Risk of acquired drug resistance during short-course directly observed treatment of tuberculosis in an area with high levels of drug resistance.
Affiliation
Australian International Health Institute, University of Melbourne, Australia.Issue Date
2007-06-01
Metadata
Show full item recordJournal
Clinical Infectious DiseasesAbstract
BACKGROUND: Data on the performance of standardized short-course directly observed treatment (DOTS) of tuberculosis (TB) in areas with high levels of drug resistance and on the potential impact of DOTS on amplification of resistance are limited. Therefore, we analyzed treatment results from a cross-sectional sample of patients with TB enrolled in a DOTS program in an area with high levels of drug resistance in Uzbekistan and Turkmenistan in Central Asia. METHODS: Sputum samples for testing for susceptibility to 5 first-line drugs and for molecular typing were obtained from patients starting treatment in 8 districts. Patients with sputum smear results positive for TB at the end of the intensive phase of treatment and/or at 2 months into the continuation phase were tested again. RESULTS. Among 382 patients with diagnoses of TB, 62 did not respond well to treatment and were found to be infected with an identical Mycobacterium tuberculosis strain when tested again; 19 of these patients had strains that developed new or additional drug resistance. Amplification occurred in only 1.2% of patients with initially susceptible or monoresistant TB strains, but it occurred in 17% of those with polyresistant strains (but not multidrug-resistant strains, defined as strains with resistance to at least isoniazid and rifampicin) and in 7% of those with multidrug-resistant strains at diagnosis. Overall, 3.5% of the patients not initially infected with multidrug-resistant TB strains developed such strains during treatment. Amplification of resistance, however, was found only in polyresistant Beijing genotype strains. CONCLUSIONS: High levels of amplification of drug resistance demonstrated under well-established DOTS program conditions reinforce the need for implementation of DOTS-Plus for multidrug-resistant TB in areas with high levels of drug resistance. The strong association of Beijing genotype and amplification in situations of preexisting resistance is striking and may underlie the strong association between this genotype and drug resistance.Publisher
Infectious Disease Society of AmericaDOI
10.1086/517536PubMed ID
17479936Additional Links
http://www.journals.uchicago.edu/CID/Language
enISSN
1537-6591ae974a485f413a2113503eed53cd6c53
10.1086/517536
Scopus Count
Collections
Related articles
- Tuberculosis recurrence and mortality after successful treatment: impact of drug resistance.
- Authors: Cox H, Kebede Y, Allamuratova S, Ismailov G, Davletmuratova Z, Byrnes G, Stone C, Niemann S, Rüsch-Gerdes S, Blok L, Doshetov D
- Issue date: 2006 Oct
- The effect of initial drug resistance on treatment response and acquired drug resistance during standardized short-course chemotherapy for tuberculosis.
- Authors: Seung KJ, Gelmanova IE, Peremitin GG, Golubchikova VT, Pavlova VE, Sirotkina OB, Yanova GV, Strelis AK
- Issue date: 2004 Nov 1
- Using treatment failure under effective directly observed short-course chemotherapy programs to identify patients with multidrug-resistant tuberculosis.
- Authors: Becerra MC, Freeman J, Bayona J, Shin SS, Kim JY, Furin JJ, Werner B, Sloutsky A, Timperi R, Wilson ME, Pagano M, Farmer PE
- Issue date: 2000 Feb
- Surveillance of Mycobacterium tuberculosis susceptibility to second-line drugs in Hong Kong, 1995-2002, after the implementation of DOTS-plus.
- Authors: Kam KM, Yip CW
- Issue date: 2004 Jun
- Multidrug-resistant tuberculosis in central Asia.
- Authors: Cox HS, Orozco JD, Male R, Ruesch-Gerdes S, Falzon D, Small I, Doshetov D, Kebede Y, Aziz M
- Issue date: 2004 May