Extensively Drug-resistant Tuberculosis Can be Managed with Aggressive Treatment Strategy
LONDON, Aug. 24, 2008--The global threat of extensively drug-resistant tuberculosis (XDR TB) could be managed with aggressive treatment programmes, reducing the mortality associated with the condition and preventing further transmission. These are the conclusions of an Article published early Online and in an upcoming edition of The Lancet, authored by Dr Salmaan Keshavjee, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA and colleagues.
The study looked at 608 patients with multidrug-resistant tuberculosis (MDR TB) in Tomsk, Russia, who had treatment in civilian or prison health services between 2000 and 2004, according to WHO protocol. Drug susceptibility testing (DST) was done on all patients, and revealed that 29 (4.8%) had XDR TB, while the others had non-XDR TB. Treatment programmes were designed for each patient based on the results of DST and previous treatments they had received, with the aim of providing at least five drugs to which that particular patient’s strain of TB was susceptible. If five effective drugs were not available, doctors considered using drugs to which resistance was known, especially if patients had no previous exposure to them. The researchers found that treatment failure was more common in XDR TB patients (31%) versus non-XDR TB patients (9%), while 48% of XDR TB patients and 67% of non-XDR TB patients had treatment cure or completion. Adverse events were similar in both sets of patients.
The authors conclude: “The chronic features of tuberculosis in these patients suggest that extensively drug-resistant tuberculosis may be acquired through previous treatments that include second-line drugs. Aggressive management of this infectious disease is feasible and can prevent high mortality rates and further transmission of drug-resistant strains of Mycobacterium tuberculosis...48% of patients with XDR tuberculosis — often termed untreatable in press reports — responded favourably to treatment.”
In an accompanying Comment, Dr Helen Cox, Macfarlane Burnet Institute for Medical Research and Public Health, Melbourne, Australia, and Médecins Sans Frontières (MSF), Cape Town, South Africa, and Dr Cheryl McDermid, MSF, Cape Town, South Africa, say: “Keshavjee and colleagues have shown that both MDR and XDR tuberculosis can be cured with aggressive treatment, with use of the most effective antituberculosis drugs available. Although we should be cautious in our hope to attain such success rates in settings with a high prevalence of HIV, aggressive treatment is the logical strategy to provide the best chance of cure while avoiding the creation of additional drug resistance.”
Dr Salmaan Keshavjee, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA. T) up to and including Friday 22 August +44-(0)79-3702-3186 ; from Monday 25 August +1-617-515-6825
Comment Dr Helen Cox, Macfarlane Burnet Institute for Medical Research and Public Health, Melbourne, Australia, and Médecins Sans Frontières, Cape Town, South Africa. T) +27 (0)21 364 5490
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Issued by Tony Kirby,
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Posted: August 2008