Anti-tuberculosis drug resistance in Bangladesh: reflections from the first nationwide survey

Kamal, Sanaa M.; Hossain, Altaf; Sultana, Sadia; Begum,; Haque, Nuruzzaman; Ahmed, Junaid; Tm, Rahman; Ka, Hyder; Hossain, Solaiman; Rahman, Mahfuzur; Cr, Ahsan; Kj, Aung; Islam, Akramul; Hasan, Rumina; A, Van Deun

doi:10.5588/ijtld.14.0200

Cited by 27 publications

(31 citation statements)

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“…In Bangladesh, the National TB Drug Resistance Survey reported that 4% of new and retreatment smearpositive patients had ethambutol resistance; this cohort included both drug-susceptible, MDR-TB and polydrug-resistant TB patients. 34 This is lower than that seen in our cohort and in many areas of the world. Niger reported a much higher prevalence of ethambutol resistance of 69%.…”

Section: Discussioncontrasting

confidence: 68%

Potentially High Number of Ineffective Drugs with the Standard Shorter Course Regimen for Multidrug-Resistant Tuberculosis Treatment in Haiti

Walsh

Souroutzidis

Vilbrun

et al. 2019

The American Journal of Tropical Medicine and Hygiene

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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.

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Section: Discussioncontrasting

confidence: 68%

Potentially High Number of Ineffective Drugs with the Standard Shorter Course Regimen for Multidrug-Resistant Tuberculosis Treatment in Haiti

Walsh

Souroutzidis

Vilbrun

et al. 2019

The American Journal of Tropical Medicine and Hygiene

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“…Details of these surveys are provided elsewhere [11]. The 6 countries represented a range of programmatic and epidemiological settings and included Azerbaijan [12], Bangladesh [13], Belarus (city of Minsk) [14], Pakistan [15], the Philippines [16], and South Africa (Gauteng and Kwazulu Natal provinces) [17]. Data on molecular markers of isoniazid resistance were also available from these countries, as well as for Ukraine [18].…”

Section: Study Populationmentioning

confidence: 99%

Prevalence and genetic profiles of isoniazid resistance in tuberculosis patients: A multicountry analysis of cross-sectional data

et al. 2020

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BackgroundThe surveillance of drug resistance among tuberculosis (TB) patients is central to combatting the global TB epidemic and preventing the spread of antimicrobial resistance. Isoniazid and rifampicin are two of the most powerful first-line anti-TB medicines, and resistance to either of them increases the risk of treatment failure, relapse, or acquisition of resistance to other drugs. The global prevalence of rifampicin resistance is well documented, occurring in 3.4% (95% CI 2.5%-4.4%) of new TB patients and 18% (95% CI 7.6%-31%) of previously treated TB patients in 2018, whereas the prevalence of isoniazid resistance at global and regional levels is less understood. In 2018, the World Health Organization (WHO) recommended a modified 6-month treatment regimen for people with isoniazid-resistant, rifampicin-susceptible TB (Hr-TB), which includes rifampicin, pyrazinamide, ethambutol, and levofloxacin. We estimated the global prevalence of Hr-TB among TB patients and investigated associated phenotypic and genotypic drug resistance patterns. Methods and findingsAggregated drug resistance data reported to WHO from either routine continuous surveillance or nationally representative periodic surveys of TB patients for the period 2003-2017 were reviewed. Isoniazid data were available from 156 countries or territories for 211,753 patients. Among these, the global prevalence of Hr-TB was 7.4% (95% CI 6.5%-8.4%) among new TB patients and 11.4% (95% CI 9.4%-13.4%) among previously treated TB patients. Additional data on pyrazinamide and levofloxacin resistance were available from 6 PLOS Medicine | https://doi.

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“…The first nationwide TB drug resistance survey in Bangladesh in 2011 demonstrated that transmission of MDR-TB may be increasing 7 . Another study demonstrated that patients with MDR-TB were more likely to have been hospitalized for TB-related causes during previous treatment 8 , highlighting delays in diagnosing drug-resistance and the potential for transmission.…”

Section: Introductionmentioning

confidence: 99%

FAST implementation in Bangladesh: high frequency of unsuspected tuberculosis justifies challenges of scale-up

Nathavitharana

Daru

Barrera

et al. 2017

int j tuberc lung dis

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SUMMARY Setting Bangladesh – National Institute of Diseases of the Chest and Hospital, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders and Chittagong Chest Disease Hospital. Objective To present operational data and discuss the challenges of implementing FAST (Find cases Actively, Separate safely and Treat effectively) as a TB transmission control strategy. Design FAST was implemented sequentially at three hospitals. Results Using Xpert MTB/RIF, 733/6028 (12.2%, 95%CI [11.4,13.0]) patients were diagnosed with unsuspected TB. Patients admitted with other lung diseases with a prior TB history had more than twice the odds of being diagnosed with unsuspected TB as those without a TB history (OR 2.6, 95%CI 2.2–3.0, p<0.001). Unsuspected MDR-TB was diagnosed in 89/1415 (6.3%, 95%CI [5.1,7.7]) patients. Patients with unsuspected TB had nearly five times the odds of being diagnosed with MDR-TB than those admitted with a known TB diagnosis (OR 4.9, 95%CI 3.1–7.6, p<0.001). Implementation challenges include staff shortages, diagnostic failure, supply-chain issues and reliance on external funding. Conclusion FAST implementation revealed a high frequency of unsuspected TB in hospitalized patients in Bangladesh. Patients with a prior TB history have increased risk. Ensuring financial resources, stakeholder engagement and laboratory capacity are important for sustainability and scalability.

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Anti-tuberculosis drug resistance in Bangladesh: reflections from the first nationwide survey

Cited by 27 publications

References 0 publications

Potentially High Number of Ineffective Drugs with the Standard Shorter Course Regimen for Multidrug-Resistant Tuberculosis Treatment in Haiti

Potentially High Number of Ineffective Drugs with the Standard Shorter Course Regimen for Multidrug-Resistant Tuberculosis Treatment in Haiti

Prevalence and genetic profiles of isoniazid resistance in tuberculosis patients: A multicountry analysis of cross-sectional data

FAST implementation in Bangladesh: high frequency of unsuspected tuberculosis justifies challenges of scale-up

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