Comprehensive treatment of extensively drug-resistant tuberculosis.
Carole D Mitnick, Sonya S Shin, Kwonjune J Seung, Michael L Rich, Sidney S Atwood, Jennifer J Furin, Garrett M Fitzmaurice, Felix A Alcantara Viru, Sasha C Appleton, Jaime N Bayona, Cesar A Bonilla, Katiuska Chalco, Sharon Choi, Molly F Franke, Hamish S F Fraser, Dalia Guerra, Rocio M Hurtado, Darius Jazayeri, Keith Joseph, Karim Llaro, Lorena Mestanza, Joia S Mukherjee, Maribel Muñoz, Eda Palacios, Epifanio Sanchez, Alexander Sloutsky, Mercedes C Becerra
Author Information
Carole D Mitnick: Harvard Medical School, Boston, USA.
BACKGROUND: Extensively drug-resistant tuberculosis has been reported in 45 countries, including countries with limited resources and a high burden of tuberculosis. We describe the management of extensively drug-resistant tuberculosis and treatment outcomes among patients who were referred for individualized outpatient therapy in Peru. METHODS: A total of 810 patients were referred for free individualized therapy, including drug treatment, resective surgery, adverse-event management, and nutritional and psychosocial support. We tested isolates from 651 patients for extensively drug-resistant tuberculosis and developed regimens that included five or more drugs to which the infecting isolate was not resistant. RESULTS: Of the 651 patients tested, 48 (7.4%) had extensively drug-resistant tuberculosis; the remaining 603 patients had multidrug-resistant tuberculosis. The patients with extensively drug-resistant tuberculosis had undergone more treatment than the other patients (mean [+/-SD] number of regimens, 4.2+/-1.9 vs. 3.2+/-1.6; P<0.001) and had isolates that were resistant to more drugs (number of drugs, 8.4+/-1.1 vs. 5.3+/-1.5; P<0.001). None of the patients with extensively drug-resistant tuberculosis were coinfected with the human immunodeficiency virus (HIV). Patients with extensively drug-resistant tuberculosis received daily, supervised therapy with an average of 5.3+/-1.3 drugs, including cycloserine, an injectable drug, and a fluoroquinolone. Twenty-nine of these patients (60.4%) completed treatment or were cured, as compared with 400 patients (66.3%) with multidrug-resistant tuberculosis (P=0.36). CONCLUSIONS: Extensively drug-resistant tuberculosis can be cured in HIV-negative patients through outpatient treatment, even in those who have received multiple prior courses of therapy for tuberculosis.
References
Lancet. 2005 Jan 22-28;365(9456):318-26
[PMID: 15664227]
