Despite a relatively high TB incidence (76 cases per 100,000 population in 2009), both TB and MDR-TB rates are actually decreasing under the local TB control programme [5]. MDR- and XDR-TB need prolonged treatment duration, from 18 to 24 months after sputum culture conversion, as recommended by the World Health Organization (WHO) [2]. The relapse rate (4.3% with mean follow-up of 5.7 yrs) observed among successfully treated MDR-TB patients in the present cohort was considerably higher than the overall relapse rates among TB patients in Hong Kong (0.9% in 2.5 yrs) [7], but lower than in a MDR-TB series in Peru (5.2% in 2 yrs) [8]. endobj MDR-TB REGIMEN FEATURES OF THE SHORTER MDR-TB REGIMEN Standardized s horter MDR -TB regimen with seven drugs and a treatment duration of 9 -12 months Indicated conditionally in MDR- TB or rifampicin resistant -TB, regardless of patient age or HIV status Monitoring for … Drug-Resistant TB (MDR TB) MMWR; Title Format; Treatment of Drug-Resistant Tuberculosis … In the subgroup analysis based on the susceptibility pattern stratifying M. tuberculosis strains into four groups (table 1), MDR strains with additional resistance to either fluoroquinolone or second-line injectables (but not both) did not appear to have a higher relapse rate. Tuberculosis in humans and its epidemiology, diagnosis and treatment in the United States. The duration of treatment for MDR-TB currently recommended by WHO is based on expert opinion and not on evidence from randomised controlled trials. The study was approved by the Ethics Committee of the Department of Health, Hong Kong. Cases were among patients who were alive and initiated therapy at diagnosis and who... At 12 months, the cumulative completion of therapy among patients with drug-susceptible, isoniazid-monoresistant, rifampin-monoresistant, or MDR TB was 87.6%, 81.0%, 17.4%, and 1.9%, respectively (Figure). The 15th day of the month was assigned as the day treatment started or ended if that information was missing. We categorized cases as isoniazid monoresistant; rifampin monoresistant; multidrug resistant (MDR), defined as resistant to at least isoniazid and rifampin; or drug susceptible, defined as susceptible to isoniazid, rifampin, and ethambutol and with no known resistance to pyrazinamide (i.e., pyrazinamide susceptible or missing test results). The remaining 386 (3.8%) cases were excluded from analysis because the patients had pyrazinamide-monoresistant TB, suggestive of Mycobacterium bovis infection (165), or they were missing susceptibility testing results for isoniazid, rifampin, or ethambutol (112) or had other resistance patterns (109). Treatment duration was shortest for patients with drug-susceptible TB (median 252 days), compared with a median of 274, 555, and 766 days for patients with isoniazid-monoresistant, rifampin-monoresistant, and MDR TB, respectively. WHO/HTM/ TB/2008. The present longitudinal analysis of a MDR-TB cohort under treatment in a programmatic setting has limitations inherent to the study design. The final clinical status of successful patients (cured or having completed treatment) and the survival status of the entire cohort were ascertained until December 31, 2009. Please use the form below to submit correspondence to the authors or contact them at the following address: Carla A. Winston, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Mailstop E91, Atlanta, GA 30333, USA. Our studies also suggested that shorter treatment duration (mean duration 14 months) might be feasible in selected MDR-TB patients. The length of TB treatment duration in the United States has improved since therapy outcomes were first recorded in the National TB Surveillance System in 1993. Noncavitary disease at baseline (p = 0.048), and sputum culture conversion at the second (p = 0.009) and third (p = 0.013) months after initiation of MDR-TB treatment were associated with the use of a shorter duration (≤15 months) of treatment in these non-XDR patients. Of all included subjects, 187 (69.3%) patients were cured or completed treatment, 26 (9.6%) died during treatment, 45 (16.7%) defaulted on treatment (with median treatment duration 5 months, range 0.5–18 months), nine (3.3%) were transferred out and three (1.1%) had treatment failure. The choice of drug regimens and their durations could have been confounded by differences in baseline characteristics and treatment response. All except two of these patients (both with additional resistance to second-line injectables alone) were given ≥18 months of treatment under our programmatic setting. 2 0 obj Topical areas of uncertainty on the composition and duration of longer MDR-TB regimens for adults and children, on when the standardized 9-12 month shorter MDR-TB regimen may be offered and the use of culture to monitor treatment response were included in the scope. Treatment Duration for Patients with Drug-Resistant Tuberculosis, United States. At 24 months, 73.9% of patients with rifampin-monoresistant TB and 40.2% with MDR TB had completed treatment. The excess relapse rate for XDR-TB underscores the importance of key XDR-TB-defining drugs in the treatment regimen, as previously demonstrated by other studies [9, 10]. Emergency Update 2008. . There were 70 known deaths (26 during treatment and 44 after treatment completion) after a mean±sd follow-up duration of 6.7±3.4 yrs: 12 (44.4%) in XDR-TB and 58 (23.9%) in other MDR-TB patients (p = 0.021). [6]. A statement of interest for W.W. Yewcanbe found atwww.erj.ersjournals.com/site/misc/statements.xhtml. We found no change in treatment duration by drug-resistance pattern after removing cases of meningeal TB or cases in children from analysis. Besides regular follow-up of patients, defaulters were also tracked through the territory-wide TB notification registry and death registry to ensure more complete ascertainment of the relevant study end-points. In our previous studies, we found that the use of ofloxacin/levofloxacin-containing regimens had a favourable effect on MDR-TB outcome [3, 4]. Among the non-XDR, MDR-TB patients successfully treated, the mortality rate was 14.4% (14 patients) after treatment completion in those who received ≤15 months of treatment versus 25.3% (20 patients) in those received >15 months of treatment (Chi-squared p = 0.07).

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