Treatment Outcomes and Survival Based on Drug Resistance Patterns in Multidrug-resistant Tuberculosis

Kim, Doh Hyung; Kim, Hee Jin; Park, Seung Kyu; Kong, Suck Jun; Kim, Young Sam; Kim, Tae Hyung; Kim, Min Jung; Lee, Ki Man; Lee, Sung-Soon; Park, Jae Seuk; Koh, Won Jung; Lee, Chang Hoon; Shim, Tae Sun

doi:10.1164/rccm.200911-1656oc

Cited by 104 publications

(71 citation statements)

References 15 publications

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“…This again raises concern about the impact of fluoroquinolone resistance on poor treatment outcome. KIM et al [10], in South Korea, Data are presented as n or n (%), unless otherwise stated. XDR: extremely drug resistant; TB: tuberculosis; pre-XDR-TB: multidrug resistant-TB plus quinolone resistance without resistance against injectables.…”

Section: Discussionmentioning

confidence: 99%

“…In XDR-TB patients, a favourable outcome can vary from 20% to 60% depending upon factors such as fluoroquinolone resistance, previous TB treatment, directly observed therapy throughout, MDR-TB treatment duration and surgical resection [2][3][4]. The key drugs in the management of MDR-TB and XDR-TB patients are newer fluoroquinolones [6][7][8] and second-line injectables [9,10].…”

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confidence: 99%

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Linezolid: an effective, safe and cheap drug for patients failing multidrug-resistant tuberculosis treatment in India

Singla¹,

Caminero²,

Jaiswal³

et al. 2011

Eur Respir J

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Linezolid is identified as an effective drug with which to treat patients failing multidrug-resistant (MDR)-tuberculosis (TB) treatment. However, cost and safety are the concerns. In India, the average price of a 600-mg pill of linezolid is less than one US dollar, much cheaper than most of the third-line drugs.A prospective study of 29 MDR-TB treatment failure patients (16 with laboratory-proven extensively drug-resistant (XDR)-TB and the remaining 13 with MDR-TB with resistance to any quinolone but sensitive to injectables) was carried out in Delhi, India. All patients received daily unsupervised therapy with linezolid, one injectable agent, one fluoroquinolone and two or more other drugs.Patients received a median of six anti-mycobacterial agents. Besides linezolid, capreomycin, moxifloxacin, levofloxacin and amoxycillin-clavulanic acid were used in 41.4%, 58.6%, 41.4%, and 79.3% of patients. Out of a total of 29 patients, 89.7% patients achieved sputum smear and culture conversion; 72.4% showed interim favourable outcome; 10.3% died, 6.8% failed and 10.3% patients defaulted. Linezolid had to be stopped in three (10.3%) patients due to adverse reactions. The outcome of treatment of 16 XDR-TB patients was comparable to the other 13 MDR-TB patients.Linezolid is an effective, cheap and relatively safe drug for patients failing MDR-TB treatment, including those with confirmed XDR-TB.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Linezolid: an effective, safe and cheap drug for patients failing multidrug-resistant tuberculosis treatment in India

Singla¹,

Caminero²,

Jaiswal³

et al. 2011

Eur Respir J

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show abstract

“…The definition of XDR-TB is resistance to Isoniazid and Rifampicin plus resistance to any fluoroquinolone and at least one of the three injectable second-line drugs used in TB treatment (amikacin, kanamycin, or capreomycin). Pre-XDR is a term given for strains which have a susceptibility in between MDR and XDR with resistance to either Fluoroquinolone or any one of the injectable second line drugs, in addition to INH and Rifampicin [4].…”

Section: Introductionmentioning

confidence: 99%

A Comparative Study of Drug Susceptibility Testing Techniques for Identification of Drug Resistant TB in a Tertiary Care Centre, South India

Kumar¹,

Srinivasa²,

Chiramal³

2017

JTR

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India tops the global list for Drug resistant Tuberculosis, but inadequate and expensive laboratory culture techniques have led to delay in the diagnosis and treatment. We studied the potential of an alternative method which could be cost-effective by combining the drugs in the same tube for identification of drug resistance. Drug Susceptibility Test (DST) results of 1000 sputum samples are got from suspected TB patients against INH (isoniazid) and Rifampicin by two techniques: a) a modified technique with both drugs in the same MGIT tube and b) a standard technique with the antibiotics in separate MGIT tubes for the diagnosis of MDR-TB (Multidrug Resistant). 39 samples were contaminated and were excluded from final analysis. 198 were smear positives by the concentrated Ziehl-Neelsen's staining method. 219 were found to be culture positive out of which 195 were identified as M. tuberculosis complex. 40 (20.5%) strains were identified as MDR-TB by the conventional method and 39 were picked up by the modified DST. INH and Rifampicin mono-resistance accounted for 32 (16.4%) and 4 (2%) respectively. 99% concordance was observed between the two tests in categorizing MDR-TB. Similarly modified technique with combination of the second line Antibiotics-Ofloxacin, Kanamycin and Capreomycin was applied on the identified MDR strains in a stepwise manner. 6 (15%) were identified as Pre-XDR strains and 2 (5%) were found to be XDR-TB strains. This study implies that combining drugs in the same tube may be an equivalent and possibly a cost-effective alternative which needs to be explored further.

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“…TB is treatable however drug resistant forms to rifampin as well as multi and extensively drug resistant strains are growing at a significant rate. The success rate of treating MDR and XDR is lower than susceptible forms with a rate of 48% and 29% respectively [1]. In addition the rise in incidence of non-tuberculous mycobacterium in patients who are immunocompromised and in vulnerable populations such as sickle cell disease by mycobacterium avium and mucogenicum infections are reported [9].…”

Section: Introductionmentioning

confidence: 99%

Is Iron Overload a Risk Factor for Mycobacterium Tuberculosis and a Potential Target of Therapy?

Shemisa

2017

JMEN

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Mycobacterium TB infection remains a significant global health problem. The increase in resistant forms of TB to once effective antibiotics has called for improved understanding of the organism's metabolism and host response to help develop new therapeutic strategies. Clinical observations have identified patients with iron overload that are at higher risk for mycobacterium tuberculosis and may have a greater risk of mortality. Understanding mechanisms of iron homeostasis have led to important experiments addressing the pathogenicity of mycobacterial species. Conditions that favor high iron concentrations serve to promote mycobacterial growth and render a survival advantage for the pathogen. Iron trafficking in the host is a complex process but serves as an important feature in the host immune response.In-vitro studies demonstrate Siderocalin molecules interfere with the function of pathogenic siderophores and inhibit the growth of mycobacterium tuberculosis. Thus, exciting therapeutic opportunities exist in the potential targeting of siderophores. In addition determining patient-specific hepcidin activity may be useful in ascertaining risk for mycobacterial infection in endemic regions.

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Treatment Outcomes and Survival Based on Drug Resistance Patterns in Multidrug-resistant Tuberculosis

Cited by 104 publications

References 15 publications

Linezolid: an effective, safe and cheap drug for patients failing multidrug-resistant tuberculosis treatment in India

Linezolid: an effective, safe and cheap drug for patients failing multidrug-resistant tuberculosis treatment in India

A Comparative Study of Drug Susceptibility Testing Techniques for Identification of Drug Resistant TB in a Tertiary Care Centre, South India

Is Iron Overload a Risk Factor for Mycobacterium Tuberculosis and a Potential Target of Therapy?

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