Comprehensive Treatment of Extensively Drug-Resistant Tuberculosis

Abstract

BACKGROUND Extensively drug-resistant tuberculosis has been reported in 45 countries, including countries with limited resources and a high burden of tuberculosis. We describe the management of extensively drug-resistant tuberculosis and treatment outcomes among patients who were referred for individualized outpatient therapy in Peru. METHODS A total of 810 patients were referred for free individualized therapy, including drug treatment, resective surgery, adverse-event management, and nutritional and psychosocial support. We tested isolates from 651 patients for extensively drug-resistant tuberculosis and developed regimens that included five or more drugs to which the infecting isolate was not resistant. RESULTS Of the 651 patients tested, 48 (7.4%) had extensively drug-resistant tuberculosis; the remaining 603 patients had multidrug-resistant tuberculosis. The patients with extensively drug-resistant tuberculosis had undergone more treatment than the other patients (mean [±SD] number of regimens, 4.2±1.9 vs. 3.2±1.6; P<0.001) and had isolates that were resistant to more drugs (number of drugs, 8.4±1.1 vs. 5.3±1.5; P<0.001). None of the patients with extensively drug-resistant tuberculosis were coinfected with the human immunodeficiency virus (HIV). Patients with extensively drug-resistant tuberculosis received daily, supervised therapy with an average of 5.3±1.3 drugs, including cycloserine, an injectable drug, and a fluoroquinolone. Twenty-nine of these patients (60.4%) completed treatment or were cured, as compared with 400 patients (66.3%) with multidrug-resistant tuberculosis (P=0.36). CONCLUSIONS Extensively drug-resistant tuberculosis can be cured in HIV-negative patients through outpatient treatment, even in those who have received multiple prior courses of therapy for tuberculosis.

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

“…The six studies where at least 50% of the XDR-TB patients received a later generation of fluoroquinolones showed a median favourable outcome of 59% [2], clearly less than 72% of the interim favourable outcomes of our study. The best outcomes published to date regarding XDR-TB patients have been achieved by KWON et al [22] in Korea (67% in 27 patients) and by MITNICK et al [23] in Peru (60% in 48 patients); both are inferior to our study results. In contrast to the study in Peru [23], our patients did not have good nutritional and psychosocial support.…”

“…The best outcomes published to date regarding XDR-TB patients have been achieved by KWON et al [22] in Korea (67% in 27 patients) and by MITNICK et al [23] in Peru (60% in 48 patients); both are inferior to our study results. In contrast to the study in Peru [23], our patients did not have good nutritional and psychosocial support. Also, the treatment was not fully supervised.…”

iniBAC induction Is Vitamin B12- and MutAB-dependent in Mycobacterium marinum

“…In the past several antibiotics that target the mycobacterial cell wall have been identified and have proven to be effective in treatment of tuberculosis. Well known examples of specific anti-cell wall antibiotics for mycobacteria are ethambutol (EMB) 2 …”

Synthesis and SAR evaluation of novel thioridazine derivatives active against drug-resistant tuberculosis

“…[4] As a consequence of these transgressions, and after half a century of little to no innovation in the field, MTB have developed multi-drug resistant (MDR), [5][6][7] extensively-drug resistant (XDR) [8] and totallydrug resistant (TDR) [9] strains, which are resistant to almost all the known available drugs. In 2012, the quinoline derivative bedaquiline [10][11] became the first new drug launched in the market in the last 40 years, since the discovery of rifampin.…”