Standard Short-Course Chemotherapy for Drug-Resistant Tuberculosis

Espinal, Marcos; Kim, Sang‐Jae; Suarez, Pedro; Kam, Kai Man; Khomenko, A G; Migliori, Giovanni Battista; Baéz, Janette; Kochi, Arata; Dye, Christopher; Raviglione, Mario C.

doi:10.1001/jama.283.19.2537

Cited by 436 publications

(343 citation statements)

References 9 publications

(6 reference statements)

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“…These data are in agreement with findings reported by other investigators [31][32][33][34] and permit us to question the imperious requirement for chemoprophylaxis in home contacts of patients with multiresistant strains, irrespective of age group.…”

Section: Discussionsupporting

confidence: 92%

Anti-tuberculosis drug resistance in strains of Mycobacterium tuberculosis isolated from patients in a tertiary hospital in Bahia

Matos¹,

Lemos²,

Bittencourt³

et al. 2007

Braz J Infect Dis

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Anti-tuberculosis drug resistance, particularly multiresistance, is a crucial issue in the control of tuberculosis (TB). This study estimated the prevalence of primary and acquired anti-tuberculosis drug resistance in strains of Mycobacterium tuberculosis isolated from hospitalized patients, to identify the risk factors for resistance, and to evaluate the its impact on hospital mortality for tuberculosis. Strains of Mycobacterium tuberculosis from 217 patients hospitalized for TB were analyzed. Subjects were recruited sequentially at a TB reference hospital in Salvador, Bahia, Brazil from July 2001 to July 2003. Multiresistant (MR) strains were defined as strains resistant to rifampicin and isoniazid. Of a total of 217 strains isolated, 41 (19.0%, 95%CI: 14.1-24.5%) were resistant to at least one drug. Prevalence of primary resistance was 7.0% (10/145), while a prevalence of 43.1% (31/72) was found for acquired resistance. Primary resistance to one drug alone was found in 2.1% (3/145) and acquired monoresistance in 5.6% (4/72). Prevalence of MR strains in general was 14.3% (31/217), of which 4.2% (6/145) consisted of primary MR and 34.7% (25/72) of acquired MR. Three strains showed resistance to more than one drug, but were not classified as MR. In the multivariate analysis, abandoning treatment remained strongly associated with resistance (adjusted OR: 7.21; 95%CI: 3.27-15.90; p<0.001) following adjustment for 3 potential confounders (gender, alcohol dependence and HIV-infection). An association was found between resistance and mortality from tuberculosis, even after adjustment for HIV status, age, sex and alcohol dependence (adjusted OR: 7.13; 95%CI: 2.25-22.57; p<0.001). High prevalences of resistance, principally acquired resistance including MR, were found in patients hospitalized for TB in Bahia. This finding was strongly associated with having abandoned treatment, and confirmed the need to standardize the procedure for requesting sensitivity tests in this population at the time of hospital admission.

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Section: Discussionsupporting

confidence: 92%

Anti-tuberculosis drug resistance in strains of Mycobacterium tuberculosis isolated from patients in a tertiary hospital in Bahia

Matos¹,

Lemos²,

Bittencourt³

et al. 2007

Braz J Infect Dis

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“…22,24,28,29 Bu durum bize, klinisyen olarak hastanın geldiği ortam ve topluluğun sorgulanmasının ne kadar önemli olduğunu göstermektedir. Doğu Avrupa, Rusya veya Türki Cumhuriyetleri gibi ÇİD TB insidansı yüksek olan ülkelerden gelen bir mültecide TB hastalığı saptanırsa ve İDT sonucu ÇİD görülürse kesinlikle dikkate alarak tedaviyi uygun şekilde düzenlemek gerekir.…”

Section: Discussionunclassified

“…Gerek hastanemizde gerekse ülkemizdeki diğer hastanelerde bu tür hastalarda %75-80'lere varan iyileşme oranları yakalanmıştır. [19][20][21][22][23][24] Ancak bu serilerde az da olsa (%2-3) hasta kaybedilmektedir. İDT sonucunda ÇİD saptansa dahi yüksek iyileşme olasılığı dikkate alınarak verilen klasik tedavi sonucunda oluşan bu istenmeyen durum, hasta haklarının ön plana çık-tığı günümüzde hukuksal bir sorumluluk getirebilir.…”

Section: Discussionunclassified

Drug Resistance Rates in Newly Diagnosed Adult Male Patients with Tuberculosis

Sezer¹,

Çiftçi²,

Kutlu³

et al. 2012

Turkiye Klinikleri J Med Sci

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ünümüzde tüberküloz (TB), tüm dünyada yılda dokuz milyondan fazla yeni hasta, iki milyondan fazla ölüm sayısıyla, toplum sağlığını tehdit eden en önemli enfeksiyon hastalıklarından birisidir. 1 Tüm uğ-raşlara rağmen TB ile ilgili epidemiyolojik parametrelerde önemli bir düzelme A An na ah ht ta ar r K Ke el li im me el le er r: : Tüberküloz; Mikobakteryum tüberkulozis; tüberküloz, çok ilaç direnci A AB BS ST TR RA AC CT T O Ob bj je ec ct ti iv ve e: : The aim of this study was to determine drug resistance rates in newly diagnosed military recruits with tuberculosis (TB). M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : Newly diagnosed, culture positive military men with TB who were followed up in our hospital between December 2006 and January 2010 were included in the study. Twenty nine subjects who were evaluated as recurrence were excluded. Drug susceptibility test (DST) was performed with BACTEC 460 TB in all cases. R Re es su ul lt ts s: : DST was run in 257 cases. Mean age of the cases (all males) was 21.8 ± 2.9 years. Smear and culture was positive in 197 cases and only culture was positive in 43 cases. While resistance to at least one drug was detected in 19,1% of the cases. Resistance to isoniazide (H), rifampicin (R), ethambutol (E), and streptomycin (S) was present as 15.2%, 5.8%, 6.6% and 2.7%, respectively. There was multi-drug resistance (min H + R) in 12 cases (4,7%). Other resistance rates were 0.8% for H + S, 0.4% for H + E, %1,6 for H + R + E and 1.9% for H + R + E + S. C Co on nc cl lu us si io on n: : While the level of resistance was high to H and H-R in military recruits with TB who represented the young male population of the country, resistance to other drugs or combinations was at acceptable levels. High-level multi-drug resistance seemed to have no clinical implication. Cure was achieved in most of these patients with conventional treatment scheme.

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“…Un componente fundamental de la estrategia DOTS para el control de la tuberculosis es el tratamiento supervisado con rifampicina, isoniacida, pirazinamida, en asocio con estreptomicina o etambutol. Este tratamiento puede ser inadecuado en áreas con elevada resistencia a estas drogas, pues las tasas de curación son inferiores y la morbilidad y mortalidad asociada es mayor (22)(23)(24)(25)(26).…”

Section: Discussionunclassified