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Observational Study
. 2019 Jan 28;19(1):94.
doi: 10.1186/s12879-019-3726-8.

Few eligible for the newly recommended short course MDR-TB regimen at a large Mumbai private clinic

Zarir F Udwadia  1 , Jeffrey A Tornheim  2 , Shashank Ganatra  3 , Andrea DeLuca  4 , Camilla S Rodrigues  3 , Amita Gupta  5
Affiliations
Observational Study

Few eligible for the newly recommended short course MDR-TB regimen at a large Mumbai private clinic

Zarir F Udwadia et al. BMC Infect Dis. .

Abstract

Background: India has the world's highest tuberculosis burden, and Mumbai is particularly affected by multidrug resistant tuberculosis (MDR-TB). WHO recommends short, intensive treatment ("Short Course") for previously untreated pulmonary MDR-TB patients but does not require universal drug susceptibility testing (DST) before Short Course. DST would likely screen out many MDR-TB patients in places like Mumbai with significant drug resistance.

Methods: MDR-TB patients at a private clinic were recruited for a prospective observational cohort. Short Course eligibility was evaluated by clinical criteria and DST results. Eligibility by DST was classified as rifampin monoresistance (as tested by Xpert MTB/RIF), rifampin, fluoroquinolones, and 2nd-line injectable drugs resistance (as tested by line probe assays) and resistance to other drugs.

Results: Of 559 participants with MDR-TB, 33% met clinical eligibility for Short Course. DST for rifampin, fluoroquinolones, and 2nd-line injectable drugs excluded 74.7% of participants. Complete phenotypic DST excluded 96.6% of participants. Prior treatment with either 1st or 2nd-line drugs did not significantly affect eligibility.

Conclusions: In a global MDR-TB hotspot, < 5% of participants with MDR-TB were appropriate for Short Course by clinical characteristics and DST results. Rapid molecular testing would not sufficiently identify drug resistance in this population. Eligibility rates were not significantly reduced by prior TB treatment.

Keywords: Bangladesh regimen; Drug susceptibility testing; MDR-TB; Short course; TB treatment.

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Conflict of interest statement

Ethics approval and consent to participate

All study participants provided written informed consent for this study, which was approved by the institutional review boards of Hinduja Hospital and Johns Hopkins University School of Medicine.

Consent for publication

Not applicable

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Prior TB Treatment Locations in India of 102 Participants with MDR-TB Treated in Mumbai, N (%). Participants with MDR-TB in this cohort received prior TB treatment throughout India, not only in Mumbai. The authors have edited an original image obtained from www.shutterstock.com (ID: 225879508)
Fig. 2
Fig. 2
Eligibility for Short Course Therapy by Clinical Criteria. Only 175 out of 530 participants with MDR-TB and full clinical data available met clinical criteria for Short Course treatment (33.0%)
See this image and copyright information in PMC

References

    1. WHO: Global Tuberculosis report 2017. In. Geneva: World Health Organization; 2017.
    1. WHO: Global Tuberculosis Report 2016. In., vol. 2016. Geneva, Switzerland: World Health Organization; 2016.
    1. WHO: WHO treatment guidelines for drug-resistant tuberculosis. In. Geneva, Switzerland: World Health Organization; 2016: 61. - PubMed
    1. RNTCP: Revised National Tuberculosis Control Program Annual Status Report Unite to end TB. In. New Delhi, India: Revised National Tuberculosis Control Program; 2017: 173.
    1. Census India 2011. Mumbai (Greater Mumbai) City Census 2011 data [http://www.census2011.co.in/census/city/365-mumbai.html].

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