Potentially High Number of Ineffective Drugs with the Standard Shorter Course Regimen for Multidrug-Resistant Tuberculosis Treatment in Haiti.
Adult
Antitubercular Agents
/ therapeutic use
Coinfection
Drug Resistance, Multiple, Bacterial
Ethambutol
/ therapeutic use
Ethionamide
/ therapeutic use
Female
Fluoroquinolones
/ therapeutic use
HIV
/ growth & development
HIV Infections
/ pathology
Haiti
Humans
Isoniazid
/ therapeutic use
Male
Microbial Sensitivity Tests
Middle Aged
Mycobacterium tuberculosis
/ drug effects
Pyrazinamide
/ therapeutic use
Retrospective Studies
Treatment Outcome
Tuberculosis, Multidrug-Resistant
/ drug therapy
Journal
The American journal of tropical medicine and hygiene
ISSN: 1476-1645
Titre abrégé: Am J Trop Med Hyg
Pays: United States
ID NLM: 0370507
Informations de publication
Date de publication:
02 2019
02 2019
Historique:
pubmed:
31
12
2018
medline:
18
12
2019
entrez:
31
12
2018
Statut:
ppublish
Résumé
Multidrug-resistant tuberculosis (MDR-TB) outcomes are poor partly because of the long treatment duration; the World Health Organization conditionally recommends a shorter course regimen to potentially improve treatment outcomes. Here, we describe the drug susceptibility patterns of a cohort of MDR-TB patients in Haiti and determine the number of likely effective drugs if they were treated with the recommended shorter course regimen. We retrospectively examined drug susceptibility patterns of adults initiating MDR-TB treatment between 2008 and 2015 at the Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections in Port-au-Prince, Haiti. First- and second-line drug susceptibility testing (DST) was analyzed and used to determine the number of presumed effective drugs. Of the 239 patients analyzed, 226 (95%), 183 (77%), 135 (57%), and 38 (16%) isolates were resistant to high-dose isoniazid, ethambutol, pyrazinamide, and ethionamide, respectively. Eight patients (3%) had resistance to either a fluoroquinolone or a second-line injectable and none had extensively resistant TB. Of the 239 patients, 132 (55%) would have fewer than five likely effective drugs in the intensive phase of the recommended shorter course regimen and 121 (51%) would have two or fewer likely effective drugs in the continuation phase. Because of the high rates of resistance to first-line TB medications, about 50% of MDR-TB patients would be left with only two effective drugs in the continuation phase of the recommended shorter course regimen, raising concerns about the effectiveness of this regimen in Haiti and the importance of using DST to guide treatment.
Identifiants
pubmed: 30594266
doi: 10.4269/ajtmh.18-0493
pmc: PMC6367639
doi:
Substances chimiques
Antitubercular Agents
0
Fluoroquinolones
0
Pyrazinamide
2KNI5N06TI
Ethambutol
8G167061QZ
Ethionamide
OAY8ORS3CQ
Isoniazid
V83O1VOZ8L
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
392-398Subventions
Organisme : FIC NIH HHS
ID : D43 TW010062
Pays : United States
Organisme : NIAID NIH HHS
ID : K24 AI098627
Pays : United States
Organisme : FIC NIH HHS
ID : R25 TW009337
Pays : United States
Commentaires et corrections
Type : CommentIn
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