Association between Regimen Composition and Treatment Response in Patients with Multidrug-Resistant Tuberculosis: A Prospective Cohort Study
PLOS Medicine December 29, 2015
Courtney M. Yuen, Ekaterina V. Kurbatova, Thelma Tupasi, Janice Campos Caoili, Martie Van Der Walt, Charlotte Kvasnovsky, Martin Yagui, Jaime Bayona, Carmen Contreras, Vaira Leimane, Julia Ershova, Laura E. Via, HeeJin Kim
World Health Organization (WHO) guidelines for the treatment of multidrug-resistant tuberculosis (MDR TB) recommend a regimen consisting of at least four second-line drugs that are likely to be effective as well as pyrazinamide . In the absence of drug susceptibility testing (DST) results for a patient’s isolate, likely effectiveness is determined based on previous exposure to a drug, background resistance levels to that drug in the community, and, in patients who were contacts to other known cases, DST results for an associated case. Furthermore, the guidelines indicate that only marginal benefit has been observed for regimens based directly on the DST results for a patient’s isolate .
A meta-analysis of cohort studies of patients with MDR TB reported that in vitro susceptibility to individual drugs was consistently and statistically significantly associated with higher odds of treatment success compared to in vitro resistance, suggesting clinical utility for DST in regimen design . In addition, the use of baseline DST results to design individualized regimens involving prolonged use of five or more drugs with likely effectiveness has been associated with decreased risks of treatment failure, death, and relapse among patient cohorts in Peru and the Russian Federation [3–5]. Together, this evidence suggests the need to reassess both the role of DST in regimen design as well as the potential benefit of including more drugs in MDR TB regimens….
Entry filed under: Antimicrobianos, Biología Molecular, CONSENSOS, Epidemiología, F.O.D, GUIDELINES, Infecciones emergentes, Infecciones respiratorias, Metodos diagnosticos, Micobacterias, Resistencia bacteriana, Update.