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Meta-Analysis
. 2012 Jun;39(6):1511-9.
doi: 10.1183/09031936.00125711. Epub 2011 Oct 17.

Multidrug resistance after inappropriate tuberculosis treatment: a meta-analysis

Marieke J van der Werf  1 , Miranda W Langendam, Emma Huitric, Davide Manissero
Affiliations
Free PMC article
Meta-Analysis

Multidrug resistance after inappropriate tuberculosis treatment: a meta-analysis

Marieke J van der Werf et al. Eur Respir J. 2012 Jun.
Free PMC article

Abstract

We conducted a systematic review and meta-analysis to assess the evidence for the postulation that inappropriate tuberculosis (TB) regimens are a risk for development of multidrug-resistant (MDR)-TB. MEDLINE, EMBASE and other databases were searched for relevant articles in January 2011. Cohort studies including TB patients who received treatment were selected and data on treatment regimen, drug susceptibility testing results and genotyping results before treatment and at failure or relapse were abstracted from the articles. Four studies were included in the systematic review and two were included in the meta-analysis. In these two studies the risk of developing MDR-TB in patients who failed treatment and used an inappropriate treatment regimen was increased 27-fold (RR 26.7, 95% CI 5.0-141.7) when compared with individuals who received an appropriate treatment regimen. This review provides evidence that supports the general opinion that the development of MDR-TB can be caused by inadequate treatment, given the drug susceptibility pattern of the Mycobacterium tuberculosis bacilli. It should be noted that only two studies provided data for the meta-analysis. The information can be used to advocate for adequate treatment for patients based on drug resistance profiles.

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Conflict of interest statement

Statement of Interest

None declared.

Figures

Figure 1–
Figure 1–
Summary of literature search and study selection. TB: tuberculosis; MDR: multidrug resistant; DST: drug susceptibility testing.
Figure 2–
Figure 2–
Forest and meta-analysis of the two included studies showing the risk ratio (RR) of inappropriate treatment and risk of developing multidrug-resistant tuberculosis. IV: inverse variance.
See this image and copyright information in PMC

References

    1. Wright A, Zignol M, Van DA, et al. Epidemiology of antituberculosis drug resistance 2002–07: an updated analysis of the Global Project on Anti-Tuberculosis Drug Resistance Surveillance. Lancet 2009; 373: 1861–1873 - PubMed
    1. Dobler CC, Marks GB, Simpson SE, et al. Recurrence of tuberculosis at a Sydney chest clinic between 1994 and 2006: reactivation or reinfection?. Med J Aust 2008; 188: 153–155 - PubMed
    1. Verver S, Warren RM, Beyers N, et al. Rate of reinfection tuberculosis after successful treatment is higher than rate of new tuberculosis. Am J Respir Crit Care Med 2005; 171: 1430–1435 - PubMed
    1. van Embden JD, Cave MD, Crawford JT, et al. Strain identification of Mycobacterium tuberculosis by DNA fingerprinting: recommendations for a standardized methodology. J Clin Microbiol 1993; 31: 406–409 - PMC - PubMed
    1. Frothingham R, Meeker-O'Connell WA. Genetic diversity in the Mycobacterium tuberculosis complex based on variable numbers of tandem DNA repeats. Microbiology 1998; 144: 1189–1196 - PubMed

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