Treatment outcomes of pregnant women with drug-resistant tuberculosis in Uganda: A retrospective review of 18 cases

Abstract

Background: There is a dearth of reports on drug-resistant tuberculosis (DRTB) treatment outcomes among pregnant women in tuberculosis (TB)/HIV high-burdened countries. We report treatment outcomes of 18 pregnant women with DRTB in Uganda. Methods: We reviewed charts of individuals who received DRTB treatment in Uganda across 16 DRTB treatment sites. We included all women who were pregnant during DRTB treatment and had a treatment outcome documented between 2013 and 2019. Results: There were 18 pregnant women with a mean age (standard deviation (SD)) of 27.5 (5.2) years, of whom 8 (44.4%) were HIV co-infected. Among these women, 12 (66.7%) had primary DRTB and 8 (44.4%) had multidrug-resistant TB. Levofloxacin (Lfx), Pyrazinamide, Cycloserine and Kanamycin (Kn) were the most (>78%) used drugs in the treatment regimen and the mean (SD) treatment duration was 17.6 (7.5) months. Elevated liver enzymes (81.8%, n = 11) and hearing loss (33.3%, n = 15) were the most frequently encountered drug adverse events. Treatment success was observed among 15 (83.3%) patients, 2 (11.1%) patients were lost to follow up and 1 (5.6%) patient died. Conclusion:The treatment success among pregnant women with DRTB in Uganda was high despite a high prevalence of HIV co-infection.

Treatment Outcomes Among Pregnant Patients With Multidrug-Resistant Tuberculosis

“…Our electronic database searches identified 487 records. After removal of duplicates, excluding studies by title and abstract screening and full-text review (eTable 5 in the Supplement ), 10 studies 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 were included in the meta-analysis, which included 288 pregnant patients with MDR-TB ( Figure 1 ).…”

“…The studies were conducted in 5 different countries, and the data were collected from 1996 to 2019 (eTable 6 in the Supplement ). Among the included studies, 9 were published in English, 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 and 1 was in Spanish. 23 Treatment outcomes were reported for all 10 studies, which included 275 of the 288 pregnant patients with MDR-TB ( Table 1 ).…”

Undernutrition and Treatment Success in Drug-Resistant Tuberculosis in Uganda

“…The management of DRTB in Uganda during the period under evaluation is described elsewhere. [33][34][35]…”

Authors’ reply re: Multidrug‐resistant tuberculosis during pregnancy and adverse birth outcomes: a systematic review and meta‐analysis

“…However, this recommendation is generally based on observational studies, and adequately powered randomised control trials are required to investigate the safety, tolerability and effectiveness, as well as the timing and duration, of a drug in pregnancy before widely recommending the drug for use in national TB programmes. A recent study from South Africa showed that bedaquiline exposure during pregnancy was not significantly associated with fetal and neonatal deaths, but was associated with low birthweight, which is an indication for further investigation 3 …”

“…Jana and colleagues have also suggested the use of the most effective regimens, including bedaquiline, for the treatment of MDR‐TB during pregnancy. Here, it is important to note that although pregnancy is not a contraindication for the treatment of MDR‐TB, the management of MDR‐TB during pregnancy is complex, lengthy and associated with adverse birth outcomes 3 . The safety and effectiveness of most second‐line TB medications have not been well studied as pregnant women have been generally excluded from experimental studies because of safety concerns 4 .…”