Isoniazid-resistant tuberculosis in Birmingham, United Kingdom, 1999–2010

Munang, Melinda; Kariuki, Mimie; Dedicoat, Martin

doi:10.1093/qjmed/hcu139

Cited by 16 publications

(11 citation statements)

References 17 publications

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“…We found success rates of 92% (95% CI: 86%-97%) for all treatments, which is higher than comparable literature of 85% [8,[15][16][17]. It is also important to recognize that in the three patients non-adherent with therapy, the prescribed duration was based on the recommendation of the treating clinician guided by available evidence at the time of care.…”

Section: Discussioncontrasting

confidence: 54%

“…The need remains for data from randomized controlled trials. Treatment success of Hr-TB is roughly 80-85% [8,[15][16][17] compared with 90-95% for drug-susceptible disease [18]. As such, we sought to review the epidemiology, incidence, and outcomes of various treatment regimens over 11 years in a multicentre, low incidence, western Canadian region.…”

Section: Introductionmentioning

confidence: 99%

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Incidence, treatment, and outcomes of isoniazid mono-resistant Mycobacterium tuberculosis infections in Alberta, Canada from 2007-2017

Edwards

Cooper

et al. 2020

PLoS ONE

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Isoniazid resistant Mycobacterium tuberculosis (Hr-TB) is the most frequently encountered TB resistance phenotype in North America but limited data exist on the effectiveness of current therapeutic regimens. Ineffective treatment of Hr-TB increases patient relapse and antimycobacterial resistance, specifically MDR-TB. We undertook a multi-centre, retrospective review of culture-positive Hr-TB patients in Alberta, Canada (2007-2017). We assessed incidence and treatment outcomes, with a focus on fluoroquinolone (FQ)-containing regimens, to understand the risk of unsuccessful outcomes. Rates of Hr-TB were determined using the midyear provincial population and odds of unsuccessful treatment was calculated using a Fisher's Exact test. One hundred eight patients of median age 37 years (IQR: 26-50) were identified with Hr-TB (6.3%), 98 of whom were able to be analyzed. Seven percent reported prior treatment. Rate of foreign birth was high (95%), but continent of origin did not predict Hr-TB (p = 0.47). Mean compliance was 95% with no difference between FQ and non-FQ regimens (p = 1.00). Treatment success was high (91.8%). FQ-containing regimens were frequently initiated (70%), with no difference in unsuccessful outcomes compared to non-FQ-containing regimens (5.8% vs. 13.8%, OR 0.4, 95% CI 0.1-2.3, p = 0.23). Only one patient (1%) utilizing a less common non-FQ-based regimen including two months of pyrazinamide developed secondary multidrug resistance. Unsuccessful treatment was low (<10%) relative to comparable literature (~15%) and showed similar outcomes for FQ and non-FQ-based regimens and no deficit to those using intermittent fluoroquinolones in the continuation phase of treatment. Our findings are similar to recent data, however prospective, randomized trials of adequate power are needed to determine the optimal treatment for Hr-TB.

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Section: Discussioncontrasting

confidence: 54%

Section: Introductionmentioning

confidence: 99%

Incidence, treatment, and outcomes of isoniazid mono-resistant Mycobacterium tuberculosis infections in Alberta, Canada from 2007-2017

Edwards

Cooper

et al. 2020

PLoS ONE

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“…The latter study (15) also found that 61% of all patients with poor treatment outcomes developed multidrug-resistant TB. However, most studies have found that the treatment regimens prescribed to patients with INH-resistant TB in clinical practice vary considerably (10,12,13,17,19). The favorable treatment outcomes in these studies ranged from approximately 80% to 98% (10,12,13,17,19).…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, various individualized treatment regimens are widely used by attending clinicians, without sufficient clinical evidence (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). Although the use of four or more effective drugs in the intensive phase and the use of at least three effective drugs during the continuation phase have been associated with fewer unfavorable outcomes (6), the currently recommended treatment regimen for INH-resistant TB usually consists of two or three effective drugs (7)(8)(9).…”

mentioning

confidence: 99%

Treatment Outcomes with Fluoroquinolone-Containing Regimens for Isoniazid-Resistant Pulmonary Tuberculosis

Lee

Jeong

Jeon

et al. 2016

Antimicrob Agents Chemother

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“…In this retrospective analysis of drug resistant isolates from Botswana, it is shown that there is a high proportion of rifampicin (R) and isoniazid (H) monoresistance posing an increased risk of the development of MDR-TB [21,22]. It was observed that 7% (4/57) of the isolates were pre-XDR-TB.…”

Section: Discussionmentioning

confidence: 99%

Detection of Second Line Drug Resistance among Drug Resistant Mycobacterium Tuberculosis Isolates in Botswana

et al. 2019

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The emergence and transmission of multidrug resistant (MDR) and extensively drug resistant (XDR) Mycobacterium tuberculosis (M.tb) strains is a threat to global tuberculosis (TB) control. The early detection of drug resistance is critical for patient management. The aim of this study was to determine the proportion of isolates with additional second-line resistance among rifampicin and isoniazid resistant and MDR-TB isolates. A total of 66 M.tb isolates received at the National Tuberculosis Reference Laboratory between March 2012 and October 2013 with resistance to isoniazid, rifampicin or both were analyzed in this study. The genotypes of the M.tb isolates were determined by spoligotyping and second-line drug susceptibility testing was done using the Hain Genotype MTBDRsl line probe assay version 2.0. The treatment outcomes were defined according to the Botswana national and World Health Organization (WHO) guidelines. Of the 57 isolates analyzed, 33 (58%) were MDR-TB, 4 (7%) were additionally resistant to flouroquinolones and 3 (5%) were resistant to both fluoroquinolones and second-line injectable drugs. The most common fluoroquinolone resistance-conferring mutation detected was gyrA A90V. All XDR-TB cases remained smear or culture positive throughout the treatment. Our study findings indicate the importance of monitoring drug resistant TB cases to ensure rapid detection of second-line drug resistance.

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Isoniazid-resistant tuberculosis in Birmingham, United Kingdom, 1999–2010

Cited by 16 publications

References 17 publications

Incidence, treatment, and outcomes of isoniazid mono-resistant Mycobacterium tuberculosis infections in Alberta, Canada from 2007-2017

Incidence, treatment, and outcomes of isoniazid mono-resistant Mycobacterium tuberculosis infections in Alberta, Canada from 2007-2017

Treatment Outcomes with Fluoroquinolone-Containing Regimens for Isoniazid-Resistant Pulmonary Tuberculosis

Detection of Second Line Drug Resistance among Drug Resistant Mycobacterium Tuberculosis Isolates in Botswana

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