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Initiation treatment on treatment outcome MDR TB

Dina Nair, Pooranaganga D Navneethapandian, Jaya Prasad Tripathy, Anthony D Harries, Joel S Klinton, Basilea Watson, Gomathi N Sivaramakrishnan, Devarajulu S Reddy, Lakshmi Murali, Mohan Natrajan, Soumya Swaminathan
BACKGROUND: India is replacing culture and drug sensitivity testing (CDST) with rapid molecular tests for diagnosing MDR-TB. We assessed the impact of rapid tests on time to initiation of treatment and outcomes in patients with MDR-TB compared with CDST. METHODS: A retrospective cohort study involving MDR-TB patients from six districts in Tamil Nadu state, who underwent CDST (2010-2011) and rapid tests (2012-2013). RESULTS: There were 135 patients in the CDST group and 389 in the rapid diagnostic test group...
October 13, 2016: Transactions of the Royal Society of Tropical Medicine and Hygiene
Amber Kunkel, Frank G Cobelens, Ted Cohen
BACKGROUND: New drugs for the treatment of tuberculosis (TB) are becoming available for the first time in over 40 y. Optimal strategies for introducing these drugs have not yet been established. The objective of this study was to compare different strategies for introducing the new TB drug bedaquiline based on patients' resistance patterns. METHODS AND FINDINGS: We created a Markov decision model to follow a hypothetical cohort of multidrug-resistant (MDR) TB patients under different bedaquiline use strategies...
October 2016: PLoS Medicine
Arshad Javaid, Mazhar Ali Khan, Mir Azam Khan, Sumaira Mehreen, Anila Basit, Raza Ali Khan, Muhammad Ihtesham, Irfan Ullah, Afsar Khan, Ubaid Ullah
OBJECTIVE: To assess the profile of TB/multidrug-resistant TB (MDR-TB) among household contacts of MDR-TB patients. METHODS: Close contacts of MDR-TB patients were traced in the cross-sectional study. Different clinical, radiological and bacteriological were performed to rule out the evidence of TB/MDR-TB. RESULTS: Between January 2012 and December 2012, a total of 200 index MDR-TB patients were initiated on MDR-TB treatment, out of which home visit and contacts screening were conducted for 154 index cases...
September 2016: Asian Pacific Journal of Tropical Medicine
Nesri Padayatchi, Naressa Naidu, Nonhlanhla Yende-Zuma, Max Roe OʼDonnell, Kogieleum Naidoo, Stanton Augustine, Alimuddin Zumla, Marian Loveday
BACKGROUND: The Xpert MTB/RIF assay has been widely implemented in South Africa for rapid tuberculosis (TB) screening. However, its usefulness in management and improving treatment outcomes in patients with multidrug-resistant TB (MDR-TB) remains undefined. The aim of this study was to evaluate the clinical impact of introduction of the Xpert MTB/RIF assay in patients with MDR-TB. METHODS: We enrolled 921 patients with MDR-TB, who presented to a specialist drug-resistant TB facility in KwaZulu-Natal, South Africa, pre- and post-rollout and implementation of the Xpert MTB/RIF assay...
September 1, 2016: Journal of Acquired Immune Deficiency Syndromes: JAIDS
Carole D Mitnick, Carly A Rodriguez, Marita L Hatton, Grania Brigden, Frank Cobelens, Martin P Grobusch, Robert Horsburgh, Christoph Lange, Christian Lienhardt, Eyal Oren, Laura J Podewils, Barbara Seaworth, Susan van den Hof, Charles L Daley, Agnes C Gebhard, Fraser Wares
INTRODUCTION: There are numerous challenges in delivering appropriate treatment for multidrug-resistant tuberculosis (MDR-TB) and the evidence base to guide those practices remains limited. We present the third updated Research Agenda for the programmatic management of drug-resistant TB (PMDT), assembled through a literature review and survey. METHODS: Publications citing the 2008 research agenda and normative documents were reviewed for evidence gaps. Gaps were formulated into questions and grouped as in the 2008 research agenda: Laboratory Support, Treatment Strategy, Programmatically Relevant Research, Epidemiology, and Management of Contacts...
2016: PloS One
Rebecca C Harris, Louis Grandjean, Laura J Martin, Alexander J P Miller, Joseph-Egre N Nkang, Victoria Allen, Mishal S Khan, Katherine Fielding, David A J Moore
BACKGROUND: Globally it is estimated that 480 000 people developed multidrug-resistant tuberculosis (MDR-TB) in 2014 and 190 000 people died from the disease. Successful treatment outcomes are achieved in only 50 % of patients with MDR-TB, compared to 86 % for drug susceptible disease. It is widely held that delay in time to initiation of treatment for MDR-TB is an important predictor of treatment outcome. The objective of this review was to assess the existing evidence on the outcomes of multidrug- and extensively drug-resistant tuberculosis patients treated early (≤4 weeks) versus late (>4 weeks) after diagnosis of drug resistance...
2016: BMC Infectious Diseases
Platon Eliseev, Grigory Balantcev, Elena Nikishova, Anastasia Gaida, Elena Bogdanova, Donald Enarson, Tara Ornstein, Anne Detjen, Russell Dacombe, Elena Gospodarevskaya, Patrick P J Phillips, Gillian Mann, Stephen Bertel Squire, Andrei Mariandyshev
BACKGROUND: In the Arkhangelsk region of Northern Russia, multidrug-resistant (MDR) tuberculosis (TB) rates in new cases are amongst the highest in the world. In 2014, MDR-TB rates reached 31.7% among new cases and 56.9% among retreatment cases. The development of new diagnostic tools allows for faster detection of both TB and MDR-TB and should lead to reduced transmission by earlier initiation of anti-TB therapy. STUDY AIM: The PROVE-IT (Policy Relevant Outcomes from Validating Evidence on Impact) Russia study aimed to assess the impact of the implementation of line probe assay (LPA) as part of an LPA-based diagnostic algorithm for patients with presumptive MDR-TB focusing on time to treatment initiation with time from first-care seeking visit to the initiation of MDR-TB treatment rather than diagnostic accuracy as the primary outcome, and to assess treatment outcomes...
2016: PloS One
Marian Loveday, Babu Sunkari, Ben J Marais, Iqbal Master, James C M Brust
BACKGROUND: The diagnosis of drug-resistant tuberculosis (DR-TB) in children is challenging and treatment is associated with many adverse effects. OBJECTIVE: We aimed to assess if careful observation, without initiation of second-line treatment, is safe in asymptomatic children referred with 'culture-confirmed' DR-TB. SETTING: KwaZulu-Natal, South Africa-an area with high burdens of HIV, TB and DR-TB. DESIGN, INTERVENTION AND MAIN OUTCOME MEASURES: We performed an outcome review of children with 'culture-confirmed' DR-TB who were not initiated on second-line TB treatment, as they were asymptomatic with normal chest radiographs on examination at our specialist referral hospital...
July 2016: Archives of Disease in Childhood
Lina Yi, Takashi Yoshiyama, Masao Okumura, Kozo Morimoto, Yuka Sasaki, Yuji Shiraishi, Hideo Ogata, Satoshi Mitarai
Linezolid (LZD) is classified as a WHO group 5 drug used in the treatment of tuberculosis (TB). Although its efficacy and long-term safety have not yet been established, it is being increasingly used in the treatment of multidrug resistant tuberculosis (MDR-TB) and extensive multidrug-resistant tuberculosis (XDR-TB). The current study is a single-center retrospective clinical analysis of hospitalized M/XDR-TB patients in Fukujuji Hospital involving 26 patients (18 males and 8 females) consecutively treated with combinations of anti-TB drugs including LZD from 2009 to 2015...
March 18, 2016: Japanese Journal of Infectious Diseases
Dominique Cadosch, Pia Abel Zur Wiesch, Roger Kouyos, Sebastian Bonhoeffer
Treatment failure after therapy of pulmonary tuberculosis (TB) infections is an important challenge, especially when it coincides with de novo emergence of multi-drug-resistant TB (MDR-TB). We seek to explore possible causes why MDR-TB has been found to occur much more often in patients with a history of previous treatment. We develop a mathematical model of the replication of Mycobacterium tuberculosis within a patient reflecting the compartments of macrophages, granulomas, and open cavities as well as parameterizing the effects of drugs on the pathogen dynamics in these compartments...
March 2016: PLoS Computational Biology
Jingtao Gao, Yan Ma, Jian Du, Guofeng Zhu, Shouyong Tan, Yanyong Fu, Liping Ma, Lianying Zhang, Feiying Liu, Daiyu Hu, Yanling Zhang, Xiangqun Li, Liang Li, Qi Li
BACKGROUNDS: The failure of current Standard Short-Course Chemotherapy (SCC) in new and previously treated cases with tuberculosis (TB) was mainly due to drug resistance development. But little is known on the characteristics of acquired drug resistant TB during SCC and its correlation with SCC failure. The objective of the study is to explore the traits of acquired drug resistant TB emergence and evaluate their impacts on treatment outcomes. METHODS: A prospective observational study was performed on newly admitted smear positive pulmonary TB (PTB) cases without drug resistance pretreatment treated with SCC under China's National TB Control Program (NTP) condition from 2008 to 2010...
2016: BMC Pulmonary Medicine
S K Heysell, O B Ogarkov, S Zhdanova, E Zorkaltseva, S Shugaeva, J Gratz, S Vitko, E D Savilov, M E Koshcheyev, E R Houpt
SETTING: A referral hospital for tuberculosis (TB) in Irkutsk, the Russian Federation. OBJECTIVE: To describe disease characteristics, treatment and hospital outcomes of TB-HIV (human immunodeficiency virus). DESIGN: Observational cohort of HIV-infected patients admitted for anti-tuberculosis treatment over 6 months. RESULTS: A total of 98 patients were enrolled with a median CD4 count of 147 cells/mm(3) and viral load of 205 943 copies/ml...
February 2016: International Journal of Tuberculosis and Lung Disease
Dmytro О Butov, Mikhail M Kuzhko, Irina М Kalmykovа, Irina М Kuznetsova, Tatyana S Butova, Olena О Grinishina, Olga А Maksimenko
BACKGROUND: There is a paucity of published data on the effect of TB chemotherapy on nitric oxide (NO) synthesis and metabolism in newly diagnosed and relapsed patients with or without multi-drug resistant tuberculosis (MDRTB). METHODS: The pattern of NO response in 140 patients with pulmonary TB, including 74 with MDR-TB and 66 without MDR-TB has been studied and compared to the NO status of 30 healthy donors. Patients comprised those with newly diagnosed TB and recurrent or relapsed TB...
June 2014: International Journal of Mycobacteriology
Courtney M Yuen, Ekaterina V Kurbatova, Thelma Tupasi, Janice Campos Caoili, Martie Van Der Walt, Charlotte Kvasnovsky, Martin Yagui, Jaime Bayona, Carmen Contreras, Vaira Leimane, Julia Ershova, Laura E Via, HeeJin Kim, Somsak Akksilp, Boris Y Kazennyy, Grigory V Volchenkov, Ruwen Jou, Kai Kliiman, Olga V Demikhova, Irina A Vasilyeva, Tracy Dalton, J Peter Cegielski
BACKGROUND: For treating multidrug-resistant tuberculosis (MDR TB), the World Health Organization (WHO) recommends a regimen of at least four second-line drugs that are likely to be effective as well as pyrazinamide. WHO guidelines indicate only marginal benefit for regimens based directly on drug susceptibility testing (DST) results. Recent evidence from isolated cohorts suggests that regimens containing more drugs may be beneficial, and that DST results are predictive of regimen effectiveness...
December 2015: PLoS Medicine
K-C Chang, W-W Yew, G Sotgiu
To supplement previous state-of-art reviews on anti-tuberculosis treatment and to pave the way forward with reference to the current status, we systematically reviewed published literature on clinical research on tuberculosis (TB) over the past decade in the treatment of drug-susceptible and multidrug-resistant TB (MDR-TB), with a focus on drugs, dosing factors and regimens. Our review was restricted to Phase II/III clinical trials, cohort and case-control studies, and systematic reviews of clinical studies...
December 2015: International Journal of Tuberculosis and Lung Disease
Habteyes Hailu Tola, Davoud Shojaeizadeh, Gholamreza Garmaroudi, Azar Tol, Mir Saeed Yekaninejad, Luche Tadesse Ejeta, Abebaw Kebede, Mehrdad Karimi, Desta Kassa
BACKGROUND: Psychological distress is the major comorbidity among tuberculosis (TB) patients. However, its magnitude, associated factors, and effect on treatment outcome have not been adequately studied in low-income countries. OBJECTIVE: This study aimed to determine the magnitude of psychological distress and its effect on treatment outcome among TB patients on treatment. DESIGN: A follow-up study was conducted in Addis Ababa, Ethiopia, from May to December 2014...
2015: Global Health Action
Baba Maiyaki Musa, Denny John, Abdulrazaq G Habib, Andreas Kuznik
OBJECTIVE: To compare the cost of facility-based MDR TB care (F) to home-based care (H) from the perspective of the Nigerian national health system. METHODS: We assessed the expected costs of the two MDR TB treatment approaches using a decision-analytic model with a follow-up of 6 months. MDR TB treatment outcomes were obtained from a systematic review of randomised clinical trials. The outcomes of interest included treatment success, treatment failure, treatment default and mortality and did not vary significantly between the two alternatives...
February 2016: Tropical Medicine & International Health: TM & IH
Johnny Flippie Daniels, Mohammed Khogali, Erika Mohr, Vivian Cox, Sizulu Moyo, Mary Edginton, Sven Gudmund Hinderaker, Graeme Meintjes, Jennifer Hughes, Virginia De Azevedo, Gilles van Cutsem, Helen Suzanne Cox
SETTING: Khayelitsha, South Africa, with high burdens of rifampicin-resistant tuberculosis (RR-TB) and HIV co-infection. OBJECTIVE: To describe time to antiretroviral treatment (ART) initiation among HIV-infected RR-TB patients initiating RR-TB treatment and to assess the association between time to ART initiation and treatment outcomes. DESIGN: A retrospective cohort study of patients with RR-TB and HIV co-infection not on ART at RR-TB treatment initiation...
2015: PloS One
Teye Umanah, Jabulani Ncayiyana, Xavier Padanilam, Peter S Nyasulu
BACKGROUND: Multidrug resistant-tuberculosis (MDR-TB) is a threat to global tuberculosis control which is worsened by human immune-deficiency virus (HIV) co-infection. There is however paucity of data on the effects of antiretroviral treatment (ART) before or after starting MDR-TB treatment. This study determined predictors of mortality and treatment failure among HIV co-infected MDR-TB patients on ART. METHODS: A retrospective medical record review of 1200 HIV co-infected MDR-TB patients admitted at Sizwe Tropical Disease Hospital, Johannesburg from 2007 to 2010 was performed...
October 28, 2015: BMC Infectious Diseases
Daniel Meressa, Rocío M Hurtado, Jason R Andrews, Ermias Diro, Kassim Abato, Tewodros Daniel, Paritosh Prasad, Rebekah Prasad, Bekele Fekade, Yared Tedla, Hanan Yusuf, Melaku Tadesse, Dawit Tefera, Abraham Ashenafi, Girma Desta, Getachew Aderaye, Kristian Olson, Sok Thim, Anne E Goldfeld
BACKGROUND: In Africa, fewer than half of patients receiving therapy for multidrug-resistant TB (MDR TB) are successfully treated, with poor outcomes reported for HIV-coinfected patients. METHODS: A standardised second-line drug (SLD) regimen was used in a non-governmental organisation-Ministry of Health (NGO-MOH) collaborative community and hospital-based programme in Ethiopia that included intensive side effect monitoring, adherence strategies and nutritional supplementation...
December 2015: Thorax
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