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. 2021 Mar 31:12:640555.
doi: 10.3389/fphar.2021.640555. eCollection 2021.

Treatment Outcomes of Extensively Drug-Resistant Tuberculosis in Pakistan: A Countrywide Retrospective Record Review

Muhammad Abubakar  1 , Nafees Ahmad  1 , Abdul Ghafoor  2 , Abdullah Latif  3 , Izaz Ahmad  4 , Muhammad Atif  5 , Fahad Saleem  1 , Shereen Khan  6 , Amjad Khan  7 , Amer Hayat Khan  8
Affiliations

Treatment Outcomes of Extensively Drug-Resistant Tuberculosis in Pakistan: A Countrywide Retrospective Record Review

Muhammad Abubakar et al. Front Pharmacol. .

Abstract

Background: The current study is conducted with the aim to the fill the gap of information regarding treatment outcomes and variables associated with unsuccessful outcome among XDR-TB patients from Pakistan. Methods: A total of 404 culture confirmed XDR-TB patients who received treatment between 1st May 2010 and June 30, 2017 at 27 treatment centers all over Pakistan were retrospectively followed until their treatment outcomes were reported. A p-value <0.05 reflected a statistical significant association. Results: The patients had a mean age 32.9 ± 14.1 years. The overall treatment success rate was 40.6% (95% confidence interval [CI]:35.80-45.60%). A total of 155 (38.4%) patients were declared cured, 9 (2.2%) completed treatment, 149 (36.9%) died, 60 (14.9%) failed treatment and 31 (7.7%) were lost to follow up (LTFU). The results of the multivariate binary logistic regression analysis revealed that the patients' age of >60 years (OR = 4.69, 95%CI:1.57-15.57) and receiving high dose isoniazid (OR = 2.36, 95%CI:1.14-4.85) had statistically significant positive association with death, whereas baseline body weight >40 kg (OR = 0.43, 95%CI:0.25-0.73) and sputum culture conversion in the initial two months of treatment (OR = 0.33, 95%CI:0.19-0.58) had statistically significant negative association with death. Moreover, male gender had statistically significant positive association (OR = 1.92, 95%CI:1.04-3.54) with LTFU. Conclusion: The treatment success rate (40.6%) of XDR-TB patients in Pakistan was poor. Providing special attention and enhanced clinical management to patients with identified risk factors for death and LTFU in the current cohort may improve the treatment outcomes.

Keywords: XDR-TB; death; high-dose isoniazid; sputum culture conversion; treatment outcomes.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Enrolment, inclusion and exclusion of study participants. DST, drug susceptibility testing; FQ fluoroquinolones; SLI, second-line injectables; XDR-TB, extensively drug resistant tuberculosis
See this image and copyright information in PMC

References

    1. Abbate E., Vescovo M., Natiello M., Cufré M., García A., Gonzalez Montaner P., et al. (2012). Successful alternative treatment of extensively drug-resistant tuberculosis in Argentina with a combination of linezolid, moxifloxacin and thioridazine. J. Antimicrob. Chemother. 67, 473–477. 10.1093/jac/dkr500 - DOI - PubMed
    1. Ahmad N., Javaid A., Basit A., Afridi A. K., Khan M. A., Ahmad I., et al. (2015). Management and treatment outcomes of MDR-TB: results from a setting with high rates of drug resistance. Int. J. Tuberc. Lung Dis. 19, 1109–1114. 10.5588/ijtld.15.0167 - DOI - PubMed
    1. Alene K. A., Yi H., Viney K., McBryde E. S., Yang K., Bai L., et al. (2017). Treatment outcomes of patients with multidrug-resistant and extensively drug resistant tuberculosis in Hunan Province, China. BMC Infect. Dis. 17, 573. 10.1186/s12879-017-2662-8 - DOI - PMC - PubMed
    1. Byrd R. P., Jr., Mehta J. B., Roy T. M. (2002). Malnutrition and pulmonary tuberculosis . Clin. Infect. Dis.: Official Publ. Infect. Dis. Soc. Am. 35, 634–635. 10.1086/342314 - DOI - PubMed
    1. Chesov D., Ciobanu N., Lange C., Heyckendorf J., Crudu V. (2017). High-dose isoniazid in the shorter-course multidrug-resistant tuberculosis regimen in the Republic of Moldova. Eur. Respir. J. 50, 1701340. 10.1183/13993003.01340-2017 - DOI - PubMed

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