Coronavirus disease has disrupted tuberculosis services globally. Data from 33 centers in 16 countries on 5 continents showed that attendance at tuberculosis centers was lower during the first 4 months of the pandemic in 2020 than for the same period in 2019. Resources are needed to ensure tuberculosis care continuity during the pandemic.
The continuous flow of new research articles on MDR-TB diagnosis, treatment, prevention and rehabilitation requires frequent update of existing guidelines. This review is aimed at providing clinicians and public health staff with an updated and easy-to-consult document arising from consensus of Global Tuberculosis Network (GTN) experts.The core published documents and guidelines have been reviewed, including the recently published MDR-TB WHO rapid advice and ATS/CDC/ERS/IDSA guidelines.After a rapid review of epidemiology and risk factors, the clinical priorities on MDR-TB diagnosis (including whole genome sequencing and drug-susceptibility testing interpretations) and treatment (treatment design and management, TB in children) are discussed. Furthermore, the review comprehensively describes the latest information on contact tracing and LTBI management in MDR-TB contacts, while providing guidance on post-treatment functional evaluation and rehabilitation of TB sequelae, infection control and other public health priorities.
The World Health Organization (WHO) recommends that countries implement pharmacovigilance and collect information on active drug safety monitoring (aDSM) and management of adverse events.The aim of this prospective study was to evaluate the frequency and severity of adverse events to anti-tuberculosis (TB) drugs in a cohort of consecutive TB patients treated with new (i.e. bedaquiline, delamanid) and repurposed (i.e. clofazimine, linezolid) drugs, based on the WHO aDSM project. Adverse events were collected prospectively after attribution to a specific drug together with demographic, bacteriological, radiological and clinical information at diagnosis and during therapy. This interim analysis included patients who completed or were still on treatment at time of data collection.Globally, 45 centres from 26 countries/regions reported 658 patients (68.7% male, 4.4% HIV co-infected) treated as follows: 87.7% with bedaquiline, 18.4% with delamanid (6.1% with both), 81.5% with linezolid and 32.4% with clofazimine. Overall, 504 adverse event episodes were reported: 447 (88.7%) were classified as minor (grade 1–2) and 57 (11.3%) as serious (grade 3–5). The majority of the 57 serious adverse events reported by 55 patients (51 out of 57, 89.5%) ultimately resolved. Among patients reporting serious adverse events, some drugs held responsible were discontinued: bedaquiline in 0.35% (two out of 577), delamanid in 0.8% (one out of 121), linezolid in 1.9% (10 out of 536) and clofazimine in 1.4% (three out of 213) of patients. Serious adverse events were reported in 6.9% (nine out of 131) of patients treated with amikacin, 0.4% (one out of 221) with ethionamide/prothionamide, 2.8% (15 out of 536) with linezolid and 1.8% (eight out of 498) with cycloserine/terizidone.The aDSM study provided valuable information, but implementation needs scaling-up to support patient-centred care.
ФГБОУ ВО «Северный государственный медицинский университет», г. Архангельск, Россия 2 ГБУЗ АО «Архангельский клинический противотуберкулезный диспансер», г. Архангельск, Россия Цель: оценка результатов лечения больных с широкой лекарственной устойчивостью возбудителя (ШЛУ-ТБ) с применением новых противотуберкулезных препаратов в гражданском обществе Архангельской области� Проанализированы все случаи ШЛУ-ТБ, зарегистрированные на территории Архангельской области в гражданском обществе с ноября 2006 г� по декабрь 2016 г�, и оценены результаты лечения 21 больного, где в схему лечения включены новые противотуберкулезные препараты (бедаквилин, деламанид, линезолид, клофазимин, имипенем в комбинации с амоксиклавом)� У 16 больных схема лечения состояла из 4 новых противотуберкулезных препаратов� В схему лечения по IV категории 2 пациентам добавлены два препарата-бедаквилин, линезолид и бедаквилин, клофаземин и 3 больным-один бедаквилин� С ноября 2006 г� по декабрь 2017 г� в Архангельской области зарегистрировано 175 больных ШЛУ-ТБ� Эффективный курс химиотерапии с новыми лекарственными препаратами составил 57%, а смертность-4,7%� На прием новых лекарственных средств наблюдались в большинстве случаев побочные реакции слабой и умеренной степени тяжести� Необходимо продолжить изучение новых противотуберкулезных препаратов для разработки наиболее эффективного режима терапии для больных с ШЛУ-ТБ� Ключевые слова: туберкулез с широкой лекарственной устойчивостью микобактерий, лечение, новые препараты
The objective: to compare treatment efficacy and relapse rates in patients with isoniazid-resistant tuberculosis treated with 9- and 6-month courses of chemotherapy.Subjects and Methods. A retrospective cohort study was conducted. The period from 2010 to 2015 was evaluated. The cases of tuberculosis registered on the territory of Arkhangelsk Region were studied. In 2010-2013, all patients with isoniazid-resistant tuberculosis (n = 130) in the region received a 9-month course of treatment. From 2014 to 2015, the duration of treatment for isoniazid-resistant tuberculosis in the region was reduced from 9 to 6 months. The patients (n = 54) received short-course treatment: aminoglycoside or polypeptide (2 months), rifampicin, pyrazinamide, fluoroquinolone, and ethambutol.There was no statistically significant difference in treatment outcomes of isoniazid-resistant tuberculosis between two regimens: The outcome of effective treatment made 76.2% for the 9-month regimen and 74.1% for the 6-month regimen. The relapse rate per 100 person-years was 0.7 (95% CI 0.1-1.9) for the 9-month regimen and 1.9 (95% CI 0.2-6.7) for the 6-month regimen. This study confirmed the need to decrease the duration of treatment for isoniazid-resistant tuberculosis to 6 months.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.