Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Jul 1;59(1):9-15.
doi: 10.1093/cid/ciu209. Epub 2014 Apr 11.

Improving outcomes for multidrug-resistant tuberculosis: aggressive regimens prevent treatment failure and death

Gustavo E Velásquez  1 , Mercedes C Becerra  2 , Irina Y Gelmanova  3 , Alexander D Pasechnikov  3 , Askar Yedilbayev  3 , Sonya S Shin  4 , Yevgeny G Andreev  5 , Galina Yanova  6 , Sidney S Atwood  7 , Carole D Mitnick  2 , Molly F Franke  8 , Michael L Rich  2 , Salmaan Keshavjee  2
Affiliations

Improving outcomes for multidrug-resistant tuberculosis: aggressive regimens prevent treatment failure and death

Gustavo E Velásquez et al. Clin Infect Dis. .

Abstract

Background: Evidence is sparse regarding the optimal construction of regimens to treat multidrug-resistant (MDR) tuberculosis disease due to strains of Mycobacterium tuberculosis resistant to at least both isoniazid and rifampin. Given the low potency of many second-line antituberculous drugs, we hypothesized that an aggressive regimen of at least 5 likely effective drugs during the intensive phase, including a fluoroquinolone and a parenteral agent, would be associated with a reduced risk of death or treatment failure.

Methods: We conducted a retrospective cohort study of patients initiating MDR tuberculosis treatment between 2000 and 2004 in Tomsk, Russian Federation. We used a multivariate Cox proportional hazards model to assess whether monthly exposure to an aggressive regimen was associated with the risk of death or treatment failure.

Results: Six hundred fourteen individuals with confirmed MDR tuberculosis were eligible for analysis. On multivariable analysis that adjusted for extensively drug-resistant (XDR) tuberculosis-MDR tuberculosis isolates resistant to fluoroquinolones and parenteral agents-we found that monthly exposure to an aggressive regimen was significantly associated with a lower risk of death or treatment failure (hazard ratio, 0.52 [95% confidence interval, .29-.94]; P = .030).

Conclusions: Receipt of an aggressive treatment regimen was a robust predictor of decreased risk of death or failure during MDR tuberculosis treatment. These findings further support the use of this regimen definition as the benchmark for the standard of care of MDR tuberculosis patients and should be used as the basis for evaluating novel therapies.

Keywords: MDR-TB; clinical outcomes; drug resistance; optimized background regimen; treatment.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Death or treatment failure among patients treated for multidrug-resistant tuberculosis by time-varying monthly exposure to an aggressive regimen.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. World Health Organization. Geneva, Switzerland: WHO; 2010. Multidrug and extensively drug-resistant TB (M/XDR-TB): 2010 global report on surveillance and response. Available at: http://www.who.int/tb/publications/2010/en/index.html . Accessed 20 March 2014.
    1. Keshavjee S, Farmer PE. Picking up the pace—scale-up of MDR tuberculosis treatment programs. N Engl J Med. 2010;363:1781–4. - PubMed
    1. World Health Organization. Geneva, Switzerland: WHO; 2012. Global tuberculosis report 2012. Available at: http://www.who.int/tb/publications/global_report/en/ . Accessed 4 September 2013.
    1. Mitnick CD, Bayona JJ, Palacios EE, et al. Community-based therapy for multidrug-resistant tuberculosis in Lima, Peru. N Engl J Med. 2003;348:119–28. - PubMed
    1. Shin SS, Pasechnikov AD, Gelmanova IY, et al. Treatment outcomes in an integrated civilian and prison MDR-TB treatment program in Russia. Int J Tuberc Lung Dis. 2006;10:402–8. - PubMed

Publication types

Substances