BACKGROUND: In Tomsk Oblast, Russian Federation, during the period of 1996-2000, most previously untreated patients with tuberculosis received standardized short-course chemotherapy, irrespective of drug-susceptibility testing results. A retrospective analysis was done to determine the effect of initial drug resistance on treatment outcome and acquired drug resistance in new patients receiving standardized short-course chemotherapy. METHODS: During the period of 1 November 1996 through 31 December 2000, a total of 2194 patients received a category 1 treatment regimen. Drug susceptibility test results for 1681 patients were available for analysis. Drug resistance patterns before and during treatment were compared for 73 patients whose culture results were persistently positive during treatment. Acquired resistance was defined as new drug resistance (during or at the end of treatment) that was not present at the beginning of treatment. RESULTS: Pretreatment drug resistance was strongly associated with treatment failure. In patients who had strains with pretreatment resistance patterns that included isoniazid or rifampin resistance, but not resistance to both, 17 (70.8%) of 24 cases involving treatment failures acquired new multidrug resistance. In patients with pretreatment pan-susceptible or streptomycin-monoresistant strains, 13 (41.9%) of 31 cases involving treatment failures acquired new multidrug resistance. CONCLUSIONS: Early diagnosis of drug-resistant tuberculosis and judicious use of second-line drugs is recommended to decrease transmission of drug-resistant strains and to prevent the creation of multidrug-resistant strains. Finally, if drug susceptibility tests are not available or results are delayed, physicians should recognize that patients who do not respond to directly observed empirical short-course chemotherapy are at high risk of having multidrug-resistant tuberculosis and should be treated accordingly.
BACKGROUND: In Tomsk Oblast, Russian Federation, during the period of 1996-2000, most previously untreated patients with tuberculosis received standardized short-course chemotherapy, irrespective of drug-susceptibility testing results. A retrospective analysis was done to determine the effect of initial drug resistance on treatment outcome and acquired drug resistance in new patients receiving standardized short-course chemotherapy. METHODS: During the period of 1 November 1996 through 31 December 2000, a total of 2194 patients received a category 1 treatment regimen. Drug susceptibility test results for 1681 patients were available for analysis. Drug resistance patterns before and during treatment were compared for 73 patients whose culture results were persistently positive during treatment. Acquired resistance was defined as new drug resistance (during or at the end of treatment) that was not present at the beginning of treatment. RESULTS: Pretreatment drug resistance was strongly associated with treatment failure. In patients who had strains with pretreatment resistance patterns that included isoniazid or rifampin resistance, but not resistance to both, 17 (70.8%) of 24 cases involving treatment failures acquired new multidrug resistance. In patients with pretreatment pan-susceptible or streptomycin-monoresistant strains, 13 (41.9%) of 31 cases involving treatment failures acquired new multidrug resistance. CONCLUSIONS: Early diagnosis of drug-resistant tuberculosis and judicious use of second-line drugs is recommended to decrease transmission of drug-resistant strains and to prevent the creation of multidrug-resistant strains. Finally, if drug susceptibility tests are not available or results are delayed, physicians should recognize that patients who do not respond to directly observed empirical short-course chemotherapy are at high risk of having multidrug-resistant tuberculosis and should be treated accordingly.
Authors: Aditya Sharma; Andrew Hill; Ekaterina Kurbatova; Martie van der Walt; Charlotte Kvasnovsky; Thelma E Tupasi; Janice C Caoili; Maria Tarcela Gler; Grigory V Volchenkov; Boris Y Kazennyy; Olga V Demikhova; Jaime Bayona; Carmen Contreras; Martin Yagui; Vaira Leimane; Sang Nae Cho; Hee Jin Kim; Kai Kliiman; Somsak Akksilp; Ruwen Jou; Julia Ershova; Tracy Dalton; Peter Cegielski Journal: Lancet Infect Dis Date: 2017-05-09 Impact factor: 25.071
Authors: Alistair D Calver; Alecia A Falmer; Megan Murray; Odelia J Strauss; Elizabeth M Streicher; Madelene Hanekom; Thelma Liversage; Mothusi Masibi; Paul D van Helden; Robin M Warren; Thomas C Victor Journal: Emerg Infect Dis Date: 2010-02 Impact factor: 6.883
Authors: Courtney M Yuen; Arielle W Tolman; Ted Cohen; Jonathan B Parr; Salmaan Keshavjee; Mercedes C Becerra Journal: Pediatr Infect Dis J Date: 2013-05 Impact factor: 2.129
Authors: I Y Gelmanova; S Keshavjee; V T Golubchikova; V I Berezina; A K Strelis; G V Yanova; S Atwood; M Murray Journal: Bull World Health Organ Date: 2007-09 Impact factor: 9.408
Authors: Francine Matthys; Leen Rigouts; Vinciane Sizaire; Natalia Vezhnina; Maryvonne Lecoq; Vera Golubeva; Françoise Portaels; Patrick Van der Stuyft; Michael Kimerling Journal: PLoS One Date: 2009-11-23 Impact factor: 3.240