Shorter treatment duration for selected patients with multidrug-resistant tuberculosis

Leung, Eric Chung Ching; Yew, Wing Wai; Leung, Chi Chiu; Leung, Wai Man; Tam, Cheuk Ming

doi:10.1183/09031936.00186310

Cited by 17 publications

(15 citation statements)

References 11 publications

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“…15,27 The paucibacillary nature of MDR tuberculosis in many children implies that bacillary clearance can be faster in children than in adults, 7 although one of the studies included in this study had very high rates of smear-positive disease, most likely because of progression of disease before MDR tuberculosis was diagnosed. 24 Shortening treatment duration is an important goal for MDR tuberculosis management programmes, 32 and fewer drugs and shorter treatment durations (12 months compared with 18 months for adults) can potentially suffi ce in early, non-extensive childhood disease. 33 Future research should further assess the potential for shorter treatment as a method to limit costs and adverse events, especially because improvements in diagnostics might increase the number of individuals needing treatment.…”

Section: Discussionmentioning

confidence: 99%

Treatment outcomes for children with multidrug-resistant tuberculosis: a systematic review and meta-analysis

Ettehad

Schaaf

Seddon

et al. 2012

The Lancet Infectious Diseases

156

115

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Section: Discussionmentioning

confidence: 99%

Treatment outcomes for children with multidrug-resistant tuberculosis: a systematic review and meta-analysis

Ettehad

Schaaf

Seddon

et al. 2012

The Lancet Infectious Diseases

156

115

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“…It should be noted that these suggestions are based on expert opinion and personal experience [25, 181]. WHO has provided guidance to countries listing the criteria under which these shorter regimens for MDR-TB treatment can be used [24].…”

Section: Duration Of Mdr/xdr-tb Treatmentmentioning

confidence: 99%

“…It could be argued that as paediatric TB is usually paucibacillary, bacterial clearance may be achieved more rapidly in children than in adults and, thus, shorter regimens may suffice. L eung et al [181] have described successful reduction of treatment duration for selected adult patients with MDR-TB. However, there are no clinical trials in children supporting this approach at present.…”

Section: Special Considerations For Mdr/xdr-tb In Childrenmentioning

confidence: 99%

Management of patients with multidrug-resistant/extensively drug-resistant tuberculosis in Europe: a TBNET consensus statement

Lange¹,

Abubakar²,

Alffenaar³

et al. 2014

European Respiratory Journal

263

237

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The emergence of multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis (TB) substantially challenges TB control, especially in the European Region of the World Health Organization, where the highest prevalence of MDR/XDR cases is reported. The current management of patients with MDR/XDR-TB is extremely complex for medical, social and public health systems. The treatment with currently available anti-TB therapies to achieve relapse-free cure is long and undermined by a high frequency of adverse drug events, suboptimal treatment adherence, high costs and low treatment success rates. Availability of optimal management for patients with MDR/XDR-TB is limited even in the European Region. In the absence of a preventive vaccine, more effective diagnostic tools and novel therapeutic interventions the control of MDR/XDR-TB will be extremely difficult. Despite recent scientific advances in MDR/XDR-TB care, decisions for the management of patients with MDR/XDR-TB and their contacts often rely on expert opinions, rather than on clinical evidence.This document summarises the current knowledge on the prevention, diagnosis and treatment of adults and children with MDR/XDR-TB and their contacts, and provides expert consensus recommendations on questions where scientific evidence is still lacking.

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“…All MDR-TB patients notified from 1997 to 2006 were identified from the territory-wide TB registry and laboratory surveillance data as reported previously [10].…”

Section: Methodsmentioning

confidence: 99%

Transmission of multidrug-resistant and extensively drug-resistant tuberculosis in a metropolitan city

Leung

Leung²,

Kam³

et al. 2012

Eur Respir J

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Multidrug-resistant (MDR)-tuberculosis (TB) and extensively drug resistant (XDR)-TB reportedly lead to increased household transmission. This is a retrospective cohort study of active TB occurring among household contacts exposed to MDR-TB.Of 704 contacts in 246 households, initial screening identified 12 (1.7%) TB cases (prevalent cases) and 17 (2.4%) contacts that subsequently developed active TB (secondary cases) after a median (range) duration of 17 (5-62.5) months. Eight prevalent cases and three secondary cases had MDR-TB. TB incidence rates per 100 000 person-years were 254.9 overall and 45.0 for MDR-TB. XDR-TB in the index MDR-TB patient significantly increased the odds of identifying a prevalent TB case to 4.8 (95% CI 1.02-22.5), and the hazard of finding a secondary TB case to 4.7 (95% CI 1.7-13.5). Molecular fingerprinting confirmed household transmission of MDR-TB. Of 20 retrievable isolates from 27 XDR-TB index cases, restriction fragment length polymorphism analysis showed clustering among 13 (65%), with 11 (55%) due to recent transmission by n-1 method and an identifiable household source in only three (27.2%) of the 11 cases.XDR-TB relative to MDR-TB significantly increases household transmission of TB, probably reflecting prolonged/higher infectivity, and indicating a need for prolonged household surveillance. XDR-TB may largely transmit outside of the household settings.

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Shorter treatment duration for selected patients with multidrug-resistant tuberculosis

Cited by 17 publications

References 11 publications

Treatment outcomes for children with multidrug-resistant tuberculosis: a systematic review and meta-analysis

Treatment outcomes for children with multidrug-resistant tuberculosis: a systematic review and meta-analysis

Management of patients with multidrug-resistant/extensively drug-resistant tuberculosis in Europe: a TBNET consensus statement

Transmission of multidrug-resistant and extensively drug-resistant tuberculosis in a metropolitan city

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