Multidrug-resistant tuberculosis treatment outcomes in Karakalpakstan, Uzbekistan: treatment complexity and XDR-TB among treatment failures.

Hdl Handle:
http://hdl.handle.net/10144/26473
Title:
Multidrug-resistant tuberculosis treatment outcomes in Karakalpakstan, Uzbekistan: treatment complexity and XDR-TB among treatment failures.
Authors:
Cox, H; Kalon, S; Allamuratova, S; Sizaire, V; Tigay, Z; Rüsch-Gerdes, S; Karimovich, H; Kebede, Y; Mills, C
Journal:
PLoS ONE
Abstract:
BACKGROUND: A pilot programme to treat multidrug-resistant TB (MDR-TB) was implemented in Karakalpakstan, Uzbekistan in 2003. This region has particularly high levels of MDR-TB, with 13% and 40% among new and previously treated cases, respectively. METHODOLOGY: This study describes the treatment process and outcomes for the first cohort of patients enrolled in the programme, between October 2003 and January 2005. Confirmed MDR-TB cases were treated with an individualised, second-line drug regimen based on drug susceptibility test results, while suspected MDR-TB cases were treated with a standardised regimen pending susceptibility results. PRINCIPAL FINDINGS: Of 108 MDR-TB patients, 87 were started on treatment during the study period. Of these, 33 (38%) were infected with strains resistant to at least one second-line drug at baseline, but none had initial ofloxacin resistance. Treatment was successful for 54 (62%) patients, with 13 (15%) dying during treatment, 12 (14%) defaulting and 8 (8%) failing treatment. Poor clinical condition and baseline second-line resistance contributed to treatment failure or death. Treatment regimens were changed in 71 (82%) patients due to severe adverse events or drug resistance. Adverse events were most commonly attributed to cycloserine, ethionamide and p-aminosalicylic acid. Extensively drug resistant TB (XDR-TB) was found among 4 of the 6 patients who failed treatment and were still alive in November 2006. CONCLUSIONS: While acceptable treatment success was achieved, the complexity of treatment and the development of XDR-TB among treatment failures are important issues to be addressed when considering scaling up MDR-TB treatment.
Affiliation:
Macfarlane Burnet Institute for Medical Research and Public Health, Melbourne, Australia.
Publisher:
PLoS
Issue Date:
2007
URI:
http://hdl.handle.net/10144/26473
DOI:
10.1371/journal.pone.0001126
PubMed ID:
17987113
Language:
en
ISSN:
1932-6203
Appears in Collections:
TB

Full metadata record

DC FieldValue Language
dc.contributor.authorCox, H-
dc.contributor.authorKalon, S-
dc.contributor.authorAllamuratova, S-
dc.contributor.authorSizaire, V-
dc.contributor.authorTigay, Z-
dc.contributor.authorRüsch-Gerdes, S-
dc.contributor.authorKarimovich, H-
dc.contributor.authorKebede, Y-
dc.contributor.authorMills, C-
dc.date.accessioned2008-05-16T09:50:30Z-
dc.date.available2008-05-16T09:50:30Z-
dc.date.issued2007-
dc.identifier.citationMultidrug-resistant tuberculosis treatment outcomes in Karakalpakstan, Uzbekistan: treatment complexity and XDR-TB among treatment failures. 2007, 2 (11):e1126 PLoS ONEen
dc.identifier.issn1932-6203-
dc.identifier.pmid17987113-
dc.identifier.doi10.1371/journal.pone.0001126-
dc.identifier.urihttp://hdl.handle.net/10144/26473-
dc.description.abstractBACKGROUND: A pilot programme to treat multidrug-resistant TB (MDR-TB) was implemented in Karakalpakstan, Uzbekistan in 2003. This region has particularly high levels of MDR-TB, with 13% and 40% among new and previously treated cases, respectively. METHODOLOGY: This study describes the treatment process and outcomes for the first cohort of patients enrolled in the programme, between October 2003 and January 2005. Confirmed MDR-TB cases were treated with an individualised, second-line drug regimen based on drug susceptibility test results, while suspected MDR-TB cases were treated with a standardised regimen pending susceptibility results. PRINCIPAL FINDINGS: Of 108 MDR-TB patients, 87 were started on treatment during the study period. Of these, 33 (38%) were infected with strains resistant to at least one second-line drug at baseline, but none had initial ofloxacin resistance. Treatment was successful for 54 (62%) patients, with 13 (15%) dying during treatment, 12 (14%) defaulting and 8 (8%) failing treatment. Poor clinical condition and baseline second-line resistance contributed to treatment failure or death. Treatment regimens were changed in 71 (82%) patients due to severe adverse events or drug resistance. Adverse events were most commonly attributed to cycloserine, ethionamide and p-aminosalicylic acid. Extensively drug resistant TB (XDR-TB) was found among 4 of the 6 patients who failed treatment and were still alive in November 2006. CONCLUSIONS: While acceptable treatment success was achieved, the complexity of treatment and the development of XDR-TB among treatment failures are important issues to be addressed when considering scaling up MDR-TB treatment.en
dc.language.isoenen
dc.publisherPLoSen
dc.rightsPublished by Public Library of Science, [url]http://www.plosone.org/[/url] Archived on this site by Open Access permissionen
dc.titleMultidrug-resistant tuberculosis treatment outcomes in Karakalpakstan, Uzbekistan: treatment complexity and XDR-TB among treatment failures.en
dc.contributor.departmentMacfarlane Burnet Institute for Medical Research and Public Health, Melbourne, Australia.en
dc.identifier.journalPLoS ONEen

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