Management of patients with multidrug-resistant/extensively drug-resistant tuberculosis in Europe: a TBNET consensus statement

Abstract

The emergence of multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis (TB) substantially challenges TB control, especially in the European Region of the World Health Organization, where the highest prevalence of MDR/XDR cases is reported. The current management of patients with MDR/XDR-TB is extremely complex for medical, social and public health systems. The treatment with currently available anti-TB therapies to achieve relapse-free cure is long and undermined by a high frequency of adverse drug events, suboptimal treatment adherence, high costs and low treatment success rates. Availability of optimal management for patients with MDR/XDR-TB is limited even in the European Region. In the absence of a preventive vaccine, more effective diagnostic tools and novel therapeutic interventions the control of MDR/XDR-TB will be extremely difficult. Despite recent scientific advances in MDR/XDR-TB care, decisions for the management of patients with MDR/XDR-TB and their contacts often rely on expert opinions, rather than on clinical evidence. This document summarises the current knowledge on the prevention, diagnosis and treatment of adults and children with MDR/XDR-TB and their contacts, and provides expert consensus recommendations on questions where scientific evidence is still lacking.

Figure 1–

Percentage of notified tuberculosis (TB) cases with multidrug resistance among all TB cases with drug susceptibility results in the World Health Organization European Region, 2011. Note that the data from Azerbaijan, Italy, Kyrgyzstan, Serbia, Spain, Tajikistan, Turkey, Turkmenistan and Uzbekistan cover only part of the country, and may therefore not be representative and should be interpreted with care. In addition, note that data from the United Nations Administrated Province of Kosovo (in accordance with Security Council Resolution 1244 (1999)) is not included in the figures reported for Serbia. Reproduced from [7] with permission from the publisher.

Figure 2–

Choosing an initial drug regimen for the treatment of patients with suspected/confirmed multidrug-resistant (MDR)/extensively drug-resistant (XDR) tuberculosis (TB). DST: drug susceptibility testing; M. tuberculosis: Mycobacterium tuberculosis.

Figure 3–

Association of the duration of initial intensive phase and total treatment with adjusted odds of treatment success in patients with multidrug-resistant tuberculosis. aOR: adjusted odds ratio. Data from [178].