Multidrug-Resistant Tuberculosis in Europe, 2010–2011

Günther, Gunar; Leth, Frank van; Alexandru, Sofia; Altet, Neus; Avsar, Korkut; Bang, Didi; Bărbuţă, R; Bothamley, Graham; Ciobanu, Ana; Crudu, Valeriu; Davilovits, Manfred; Dedicoat, Martin; Duarte, Raquel; Gualano, Gina; Kunst, Heinke; Lange, Wiel de; Leimane, Vaira; Magis-Escurra, Cécile; McLaughlin, Anne-Marie; Muylle, Inge; Polcová, Veronika; Pontali, Emanuele; Popa, Christina; Rumetshofer, Rudolf; Skrahina, Alena; Solodovnikova, Varvara; Spînu, Victor; Tiberi, Simon; Viiklepp, Piret; Lange, Christoph

doi:10.3201/eid2103.141343

Cited by 86 publications

(63 citation statements)

References 22 publications

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“…However, the largest number of patients (approximately one‐third) identified with MDR‐TB live in the WHO Europe Region. Pyrazinamide and ethambutol resistance in this region have been reported to be 59.7% and 59.3%, respectively, in patients with MDR‐TB, and 94.4% and 81.8%, respectively, in patients with XDR‐TB . More than 25% of patients with MDR‐TB from this region have resistance to an SLID and almost 20% also to a fluoroquinolone .…”

Section: Should the Shorter Mdr‐tb Regimen Be Implemented Globally: Pmentioning

confidence: 91%

“…Pyrazinamide and ethambutol resistance in this region have been reported to be 59.7% and 59.3%, respectively, in patients with MDR‐TB, and 94.4% and 81.8%, respectively, in patients with XDR‐TB . More than 25% of patients with MDR‐TB from this region have resistance to an SLID and almost 20% also to a fluoroquinolone . The regimen also advocates the use of high‐dose isoniazid, which may only benefit patients who are infected with strains due to a mutation in position 8, 15 or 16 in the promoter of the inhA gene in the absence of a mutation in the katG gene (position 315).…”

Section: Should the Shorter Mdr‐tb Regimen Be Implemented Globally: Pmentioning

confidence: 99%

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Recent controversies about MDR and XDR‐TB: Global implementation of the WHO shorter MDR‐TB regimen and bedaquiline for all with MDR‐TB?

et al. 2017

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Tuberculosis (TB) is now the biggest infectious disease killer worldwide. Although the estimated incidence of TB has marginally declined over several years, it is out of control in some regions including in Africa. The advent of multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB) threatens to further destabilize control in several regions of the world. Drug-resistant TB constitutes a significant threat because it underpins almost 25% of global TB mortality, is associated with high morbidity, is a threat to healthcare workers and is unsustainably costly to treat. The advent of highly resistant TB with emerging bacillary resistance to newer drugs has raised further concern. Encouragingly, in addition to preventative strategies, several interventions have recently been introduced to curb the drug-resistant TB epidemic, including newer molecular diagnostic tools, new (bedaquiline and delamanid) and repurposed (linezolid and clofazimine) drugs and shorter and individualized treatment regimens. However, there are several controversies that surround the use of new drugs and regimens, including whether, how and to what extent they should be used, and who specifically should be treated so that outcomes are optimally improved without amplifying the burden of drug resistance, and other potential drawbacks, thus sustaining effectiveness of the new drugs. The equipoise surrounding these controversies is discussed and some recommendations are provided.

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Section: Should the Shorter Mdr‐tb Regimen Be Implemented Globally: Pmentioning

confidence: 91%

Section: Should the Shorter Mdr‐tb Regimen Be Implemented Globally: Pmentioning

confidence: 99%

Recent controversies about MDR and XDR‐TB: Global implementation of the WHO shorter MDR‐TB regimen and bedaquiline for all with MDR‐TB?

et al. 2017

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“…Standardized therapy regimens have the potential to lead to high cure rates in patients with M/XDR‐TB . However, strains found in M/XDR‐TB patients especially from Europe show high rates of resistance to second‐line drugs . Standardized regimens such as the shorter regimen endorsed by the WHO are most likely not suitable for this setting and the implementation to such a population might lead to an increase of MDR‐TB .…”

Section: Individualized Therapy Versus Standardized Treatment Regimenmentioning

confidence: 99%

Drug‐resistant tuberculosis: An update on disease burden, diagnosis and treatment

et al. 2018

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The emergence of antimicrobial resistance against Mycobacterium tuberculosis, the leading cause of mortality due to a single microbial pathogen worldwide, represents a growing threat to public health and economic growth. The global burden of multidrug-resistant tuberculosis (MDR-TB) has recently increased by an annual rate of more than 20%. According to the World Health Organization approximately only half of all patients treated for MDR-TB achieved a successful outcome. For many years, patients with drug-resistant tuberculosis (TB) have received standardized treatment regimens, thereby accelerating the development of MDR-TB through drug-specific resistance amplification. Comprehensive drug susceptibility testing (phenotypic and/or genotypic) is necessary to inform physicians about the best drugs to treat individual patients with tailor-made treatment regimens. Phenotypic drug resistance can now often, but with variable sensitivity, be predicted by molecular drug susceptibility testing based on whole genome sequencing, which in the future could become an affordable method for the guidance of treatment decisions, especially in high-burden/resource-limited settings. More recently, MDR-TB treatment outcomes have dramatically improved with the use of bedaquiline-based regimens. Ongoing clinical trials with novel and repurposed drugs will potentially further improve cure-rates, and may substantially decrease the duration of MDR-TB treatment necessary to achieve relapse-free cure.

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“…The work showed the paucity of drug-sensitivity testing for second-line drugs other than fluoroquinolones and injectables [8,9], mainly due to the absence of reliable tools for patients with MDR-TB. When available, drug-sensitivity testing revealed a high prevalence of additional drug resistance for ethambutol, pyrazinamide and protionamide/ethionamide, as well as moxifloxacin and kanamycin, especially in high-TB-incidence countries within Europe [8,9]. All these drugs are key components of the short regimen for MDR-TB, resulting in limited scope of this regimen, with on average only 8% of patients with MDR-TB in Europe being eligible [10].…”

Section: Tbnet's Achievementsmentioning

confidence: 99%

The Tuberculosis Network European Trials group (TBnet) ERS Clinical Research Collaboration: addressing drug-resistant tuberculosis through European cooperation

et al. 2019

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While the incidence of tuberculosis (TB) has fallen steadily within the European Union, the region has by far the highest estimated incidence of multidrug-resistant (MDR)-TB among TB patients [1, 2], which hampers the goal of the World Health Organization (WHO) of TB elimination in the region [3]. MDR-TB has the potential to be the most important infectious threat to European health over the coming decades, unless effective treatment can be found and relapses prevented.

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Multidrug-Resistant Tuberculosis in Europe, 2010–2011

Abstract: Ongoing transmission, high levels of drug resistance, and poor diagnostic

Cited by 86 publications

References 22 publications

Recent controversies about MDR and XDR‐TB: Global implementation of the WHO shorter MDR‐TB regimen and bedaquiline for all with MDR‐TB?

Recent controversies about MDR and XDR‐TB: Global implementation of the WHO shorter MDR‐TB regimen and bedaquiline for all with MDR‐TB?

Drug‐resistant tuberculosis: An update on disease burden, diagnosis and treatment

The Tuberculosis Network European Trials group (TBnet) ERS Clinical Research Collaboration: addressing drug-resistant tuberculosis through European cooperation

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