Multidrug resistant tuberculosis treatment outcome in children in developing and developed countries: A systematic review and meta-analysis

Tola, Habteyes Hailu; Khadoura, Khalid Jamal; Jimma, Worku; Majdzadeh, Reza

doi:10.1016/j.ijid.2020.03.064

Cited by 13 publications

(14 citation statements)

References 24 publications

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“…A total of 35 (16.4%) participants of this study died. This was consistent with the death rate (16%) among children and adolescent MDR-TB patients reported from India [ 10 ], but above the rates reported from Peru (4.3%) [ 9 ], by a meta-analysis of 1343 childhood MDR-TB patients (8%) [ 11 ] and a study from South Africa (2%) [ 6 ]. In our study, none of the participants was LTFU.…”

Section: Discussionsupporting

confidence: 86%

“…Furthermore, it was above the success rates (range: 40.5–76.9%) reported among MDR-TB patients (adults and children combined) treated with LTR in Pakistan [ 17 – 21 ]. However, it was lower than the success rate observed among childhood MDR-TB patients in South Africa (92%) [ 6 ] and the pooled treatment success rate observed in developed countries (87%) [ 11 ]. A total of 35 (16.4%) participants of this study died.…”

Section: Discussionmentioning

confidence: 88%

“…The treatment success rate (81.7%) in the current cohort was above the target set by WHO (> 75%) and success rates observed among children and adolescent MDR-TB patients in India (62%) [ 10 ], children MDR-TB patients in Peru (77.3%) [ 9 ] and pooled treatment success rate of childhood MDR-TB (73%) in developing countries [ 11 ]. Furthermore, it was above the success rates (range: 40.5–76.9%) reported among MDR-TB patients (adults and children combined) treated with LTR in Pakistan [ 17 – 21 ].…”

Section: Discussionmentioning

confidence: 96%

“…The previously published very few individual cohorts of childhood MDR-TB patients have reported variable rates of successful treatment outcomes (range 62–92%) [ 6 , 9 , 10 ]. A systematic review and meta-analysis of 1413 childhood MDR-TB patients has reported a pooled treatment success rate of 73% in developing and 87% in developed countries [ 11 ]. An individual patients’ data meta-analysis of 975 childhood MDR-TB patients has reported a treatment success rate of 78% [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

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High rate of successful treatment outcomes among childhood rifampicin/multidrug-resistant tuberculosis in Pakistan: a multicentre retrospective observational analysis

et al. 2021

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Background There was a complete lack of information about the treatment outcomes of rifampicin/multidrug resistant (RR/MDR) childhood TB patients (age ≤ 14 years) from Pakistan, an MDR-TB 5th high burden country. Therefore, this study evaluated the socio-demographic characteristics, drug resistance pattern, treatment outcomes and factors associated with unsuccessful outcomes among childhood RR/MDR-TB patients in Pakistan. Methods This was a multicentre retrospective record review of all microbiologically confirmed childhood RR/MDR-TB patients (age ≤ 14 years) enrolled for treatment at seven units of programmatic management of drug-resistant TB (PMDT) in Pakistan. The baseline and follow-up information of enrolled participants from treatment initiation until the end of treatment were retrieved from electronic nominal recording and reporting system. World Health Organization (WHO) defined criterion was used for deciding treatment outcomes. The outcomes of “cured” and “treatment completed” were collectively grouped as successful, whereas “death”, “treatment failure” and “lost to follow-up” were grouped together as unsuccessful outcomes. Multivariable binary logistic regression analysis was used to find factors associated with unsuccessful outcomes. A p-value < 0.05 reflected statistically significant findings. Results A total of 213 children RR/MDR-TB (84 RR and 129 MDR-TB) were included in the study. Majority of them were females (74%), belonged to the age group 10–14 years (82.2%) and suffered from pulmonary TB (85.9%). A notable proportion (37.1%) of patients had no history of previous TB treatment. Patients were resistant to a median of two drugs (interquartile range: 1–4) and 23% were resistant to any second line anti-TB drug. A total of 174 (81.7%) patients achieved successful treatment outcomes with 144 (67.6%) patients being cured and 30 (14.1%) declared treatment completed. Among the 39 (18.3%) patients with unsuccessful outcomes, 35 (16.4%) died and 4 (1.9%) experienced treatment failure. In multivariable analysis, the use of ethambutol had statistically significant negative association with unsuccessful outcomes (odds ratio = 0.36, p-value = 0.02). Conclusions In this study, the WHO target of successful treatment outcomes (≥ 75%) among childhood RR/MDR-TB patients was achieved. The notable proportion of patients with no history of previous TB treatment (37.1%) and the disproportionately high number of female patients (74%) respectively stress for infection control measures and provision of early and high quality care for female drug susceptible TB patients.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

High rate of successful treatment outcomes among childhood rifampicin/multidrug-resistant tuberculosis in Pakistan: a multicentre retrospective observational analysis

et al. 2021

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“…Healthcare workers, care givers or parents are required to be trained accordingly, because most of the children may not be able to report the drug-associated ADRs. The MDR-TB treatment outcomes in children are well achieved in many countries by using the currently available drugs [32,33]. However, the improvement of the MDR-TB treatment programme can be achieved by: (1) implementing targeted or cohort event monitoring of adverse events, with the use of MDR-TB drugs in children; and…”

Section: Prevalence Of Adverse Events Associated With Second-line Anti-tb Drugs In Childrenmentioning

confidence: 99%

Adverse Drug Reactions Associated with Anti-Tuberculosis Therapy

Kalaiselvan¹,

Shukla²,

Kumar³

et al. 2021

New Insights Into the Future of Pharmacoepidemiology and Drug Safety

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The pharmacovigilance has been evolved as a professional and ethical practice in ensuring the safety of medicines. The Adverse Drug Reactions (ADRs) associated with the use of medicines including Anti-Tuberculous Therapy (ATT) through a robust system of pharmacovigilance helps in promoting the safety of patients at large. The occurrence of ADRs associated with the use of ATT is expected, a large number of medicines are combined and used for prolonged duration. The suspected ADRs associated with first line ATT are well documented. However, the drugs used in second line or multidrug resistant to tuberculosis (TB), namely bedaquiline, reported to cause QT prolongation in electrocardiogram reading as one of the most common ADRs. Therefore, early identification and prevention of ADRs during ATT is essential for promoting the rational use and reduce the burden of anti-microbial resistance, besides achieving better treatment outcomes.

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Treatment Outcomes Among Pregnant Patients With Multidrug-Resistant Tuberculosis

et al. 2022

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Key Points Question What are the treatment outcomes and adverse events among pregnant patients with multidrug-resistant tuberculosis (MDR-TB)? Findings In a systematic review and meta-analysis of 10 studies including 275 pregnant patients with MDR-TB, the pooled proportion of treatment success was 72.5%, and the pooled proportion of favorable pregnancy outcomes was 73.2%. Adverse events, such as liver function impairment, kidney function impairment, hearing loss, and hypokalemia, were common among pregnant patients with MDR-TB, occurring in more than half of the patients. Meaning This study suggests that a high rate of treatment success and favorable pregnancy outcomes can be achieved when pregnant patients with MDR-TB are treated with effective regimens.

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Multidrug resistant tuberculosis treatment outcome in children in developing and developed countries: A systematic review and meta-analysis

Cited by 13 publications

References 24 publications

High rate of successful treatment outcomes among childhood rifampicin/multidrug-resistant tuberculosis in Pakistan: a multicentre retrospective observational analysis

High rate of successful treatment outcomes among childhood rifampicin/multidrug-resistant tuberculosis in Pakistan: a multicentre retrospective observational analysis

Adverse Drug Reactions Associated with Anti-Tuberculosis Therapy

Treatment Outcomes Among Pregnant Patients With Multidrug-Resistant Tuberculosis

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