Resistance to fluoroquinolones and second-line injectable drugs: Impact on multidrug-resistant TB outcomes

Dennis Falzon, Neel Gandhi, Giovanni B. Migliori, Giovanni Sotgiu, Helen S. Cox, Timothy H. Holtz, Maria Graciela Hollm-Delgado, Salmaan Keshavjee, Kathryn DeRiemer, Rosella Centis, Lia D'Ambrosio, Christoph G. Lange, Melissa Bauer, Dick Menzies, S. D. Ahuja, D. Ashkin, M. Avendaño, R. Banerjee, M. Bauer, M. C. BecerraA. Benedetti, M. Burgos, R. Centis, E. D. Chan, C. Y. Chiang, F. Cobelens, H. Cox, L. D'Ambrosio, W. C M De Lange, D. Enarson, D. Falzon, K. L. Flanagan, J. Flood, N. Gandhi, M. L. Garcia-Garcia, R. M. Granich, M. G. Hollm-Delgado, T. H. Holtz, P. Hopewell, M. D. Iseman, L. G. Jarlsberg, S. Keshavjee, H. R. Kim, W. J. Koh, J. L. Lancaster, C. Lange, V. Leimane, C. C. Leung, J. Li, D. Menzies, G. B. Migliori, C. D. Mitnick, M. Narita, E. Nathanson, R. Odendaal, P. O'Riordan, M. Pai, D. Palmero, S. K. Park, G. Pasvol, J. M. Pena, C. Pérez-Guzmán, A. Ponce-De-Leon, M. I D Quelapio, H. T. Quy, V. Riekstina, J. Robert, S. Royce, M. Salim, H. S. Schaaf, K. J. Seung, L. Shah, K. Shean, T. S. Shim, S. S. Shin, Y. Shiraishi, J. Sifuentes-Osornio, G. Sotgiu, M. J. Strand, S. W. Sung, P. Tabarsi, T. E. Tupasi, M. H. Vargas, R. Van Altena, M. L. Van Der Walt, T. S. Van Der Werf, P. Viiklepp, J. Westenhouse, W. W. Yew, J. J. Yim

研究成果: 雜誌貢獻文章

269 引文 斯高帕斯(Scopus)

摘要

A meta-analysis for response to treatment was undertaken using individual data of multidrug-resistant tuberculosis (MDR-TB) (resistance to isoniazid and rifampicin) patients from 26 centres. The analysis assessed the impact of additional resistance to fluoroquinolones and/or second-line injectable drugs on treatment outcome. Compared with treatment failure, relapse and death, treatment success was higher in MDR-TB patients infected with strains without additional resistance (n=4763; 64%, 95%CI 57-72%) or with resistance to second-line injectable drugs only (n=1130; 56%, 95%CI 45-66%), than in those having resistance to fluoroquinolones alone (n=426; 48%, 95%CI 36-60%) or to fluoroquinolones plus second-line injectable drugs (extensively drug resistant (XDR)-TB) (n=405; 40%, 95%CI 27-53%). In XDR-TB patients, treatment success was highest if at least six drugs were used in the intensive phase (adjusted OR 4.9, 95%CI 1.4-16.6; reference fewer than three drugs) and four in the continuation phase (OR 6.1, 95%CI 1.4-26.3). The odds of success in XDR-TB patients was maximised when the intensive phase reached 6.6-9.0 months duration and the total duration of treatment 20.1-25.0 months. In XDR-TB patients, regimens containing more drugs than those recommended in MDR-TB but given for a similar duration were associated with the highest odds of success. All data were from observational studies and methodologies varied between centres, therefore, the bias may be substantial. Better quality evidence is needed to optimise regimens.

原文英語
頁(從 - 到)156-168
頁數13
期刊European Respiratory Journal
42
發行號1
DOIs
出版狀態已發佈 - 七月 1 2013
對外發佈Yes

    指紋

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

引用此

Falzon, D., Gandhi, N., Migliori, G. B., Sotgiu, G., Cox, H. S., Holtz, T. H., Hollm-Delgado, M. G., Keshavjee, S., DeRiemer, K., Centis, R., D'Ambrosio, L., Lange, C. G., Bauer, M., Menzies, D., Ahuja, S. D., Ashkin, D., Avendaño, M., Banerjee, R., Bauer, M., ... Yim, J. J. (2013). Resistance to fluoroquinolones and second-line injectable drugs: Impact on multidrug-resistant TB outcomes. European Respiratory Journal, 42(1), 156-168. https://doi.org/10.1183/09031936.00134712