Management of drug-resistant tuberculosis in Indonesia: a four-year cascade of care analysis

Lestari, Bony Wiem; Nijman, Gerine; Larasmanah, Alamanda; Soeroto, Arto Yuwono; Santoso, Prayudi; Alisjahbana, Bachti; Chaidir, Lidya; Andriyoko, Basti; van Crevel, Reinout; Hill, Philip C.

doi:10.1016/j.lansea.2023.100294

Cited by 3 publications

(1 citation statement)

References 18 publications

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“…Only 57% of the patients who initiated treatment successfully completed it, aligning with the global MDR-TB treatment success rate of 59%. ADRs lack financial and/or social support, initial comorbidities with increased pill counts, early discontinuation of treatment after symptoms disappear, long distance to health facilities, and other factors that may impede the success of MDR treatment (Lestari et al, 2023).…”

Section: Mdr-tb Treatment Problemsmentioning

confidence: 99%

Article Review: The Treatment Problem and Adverse Drug Reactions in the Treatment of Multidrug-Resistant Tuberculosis

Aprianti,

Prayudi Santoso,

Melisa Intan Barliana

et al. 2023

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Multidrug-resistant tuberculosis (MDR-TB) is the resistance of Mycobacterium tuberculosis to at least two tuberculosis (TB) drugs, rifampicin and isoniazid. The disease requires a long treatment duration with several second-line drugs. This leads to a globally low success rate of approximately 56% for MDR-TB treatment. Studies have reported that adverse drug reactions (ADRs) contribute to high rates of non-compliance, treatment discontinuation, and failure. This narrative review aimed to provide information about MDR-TB treatment modalities, various ADRs, challenges encountered in MDR-TB treatment, and instances of ADRs that can impact treatment success. This narrative review study was conducted by searching for scientific information from the primary electronic databases PubMed and Google Scholar, covering 2012-2022. Based on the literature search results, 14 studies were identified, demonstrating challenges in TB and MDR-TB treatment, along with 6 ADRs that can influence treatment success in MDR-TB patients. ADRs during MDR-TB treatment can affect patients’ physical, mental, and social well-being as well as their beliefs and behaviors related to treatment. Comprehensive support from families, communities, and healthcare providers is essential to assist patients in addressing treatment challenges and adverse ADRs. Rapid identification and strategies for monitoring and managing treatment challenges and ADRs can improve compliance and success of MDR-TB treatment. Keywords: Adverse Drug Reactions, Drug Side Effects, Multi Drug-Resistant Tuberculosis (MDR-TB), Treatment Success

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Section: Mdr-tb Treatment Problemsmentioning

confidence: 99%

Article Review: The Treatment Problem and Adverse Drug Reactions in the Treatment of Multidrug-Resistant Tuberculosis

Aprianti,

Prayudi Santoso,

Melisa Intan Barliana

et al. 2023

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Clinical Features, Adverse Events and Treatment Outcomes of Multidrug/Rifampicin-resistant Tuberculosis in Children and Adolescents: An Eight-year Retrospective Cohort Study in Bandung, Indonesia

Nataprawira,

Gafar,

Sari

et al. 2024

Pediatric Infectious Disease Journal

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Background: Data on childhood and adolescent multidrug/rifampicin-resistant tuberculosis (MDR/RR-TB) in Indonesia are lacking. We aimed to assess clinical features, adverse events (AEs) and treatment outcomes of childhood and adolescent MDR/RR-TB. Methods: A retrospective cohort study was performed in children and adolescents aged <18 years treated for MDR/RR-TB at Hasan Sadikin General Hospital in Bandung, Indonesia, between June 2016 and March 2024. Multivariable logistic regression analyses were used to calculate adjusted odds ratios (aOR) for predictors of all-cause mortality. Results: Among 84 included patients, 69 (82%) were adolescents aged 10–17 years, 54 (64%) were female, 54 (64%) were malnourished and 55 (65%) had culture-confirmed disease. Among 69 (82%) patients with known outcomes, 48 (70%) were successfully treated, 14 (20%) died (including 5 pretreatment deaths) and 7 (10%) were lost to follow-up (LTFU) (including 5 pretreatment LTFU). Predictors of all-cause mortality included shortness of breath on admission [aOR: 6.4, 95% confidence interval (CI): 1.3–49.1], high bacillary burden on Xpert MTB/RIF assay (aOR: 17.0, 95% CI: 1.6–260.5) and the presence of lung cavities on chest radiograph (aOR: 4.8, 95% CI: 1.1–23.3). Among 74 patients who initiated treatment, 39 (53%) had at least one grade 1–2 AE, and 4 (5%) had one grade 3–4 AE each, including hepatotoxicity, QT prolongation, hearing loss and rash/hyperpigmentation. Conclusion: Younger children were underrepresented among those treated for MDR/RR-TB, indicating reduced access to care. Severe AEs were uncommon during MDR/RR-TB treatment. Baseline indicators of extensive disease were associated with all-cause mortality. The high proportion of pre-treatment mortality and LTFU may reflect complex patient pathways limiting access to care.

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Treatment Outcomes of Fluoroquinolone-Resistant Multidrug-Resistant Tuberculosis: An Implication for Delamanid

Putra,

Purnamasari

2024

Tuberc Respir Dis

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Management of drug-resistant tuberculosis in Indonesia: a four-year cascade of care analysis

Cited by 3 publications

References 18 publications

Article Review: The Treatment Problem and Adverse Drug Reactions in the Treatment of Multidrug-Resistant Tuberculosis

Article Review: The Treatment Problem and Adverse Drug Reactions in the Treatment of Multidrug-Resistant Tuberculosis

Clinical Features, Adverse Events and Treatment Outcomes of Multidrug/Rifampicin-resistant Tuberculosis in Children and Adolescents: An Eight-year Retrospective Cohort Study in Bandung, Indonesia

Treatment Outcomes of Fluoroquinolone-Resistant Multidrug-Resistant Tuberculosis: An Implication for Delamanid

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