest updates to the 2006 International Standards of Tuberculosis Care to embrace these developments. The incorporation of these recent advances into optimized directly observed treatment, short course (DOTS), programs, in conjunction with more widespread deployment and enhanced political will, all provide grounds for improved control.

Extensively drug-resistant tuberculosis in the UK: 1995 to 2007

Background:The emergence of multidrug-resistant tuberculosis (MDRTB) and extensively drug-resistant tuberculosis (XDRTB) is a threat to global tuberculosis control. Limited information is, however, available on the outcome of XDRTB cases. This...

Multidrug-Resistant Tuberculosis Treatment Outcomes in Karakalpakstan, Uzbekistan: Treatment Complexity and XDR-TB among Treatment Failures

BackgroundA pilot programme to treat multidrug-resistant TB (MDR-TB) was implemented in Karakalpakstan, Uzbekistan in 2003. This region has particularly high levels of MDR-TB, with 13% and 40% among new and previously treated cases, respectively.MethodologyThis study describes the treatment process and outcomes for the first cohort of patients enrolled in the programme, between October 2003 and January 2005. Confirmed MDR-TB cases were treated with an individualised, second-line drug regimen based on drug susceptibility test results, while suspected MDR-TB cases were treated with a standardised regimen pending susceptibility results.Principal FindingsOf 108 MDR-TB patients, 87 were started on treatment during the study period. Of these, 33 (38%) were infected with strains resistant to at least one second-line drug at baseline, but none had initial ofloxacin resistance. Treatment was successful for 54 (62%) patients, with 13 (15%) dying during treatment, 12 (14%) defaulting and 8 (8%) failing treatment. Poor clinical condition and baseline second-line resistance contributed to treatment failure or death. Treatment regimens were changed in 71 (82%) patients due to severe adverse events or drug resistance. Adverse events were most commonly attributed to cycloserine, ethionamide and p-aminosalicylic acid. Extensively drug resistant TB (XDR-TB) was found among 4 of the 6 patients who failed treatment and were still alive in November 2006.ConclusionsWhile acceptable treatment success was achieved, the complexity of treatment and the development of XDR-TB among treatment failures are important issues to be addressed when considering scaling up MDR-TB treatment.

Managing multidrug-resistant tuberculosis in hospitalised patients: a review of treatment outcomes

The admission trends, management practices, and interim treatment outcomes of multidrug-resistant tuberculosis (MDR-TB) patients admitted in a specialised referral hospital in Johannesburg were reviewed. Across-sectional study with both descriptive and analytic features was done on 237 MDR-TB patients hospitalised from the beginning of June 1998 to the end of May 2003. Data were analysed using SPSS version 12 software!Main interim outcome measures after in-patient care were protracted hospitalisation, transfer out, absconding, and death rates. Multiple logistic regression analysis was performed to determine risk factors for poor treatment outcomes. The allocated hospital beds were insufficient for patients meeting the in-patient care criteria. Nearly half of the patients were hospitalised on suspicion of MDR-TB based on contact history and persistency of positive sputum despite treatment for drug-susceptible TB. With regard to the period between confirmation of MDR-TB and admission, patients with primary ...