K J M Aung1, A Van Deun2, E Declercq3, M R Sarker1, P K Das1, M A Hossain1, H L Rieder4. 1. Damien Foundation, Dhaka, Bangladesh. 2. Mycobacteriology Unit, Institute of Tropical Medicine, Antwerp, Belgium. 3. Damien Foundation, Brussels, Belgium. 4. International Union Against Tuberculosis and Lung Disease, Paris, France.
Abstract
SETTING: Tuberculosis (TB) program, Damien Foundation Projects, Bangladesh. OBJECTIVE: To summarize the outcome and its determinants of the first treatment for multidrug-resistant TB using a standardized regimen consisting of a minimum 9 months. DESIGN: This was a prospective, observational study of a gatifloxacin (GFX) based directly observed regimen, mainly with initial hospitalization. The 4-month intensive phase was extended until sputum smear conversion. Patients were monitored using culture for up to 2 years after treatment completion. RESULTS: Of the 515 patients who met the study inclusion criteria and were successively enrolled from 2005 to 2011, 84.4% had a bacteriologically favorable outcome. Due to extensive disease with delayed sputum conversion, only half of the patients completed treatment within 9 months; however, 95% were able to complete treatment within 12 months. Eleven patients failed or relapsed, and 93.1% of the 435 patients who were successfully treated completed at least 12 months post-treatment follow-up. The strongest risk factor for a bacteriologically unfavorable outcome was high-level fluoroquinolone (FQ) resistance, particularly when compounded by initial pyrazinamide (PZA) resistance. Low-level FQ resistance had no unfavorable effect on treatment outcome. Amplification of drug resistance occurred only once, in a patient strain that was initially only susceptible to kanamycin and clofazimine. CONCLUSION: The excellent outcome of the Bangladesh regimen was largely maintained. Bacteriological treatment failures and relapses were rare, except among patients with high-level GFX resistance, notably in the presence of PZA resistance.
SETTING:Tuberculosis (TB) program, Damien Foundation Projects, Bangladesh. OBJECTIVE: To summarize the outcome and its determinants of the first treatment for multidrug-resistant TB using a standardized regimen consisting of a minimum 9 months. DESIGN: This was a prospective, observational study of a gatifloxacin (GFX) based directly observed regimen, mainly with initial hospitalization. The 4-month intensive phase was extended until sputum smear conversion. Patients were monitored using culture for up to 2 years after treatment completion. RESULTS: Of the 515 patients who met the study inclusion criteria and were successively enrolled from 2005 to 2011, 84.4% had a bacteriologically favorable outcome. Due to extensive disease with delayed sputum conversion, only half of the patients completed treatment within 9 months; however, 95% were able to complete treatment within 12 months. Eleven patients failed or relapsed, and 93.1% of the 435 patients who were successfully treated completed at least 12 months post-treatment follow-up. The strongest risk factor for a bacteriologically unfavorable outcome was high-level fluoroquinolone (FQ) resistance, particularly when compounded by initial pyrazinamide (PZA) resistance. Low-level FQ resistance had no unfavorable effect on treatment outcome. Amplification of drug resistance occurred only once, in a patient strain that was initially only susceptible to kanamycin and clofazimine. CONCLUSION: The excellent outcome of the Bangladesh regimen was largely maintained. Bacteriological treatment failures and relapses were rare, except among patients with high-level GFX resistance, notably in the presence of PZA resistance.
Authors: Bertin C Bisimwa; Jean B Nachega; Robin M Warren; Grant Theron; John Z Metcalfe; Maunank Shah; Andreas H Diacon; Nadia A Sam-Agudu; Marcel Yotebieng; André N H Bulabula; Patrick D M C Katoto; Jean-Paul Chirambiza; Rosette Nyota; Freddy M Birembano; Eric M Musafiri; Sifa Byadunia; Esto Bahizire; Michel K Kaswa; Steven Callens; Zacharie M Kashongwe Journal: Clin Infect Dis Date: 2021-07-15 Impact factor: 9.079
Authors: Vikram Saini; Nicole C Ammerman; Yong Seok Chang; Rokeya Tasneen; Richard E Chaisson; Sanjay Jain; Eric Nuermberger; Jacques H Grosset Journal: Antimicrob Agents Chemother Date: 2019-05-24 Impact factor: 5.191
Authors: J W C Alffenaar; O W Akkerman; M S Bolhuis; M J Boeree; W C M de Lange; T S van der Werf Journal: Antimicrob Agents Chemother Date: 2015-02 Impact factor: 5.191
Authors: Rosemary V Swanson; Nicole C Ammerman; Bongani Ngcobo; John Adamson; Chivonne Moodley; Afton Dorasamy; Sashen Moodley; Zinhle Mgaga; Linda A Bester; Sanil D Singh; Deepak V Almeida; Jacques H Grosset Journal: Antimicrob Agents Chemother Date: 2016-04-22 Impact factor: 5.191