Multidrug-Resistant Tuberculosis in Patients without HIV Infection

Telzak, Edward E.; Sepkowitz, Kent A.; Alpert, Peter L.; Mannheimer, Sharon; Medard, Franz; El‐Sadr, Wafaa; Blum, Steve; Gagliardi, Antonella; Salomon, Nadim; Turett, Glenn S.

doi:10.1056/nejm199510053331404

Cited by 182 publications

(67 citation statements)

References 14 publications

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“…A subsequent study by Goble et al 20 indicated a 44% treatment failure rate among 134 evaluable patients. These results were contradicted in a study by Telzak et al 19 in which 24 of 25 MDRTB patients showed a clinical response to treatment. The difference between Telzak and colleagues' study and the previous experiments was that the subjects in Telzak and colleagues' study were earlier in the progression of TB.…”

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confidence: 76%

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Treatment of Comorbid Tuberculosis and Depression

Trenton

Currier²

2001

Prim. Care Companion CNS Disord.

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confidence: 76%

“…Most patients treated with 4-drug regimens test negative within 3 months of treatment initiation. 19 Patients who have developed MDRTB have a less favorable prognosis. In trials conducted by the British Medical Research Council, of 8 patients who had MDRTB, 5 failed treatment and 2 relapsed.…”

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confidence: 99%

Treatment of Comorbid Tuberculosis and Depression

Trenton

Currier²

2001

Prim. Care Companion CNS Disord.

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“…A national molecular service for the identification of M. tuberculosis and the detection of rifampicin resistance in smear-positive sputum was instituted after Four studies in the USA [3,4,[25][26][27] had indicated a reduced mortality (even among HIV-positive individuals) as a result of early MDRTB detection and the institution of therapy based on in-vitro drug susceptibility testing. For example, in a study of 38 mainly HIV-positive MDRTB patients, an overall response rate of 50% was seen with a median survival of 315 days [25].…”

Section: Discussionmentioning

confidence: 99%

A clinical, microbiological and economic analysis of a national service for the rapid molecular diagnosis of tuberculosis and rifampicin resistance in Mycobacterium tuberculosis

Drobniewski

Watterson

Wilson

et al. 2000

Journal of Medical Microbiology

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A clinical, microbiological and economic study of a national rapid molecular service for the identification of Mycobacterium tuberculosis and the determination of rifampicin resistance in smear-positive sputum samples (and other primary specimens) was performed. Ninety-one primary specimens, of which 55 were smear-positive sputum, were examined by molecular and conventional assays. Concordance of molecular results from smear-positive sputum specimens with tuberculosis diagnosis and rifampicin resistance by conventional analysis was 52 (94.5%) of 55 and 44 (91.7%) of 48, respectively. Concordance of molecular analysis on all primary specimens was 81 (89.0%) of 91 (diagnosis) and 55 (90.2%) of 61 (rifampicin resistance). Approximately 28 days were saved in the time to diagnosis by using the molecular assay. Hospitals can reduce the cost of inappropriate isolation of patients with risk factors for multiple drugresistant tuberculosis (MDRTB) who subsequently are shown to have drug-sensitive tuberculosis. At one hospital potential annual savings were between £50 000 and £150 000. Of the nine MDRTB cases identified, all had a previous diagnosis of tuberculosis, 78% were born overseas, 44% were known to be non-compliant with therapy, but only one case (12.5%) was HIV positive. HIV status was not significantly different between MDRTB and drug-sensitive tuberculosis cases. Over 75% of specimens were taken while the patient was on therapy. Isolates from >50% of the MDRTB cases were resistant to three or more drugs and one was resistant to seven drugs. All patients were placed on additional therapy once the molecular result was known; this was subsequently modified based on the results of in-vitro drug susceptibility testing. All survived at least 6 months of follow-up. There was no difference in the proportion of successful cultures from smear-positive samples from patients with drug-sensitive tuberculosis or MDRTB who were on therapy. Molecular rifampicin resistance assays are reliable for diagnosis in cases with smear-positive disease.

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“…However, a careful review of the three articles shows that there was no comparison, nor demonstration of better outcomes attributable to a higher number of administered drugs [24]. The only reasonable conclusion from these articles [21][22][23], as from a number of others [43][44][45][46][47][48][49], is that acceptable results are obtained prescribing more than four drugs. Nevertheless, it does not demonstrate that the use of fewer drugs would entail inferior results.…”

Section: Basis Of Tb Retreatment Regimen Developmentmentioning

confidence: 99%

Management of multidrug-resistant tuberculosis and patients in retreatment

Caminero

2005

Eur Respir J

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Retreatment of tuberculosis involves the management of entities as diverse as relapse, failure, treatment after default, and poor patient adherence to the previous treatment. The emergence of conditions for selection of resistance (failure and partial abandonment) is a matter of great concern.The development of a retreatment regimen for tuberculosis requires consideration of certain basic premises. The importance of a comprehensive and directed history of drugs taken in the past, and the limited reliability of susceptibility tests to many of these drugs, should be kept in mind. Taking this into account, and possessing a thorough knowledge of all anti-tuberculosis medications, it is possible to cure almost all patients with an appropriate retreatment regimen including a minimum of three or four drugs not previously used. Nonetheless, the treatment of these patients is so complex that it should only be carried out by experienced staff.Concern about treating tuberculosis patients with drug resistance varies greatly depending on the available resources. High-income countries should provide individual treatment regimens adapted to each patient; however, in other settings, restricted resources could justify the implementation of standardised therapeutic guidelines with second-line drugs in order to facilitate management and reduce costs.

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Multidrug-Resistant Tuberculosis in Patients without HIV Infection

Abstract: In this report from New York City, HIV-negative patients with multidrug-resistant tuberculosis, contrary to previous reports, responded well to appropriate chemotherapy, both clinically and microbiologically.

Cited by 182 publications

References 14 publications

Treatment of Comorbid Tuberculosis and Depression

Treatment of Comorbid Tuberculosis and Depression

A clinical, microbiological and economic analysis of a national service for the rapid molecular diagnosis of tuberculosis and rifampicin resistance in Mycobacterium tuberculosis

Management of multidrug-resistant tuberculosis and patients in retreatment

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