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Management of MDR TB

Gunar Günther, Frank van Leth, Sofia Alexandru, Neus Altet, Korkut Avsar, Didi Bang, Raisa Barbuta, Graham Bothamley, Ana Ciobanu, Valeriu Crudu, Manfred Danilovits, Martin Dedicoat, Raquel Duarte, Gina Gualano, Heinke Kunst, Wiel de Lange, Vaira Leimane, Anne-Marie McLaughlin, Cecile Magis-Escurra, Inge Muylle, Veronika Polcová, Cristina Popa, Rudolf Rumetshofer, Alena Skrahina, Varvara Solodovnikova, Victor Spinu, Simon Tiberi, Piret Viiklepp, Christoph Lange
BACKGROUND: Multidrug-resistant tuberculosis (MDR-TB) is a major burden to public health in Europe. Reported treatment success rates are around 50% or less and cure rates are even lower. METHODS: We performed a prospective cohort study, analyzing management and treatment outcomes stratified by incidence of patients with MDR-TB in Europe. Treatment outcomes were compared by WHO and alternative simplified definitions. RESULTS: 380 patients with MDR-TB were recruited and followed-up between 2010 and 2014 in 16 European countries...
March 6, 2018: American Journal of Respiratory and Critical Care Medicine
Amal Oudghiri, Hind Karimi, Fouad Chetioui, Fathiah Zakham, Jamal Eddine Bourkadi, My Driss Elmessaoudi, Amin Laglaoui, Imane Chaoui, Mohammed El Mzibri
BACKGROUND: The emergence of extensively drug-resistant tuberculosis (XDR-TB) has raised public health concern for global TB control. Although multi drug-resistant tuberculosis (MDR- TB) prevalence and associated genetic mutations in Morocco are well documented, scarce information on XDR TB is available. Hence, the evaluation of pre-XDR and XDR prevalence, as well as the mutation status of gyrA, gyrB, rrs, tlyA genes and eis promoter region, associated with resistance to second line drugs, is of great value for better management of M/XDR TB in Morocco...
February 27, 2018: BMC Infectious Diseases
J R Francis, P Manchikanti, C C Blyth, J Denholm, C Lowbridge, C Coulter, E Donnan, R Stapledon, V L Krause, J Waring
OBJECTIVE: To describe the epidemiology and outcomes of multidrug-resistant tuberculosis (MDR-TB) diagnosed in Australia between 1998 and 2012. DESIGN: A retrospective review was undertaken involving all patients with laboratory-confirmed MDR-TB notified in Australia between 1998 and 2012 inclusive. Demographic, clinical and laboratory features are described. Clinical outcomes were defined according to World Health Organization definitions of treatment success (cure and treatment completion), treatment failure, death, loss to follow-up (including transfer out), or not evaluated at treatment completion...
March 1, 2018: International Journal of Tuberculosis and Lung Disease
Emanuele Pontali, Dina Visca, Rosella Centis, Lia D'Ambrosio, Antonio Spanevello, Giovanni Battista Migliori
PURPOSE OF REVIEW: Multidrug-resistant (MDR) tuberculosis (TB) and extensively drug-resistant (XDR)-TB epidemics are key obstacles towards TB control and elimination. RECENT FINDINGS: Diagnosis of MDR/XDR-TB is difficult and requires several weeks. New diagnostic tools are being tested and proposed allowing for shorter time to diagnosis and reduced delays in starting an adequate treatment regimen. MDR/XDR-TB treatment strategies are currently on an evolving stage...
February 20, 2018: Current Opinion in Pulmonary Medicine
Yong Chen, Zhengan Yuan, Xin Shen, Jie Wu, Zheyuan Wu, Biao Xu
In high TB-burden countries like China, the diagnosis of multidrug-resistant tuberculosis (MDR-TB) using conventional drug susceptibility testing (DST) takes months, making treatment delay inevitable. Poor outcomes of MDR-TB might be associated with delayed, even inappropriate treatment. The purpose of this study was to investigate the time to MDR-TB treatment initiation, and to assess the association between early treatment and treatment outcomes. Between April 2011 and December 2014, this population-based, retrospective cohort study collected the demographic and clinical characteristics, and the drug susceptibility profiles of all registered MDR-TB patients in Shanghai, China...
February 5, 2018: Antimicrobial Agents and Chemotherapy
Rajeswari Ramachandran, M Muniyandi
Rapid molecular diagnostic methods help in the detection of TB and Rifampicin resistance. These methods detect TB early, are accurate and play a crucial role in reducing the burden of drug resistant tuberculosis. Areas covered: This review analyses rapid molecular diagnostic tools used in the diagnosis of MDR-TB in India, such as the Line Probe Assay and GeneXpert. We have discussed the burden of MDR-TB and the impact of recent diagnostic tools on case detection and treatment outcomes. This review also discusses the costs involved in establishing these new techniques in India...
February 6, 2018: Expert Review of Anti-infective Therapy
Ming-Chih Yu, Chen-Yuan Chiang, Jen-Jyh Lee, Shun-Tien Chien, Chou-Jui Lin, Shih-Wei Lee, Chih-Bin Lin, Wen-Ta Yang, Ying-Hsun Wu, Yi-Wen Huang
Background: The proportion of treatment success among multidrug-resistant tuberculosis (MDR-TB) patients enrolled between 1992 and 1996 was 51.2%, and that among patients enrolled between 2000 and April 2007 was 61%. To address the challenge of MDR-TB, the Taiwan MDR-TB Consortium (TMTC) was established in May 2007. To assess the performance of the TMTC, we analyzed the data of patients enrolled in its first 5 years. Methods: Comprehensive care was provided at no cost to patients, who were usually hospitalized for one month initially...
January 31, 2018: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Christelle Géneviève Jouego, Valirie Ndip Agbor, Juergen Noeske, Ndo Akono Manuel, Leo Njock Ayuk
BACKGROUND: Tuberculosis remains a major cause of morbidity and mortality worldwide, especially in developing countries. The diagnosis and treatment of multi-drug resistant tuberculosis (MDR-TB) in children remain a major limitation in this setting, largely due to difficulties in isolating Mycobacterium tuberculosis from pediatric specimens, management with toxic second line drugs, and practically the inexistence of contact tracing. In 2016, the World Health Organization (WHO) recommended a standardized 9-month regimen for adults and children in zones which are highly endemic for the human immunodeficiency virus (HIV)...
January 22, 2018: BMC Research Notes
Myat K Thu, Ajay M V Kumar, Kyaw T Soe, Saw Saw, Saw Thein, Zaw Mynit, Htet M W Maung, Si T Aung
Background: Since 2011, Myanmar has adopted domiciliary care for multidrug-resistant tuberculosis (MDR-TB) patients and implemented several patient-support measures such as community-based directly observed treatment, nutritional support and financial incentives for patients and providers. We assessed treatment outcomes among MDR-TB patients registered for treatment in the Yangon and Mandalay Regions of Myanmar during 2012-2014 and factors associated with unfavourable treatment outcomes...
January 17, 2018: Transactions of the Royal Society of Tropical Medicine and Hygiene
Noura M Al-Mutairi, Suhail Ahmad, Eiman Mokaddas
Proper management of multidrug-resistant tuberculosis (MDR-TB) requires accurate drug susceptibility testing (DST) of Mycobacterium tuberculosis isolates to other (ethambutol [EMB], pyrazinamide, and streptomycin [SM]) first-line drugs. This study compared the performance of Mycobacterium Growth Indicator Tube (MGIT) 960 system for DST of MDR-TB isolates with polymerase chain reaction (PCR) sequencing of embB, rpsL, and rrs genes for detecting resistance to EMB and SM. MDR-TB strains (n = 60) and 25 pansusceptible M...
January 16, 2018: Microbial Drug Resistance: MDR: Mechanisms, Epidemiology, and Disease
Rajendra Prasad, Nikhil Gupta, Amitabh Banka
Multidrug-resistant tuberculosis (MDR-TB)/rifampicin-resistant TB (RR-TB) is human-made problem and emerging due to poor management of TB and is a threat to control of TB. Early suspicion and diagnosis are important. Culture and drug susceptibility testing are gold standards, but newer molecular methods help in rapid diagnosis. Once diagnosed, prompt treatment should be started, preferably under direct observation. Treatment can be standardized or individualized. Conventional regimen takes up to 24 months but recently shorter regimen of up to 12 months was introduced in specific subset of MDR-TB/RR-TB patients...
January 2018: Lung India: Official Organ of Indian Chest Society
Rupak Singla, Manashree Mallick, Parul Mrigpuri, Neeta Singla, Amitesh Gupta
BACKGROUND: Treatment of multidrug-resistant (MDR-TB) mainly focuses on bacteriological cure. However, only limited studies have evaluated the sequelae left after the completion of treatment among MDR-TB patients. OBJECTIVE: To assess the persistent symptoms, radiological sequelae, pulmonary function impairment and quality of life at the completion of treatment among MDR-TB patients. METHODS: Forty six MDR-TB patients were enrolled, who completed two years of treatment under programmatic management of Drug Resistant tuberculosis at a tertiary referral institute in Delhi, India...
January 2018: Lung India: Official Organ of Indian Chest Society
Pallavi Sinha, G N Srivastava, Anamika Gupta, Shampa Anupurba
Context: India is one of the high tuberculosis (TB) burden countries in the world. Improper implementation in the guidelines for the management of TB and high rate of defaults on the part of the patients are most important risk factors for the development of multi-drug resistant TB. Aims: This study examines the drug resistance profile and the effect of demographic, clinical and behavioral risk factors on the prevalence of TB and multidrug resistance (MDR) in north India...
October 2017: Journal of Global Infectious Diseases
H Simon Schaaf, Anthony J Garcia-Prats, Lindsay McKenna, James A Seddon
New and repurposed antituberculosis drugs are urgently needed to more safely and effectively treat multidrug-resistant (MDR) tuberculosis (TB) in children. Multiple challenges limit timely access to new MDR-TB treatments in children. Areas covered: Diagnosis of MDR-TB in children remains a barrier, with few children with MDR-TB diagnosed and treated. Other barriers to timely access to new and repurposed drugs are discussed, and include delayed initiation of paediatric trials, limited funding for paediatric drug development, fragmented regulatory systems and operational challenges...
December 27, 2017: Expert Review of Clinical Pharmacology
Patrick Tang, James Johnston
The treatment of latent tuberculosis infection (LTBI) is an essential component of tuberculosis (TB) elimination in regions that have a low incidence of TB. However, the decision to treat individuals with LTBI must consider the limitations of current diagnostic tests for LTBI, the risk of developing active TB disease, the potential adverse effects from chemoprophylactic therapy, and the importance of treatment adherence. When an individual has been diagnosed with LTBI and active TB has been ruled out, this is followed by an evaluation of the risks and benefits of LTBI treatment within the context of the regional epidemiology of TB and public health priorities...
2017: Current Treatment Options in Infectious Diseases
L D'Ambrosio, G Bothamley, J A Caminero Luna, R Duarte, L Guglielmetti, M Muñoz Torrico, M C Payen, N Saavedra Herrera, M A Salazar Lezama, A Skrahina, M Tadolini, S Tiberi, N Veziris, G B Migliori
As recommended by the World Health Organization (WHO), optimal management of MDR-TB cases can be ensured by a multi-speciality consultation body known as 'TB Consilium'. This body usually includes different medical specialities, competences and perspectives (e.g., clinical expertise both for adults and children; surgical, radiological and public health expertise; psychological background and nursing experience, among others), thus lowering the risk of making mistakes - or managing the patients inappropriately, in order to improve their clinical outcomes...
December 8, 2017: Revista Portuguesa de Pneumologia
Isaya Jelly, Micah D J Peters
BACKGROUND: The World Health Organization (WHO) has prioritized collaboration with communities in its 2016 "End TB" implementation strategy. Acknowledging the difficulties that some communities face in gaining access to health facilities due to barriers such as stigma, discrimination, healthcare expenditure, transport and income loss, partnering with communities in the roll-out of community-based TB management activities is vital. AIM: The aim of this project was to make a contribution to promoting evidence-based practice with regards to the community-based management of multidrug-resistant tuberculosis (MDR-TB) at Kibong'oto National Infectious Disease Hospital, Tanzania, and thereby supporting improvements in patient outcomes and resource utilization...
December 2017: JBI Database of Systematic Reviews and Implementation Reports
Linhu Li, Yuanyuan Jin, Bin Wang, Zhaoyong Yang, Mingliang Liu, Huiyuan Guo, Jun Zhang, Yu Lu
Bacterial resistance to most of the available antibiotics has stimulated the discovery of novel efficacious antibacterial agents. Bedaquiline is first of its type that has been specifically introduced for the management of MDR-TB in combination with other drugs. In this study, a series of isoniazid/ethambutol/pyrazinamide/-quinoline conjugates based on the structures of bedaquiline were designed and synthesized. Biological activity tests revealed that some of isoniazid/ethambutol/quinoline conjugates have useful antibiotic activity against MTB H37Rv (MIC: 2...
March 2018: Chemical Biology & Drug Design
Anna S Dean, Helen Cox, Matteo Zignol
As we move into the era of the Sustainable Development Goals (SDGs), the World Health Organization (WHO) has developed the End TB strategy 2016-2035 with a goal to end the global epidemic of tuberculosis (TB) by 2035. Achieving the targets laid out in the Strategy will require strengthening of the whole TB diagnosis and treatment cascade, including improved case detection, the establishment of universal drug susceptibility testing and rapid treatment initiation. An estimated 3.9% of new TB cases and 21% of previously treated cases had rifampicin-resistant (RR) or multidrug-resistant (MDR) TB in 2015...
2017: Advances in Experimental Medicine and Biology
Arif I Dela, Nitish Kumar D Tank, Anil P Singh, Kiran G Piparva
BACKGROUND: Treatment of multidrug-resistant tuberculosis (MDR-TB) requires the use of expensive and toxic second-line anti-tubercular drugs which are given for a longer duration. Adverse drug reactions (ADRs) of second-line antitubercular drugs affect compliance and thereby treatment outcome. We set out to analyze ADRs and treatment outcome of MDR-TB patients receiving directly observed treatments plus therapy. MATERIALS AND METHODS: A retrospective study of registered MDR-TB cases at district tuberculosis center during 2010-2014 was performed...
November 2017: Lung India: Official Organ of Indian Chest Society
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