A Trébucq1, V Schwoebel1, Z Kashongwe2, A Bakayoko3, C Kuaban4, J Noeske5, S Hassane6, B Souleymane6, A Piubello6, F Ciza7, V Fikouma8, M Gasana9, M Ouedraogo10, M Gninafon11, A Van Deun12, D M Cirillo13, K G Koura14, H L Rieder15. 1. International Union Against Tuberculosis and Lung Disease, Paris, France. 2. Bukavu University, Bukavu, Democratic Republic of Congo. 3. Centre hospitalier universitaire (CHU) Treichville, Abidjan, Côte d'Ivoire. 4. Bamenda University, Bamenda. 5. Independent Consultant, Yaoundé, Cameroon. 6. Action Damien, Niamey, Niger. 7. Action Damien, Bujumbura, Burundi. 8. Bangui University, Bangui, Central African Republic. 9. National Tuberculosis Programme, Kigali, Rwanda. 10. CHU Yo, Ouagadougou, Burkina-Faso. 11. National Tuberculosis Programme, Cotonou, Benin. 12. Mycobacteriology Unit, Institute of Tropical Medicine, Antwerp, Belgium. 13. Emerging Bacterial Pathogens, Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Scientific Institute, Milan, Italy. 14. International Union Against Tuberculosis and Lung Disease, Paris, France, Unité mixte de Recherche 216, Institut de Recherche pour le Développement, Paris, Communauté d'Universités et Etablissements Sorbonne Paris Cité, Université Paris Descartes, Faculté des Sciences Pharmaceutiques et Biologiques, Paris, France. 15. Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
Abstract
SETTING: Nine countries in West and Central Africa. OBJECTIVE: To assess outcomes and adverse drug events of a standardised 9-month treatment regimen for multidrug-resistant tuberculosis (MDR-TB) among patients never previously treated with second-line drugs. DESIGN: Prospective observational study of MDR-TB patients treated with a standardised 9-month regimen including moxifloxacin, clofazimine, ethambutol (EMB) and pyrazinamide (PZA) throughout, supplemented by kanamycin, prothionamide and high-dose isoniazid during an intensive phase of a minimum of 4 to a maximum of 6 months. RESULTS: Among the 1006 MDR-TB patients included in the study, 200 (19.9%) were infected with the human immunodeficiency virus (HIV). Outcomes were as follows: 728 (72.4%) cured, 93 (9.2%) treatment completed (81.6% success), 59 (5.9%) failures, 78 (7.8%) deaths, 48 (4.8%) lost to follow-up. The proportion of deaths was much higher among HIV-infected patients (19.0% vs. 5.0%). Treatment success did not differ by HIV status among survivors. Fluoroquinolone resistance was the main cause of failure, while resistance to PZA, ethionamide or EMB did not influence bacteriological outcome. The most important adverse drug event was hearing impairment (11.4% severe deterioration after 4 months). CONCLUSIONS: The study results support the use of the short regimen recently recommended by the World Health Organization. Its high level of success even among HIV-positive patients promises substantial improvements in TB control.
SETTING: Nine countries in West and Central Africa. OBJECTIVE: To assess outcomes and adverse drug events of a standardised 9-month treatment regimen for multidrug-resistant tuberculosis (MDR-TB) among patients never previously treated with second-line drugs. DESIGN: Prospective observational study of MDR-TBpatients treated with a standardised 9-month regimen including moxifloxacin, clofazimine, ethambutol (EMB) and pyrazinamide (PZA) throughout, supplemented by kanamycin, prothionamide and high-dose isoniazid during an intensive phase of a minimum of 4 to a maximum of 6 months. RESULTS: Among the 1006 MDR-TBpatients included in the study, 200 (19.9%) were infected with the human immunodeficiency virus (HIV). Outcomes were as follows: 728 (72.4%) cured, 93 (9.2%) treatment completed (81.6% success), 59 (5.9%) failures, 78 (7.8%) deaths, 48 (4.8%) lost to follow-up. The proportion of deaths was much higher among HIV-infectedpatients (19.0% vs. 5.0%). Treatment success did not differ by HIV status among survivors. Fluoroquinolone resistance was the main cause of failure, while resistance to PZA, ethionamide or EMB did not influence bacteriological outcome. The most important adverse drug event was hearing impairment (11.4% severe deterioration after 4 months). CONCLUSIONS: The study results support the use of the short regimen recently recommended by the World Health Organization. Its high level of success even among HIV-positivepatients promises substantial improvements in TB control.
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Authors: Payam Nahid; Sundari R Mase; Giovanni Battista Migliori; Giovanni Sotgiu; Graham H Bothamley; Jan L Brozek; Adithya Cattamanchi; J Peter Cegielski; Lisa Chen; Charles L Daley; Tracy L Dalton; Raquel Duarte; Federica Fregonese; C Robert Horsburgh; Faiz Ahmad Khan; Fayez Kheir; Zhiyi Lan; Alfred Lardizabal; Michael Lauzardo; Joan M Mangan; Suzanne M Marks; Lindsay McKenna; Dick Menzies; Carole D Mitnick; Diana M Nilsen; Farah Parvez; Charles A Peloquin; Ann Raftery; H Simon Schaaf; Neha S Shah; Jeffrey R Starke; John W Wilson; Jonathan M Wortham; Terence Chorba; Barbara Seaworth Journal: Am J Respir Crit Care Med Date: 2019-11-15 Impact factor: 21.405
Authors: Nicole C Ammerman; Rosemary V Swanson; Elaine M Bautista; Deepak V Almeida; Vikram Saini; Till F Omansen; Haidan Guo; Yong Seok Chang; Si-Yang Li; Asa Tapley; Rokeya Tasneen; Sandeep Tyagi; Fabrice Betoudji; Chivonne Moodley; Bongani Ngcobo; Logan Pillay; Linda A Bester; Sanil D Singh; Richard E Chaisson; Eric Nuermberger; Jacques H Grosset Journal: Antimicrob Agents Chemother Date: 2018-06-26 Impact factor: 5.191
Authors: Kathleen F Walsh; Ariadne Souroutzidis; Stalz Charles Vilbrun; Miranda Peeples; Guy Joissaint; Sobieskye Delva; Pamphile Widmann; Gertrude Royal; Jake Pry; Heejung Bang; Jean W Pape; Serena P Koenig Journal: Am J Trop Med Hyg Date: 2019-02 Impact factor: 2.345