Management and treatment outcomes of MDR-TB: results from a setting with high rates of drug resistance

Ahmad, Nafees; Javaid, Arshad; Basit, Anila; Afridi, Afsar Khan; Khan, Mir Azam; Ahmad, Izaz; Sulaiman, Siti Noraini; Khan, Amer Hayat

doi:10.5588/ijtld.15.0167

Cited by 57 publications

(81 citation statements)

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“…11 In countries in Asia, Eastern Europe and Latin America, patients aged 40 years with MDR-TB have also been reported to have worse outcomes than younger patients. [12][13][14] The higher rate of unfavourable outcomes among older adults observed in our study and elsewhere could be due in part to co-morbidities such as diabetes mellitus, hypertension and associated cardiovascular diseases, which are becoming increasingly prevalent in Asia and India. 15 In particular, diabetes mellitus in TB patients is known to be associated with an increased risk of failure and death during anti-tuberculosis treatment.…”

Section: Public Health Action Unfavourable Outcomes In Mdr-tb In Indimentioning

confidence: 82%

Predictors of unfavourable treatment outcome in patients with multidrug-resistant tuberculosis in India

Nair

Velayutham

Kannan

et al. 2017

public health action

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Section: Public Health Action Unfavourable Outcomes In Mdr-tb In Indimentioning

confidence: 82%

Predictors of unfavourable treatment outcome in patients with multidrug-resistant tuberculosis in India

Nair

Velayutham

Kannan

et al. 2017

public health action

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“…4 In summary, the drug-resistant TB suspects referred to the study site were initially evaluated with 2 sputum samples by direct sputum smear microscopy using ZiehlNeelsen stain and Xpert Mycobacterium tuberculosis/RIF (Cepheid, Sunnyvale, CA). On positive sputum smear microscopy and rapid drug susceptibility testing (DST) for M. tuberculosis and RIF resistance, patients were enrolled for MDR-TB treatment.…”

Section: Methodsmentioning

confidence: 99%

Occurrence, Management, and Risk Factors for Adverse Drug Reactions in Multidrug Resistant Tuberculosis Patients

Ahmad

Javaid

Sulaiman

et al. 2018

American Journal of Therapeutics

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Although Pakistan has a high burden of multidrug-resistant tuberculosis (MDR-TB), little is known about prevalence, management, and risk factors for adverse drug reactions (ADRs) in MDR-TB patients in Pakistan. To evaluate occurrence, management, and risk factors for ADRs in MDR-TB patients, and its impact on treatment outcomes, this observational cohort study was conducted at programmatic management unit for drug resistant TB of Lady Reading Hospital Peshawar, Pakistan. A total of 181 MDR-TB patients enrolled at the study site from January 1, 2012 to February 28, 2013 were included. Patients with drug resistant TB other than MDR-TB, transferred out patients and those who were still on treatment at the end of study duration (January 31, 2015) were excluded. Patients were followed until treatment outcomes were reported. ADRs were determined by laboratory data and/or clinical criteria. SPSS 16 was used for data analysis. A total of 131 patients (72.4%) experienced at least 1 ADR. Gastrointestinal disturbance was the most commonly observed adverse event (42%), followed by psychiatric disturbance (29.3%), arthralgia (24.3%), and ototoxicity (21%). Potentially life-threatening ADRs, such as nephrotoxicity (2.7%) and hypokalemia (2.8%) were relatively less prevalent. Owing to ADRs, treatment regimen was modified in 20 (11%) patients. On multivariate analysis, the only risk factor for ADRs was baseline body weight ≥ 40 kg (OR = 2.321, P-value = 0.013). ADRs neither led to permanent discontinuation of treatment nor adversely affected treatment outcomes. Adverse effects were prevalent in current cohort, but caused minimal modification of treatment regimen, and did not negatively impact treatment outcomes. Patient with baseline body weight ≥ 40 kg should be closely monitored.

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“…Moreover, MDR-TB treatment duration is extremely long, spanning between 20-24 months. Ahmed et al 14 reported that in Pakistan MDR-TB patients received a median of six drugs during the intensive phase. In Iran, MDR-TB treatment was initially initiated using a mean of 5.23 drugs 6 while the mean number of drugs used throughout MDR-TB treatment was 5.7 28 .…”

Section: Care For Mdr-tb Patientsmentioning

confidence: 99%

“…In Iran, MDR-TB treatment was initially initiated using a mean of 5.23 drugs 6 while the mean number of drugs used throughout MDR-TB treatment was 5.7 28 . In the study by Ahmed et al 14 , the median duration of treatment for patients who were cured was 24 months (interquartile range [IQR] 20-34). Mirsaeidi et al 6 also reported that the average MDR-TB treatment duration was 27.9 months (IQR 12-96).…”

Section: Care For Mdr-tb Patientsmentioning

confidence: 99%

Prevalence of and risk factors for multidrug-resistant tuberculosis in Iran and its neighboring countries: systematic review and meta-analysis

Jimma

Ghazisaeedi

Shahmoradi

et al. 2017

Rev. Soc. Bras. Med. Trop.

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Tuberculosis, in particular drug-resistant tuberculosis, is of global concern due to the high mortality and morbidity associated with it annually. The aim of this study was to determine the prevalence of and the risk factors for multidrug-resistant tuberculosis in Iran and its neighboring countries. Four databases (PubMed, BioMed Central, EMBASE, and Web of Science) were searched using key terms. Nineteen eligible articles were identified, of which 12 and seven were used for quantitative and qualitative analysis, respectively. The overall pooled estimate of the prevalence of multidrug-resistant tuberculosis, including both new and previously treated tuberculosis cases, in Iran, Iraq, Turkey and Pakistan was 16% (95% confidence interval [CI] 11-20). The patients with a previous tuberculosis treatment history (odds ratio [OR] = 6.45; 95% CI 5.12-7.79), those aged <45 years (OR = 1.57; 95% CI 1.12-2.03), and those who were males (OR = 1.83; 95% CI 1.19-2.48) had an increased pool risk of developing multidrug-resistant tuberculosis. The forest plot revealed that the pooled odds for the development of multidrug- resistant tuberculosis were 2.01 (95% CI 1.65-2.36). Poor adherence to treatment was one of the predictors of unsuccessful treatment outcomes. Multidrug-resistant tuberculosis is a great concern for public health programs in many countries globally, including those included in this review. The risk factors for the development of multidrug-resistant tuberculosis, specifically a previous tuberculosis treatment history, should be targeted through the implementation of specialized interventions.

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Management and treatment outcomes of MDR-TB: results from a setting with high rates of drug resistance

Abstract: The treatment outcome results were encouraging. Patients with identifiable predictors of poor treatment outcome should receive enhanced clinical management. Early detection and management of mild adverse effects can help prevent regimen modification and may improve treatment outcomes.

Cited by 57 publications

References 0 publications

Predictors of unfavourable treatment outcome in patients with multidrug-resistant tuberculosis in India

Predictors of unfavourable treatment outcome in patients with multidrug-resistant tuberculosis in India

Occurrence, Management, and Risk Factors for Adverse Drug Reactions in Multidrug Resistant Tuberculosis Patients

Prevalence of and risk factors for multidrug-resistant tuberculosis in Iran and its neighboring countries: systematic review and meta-analysis

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