Impact of second-line drug resistance on tuberculosis treatment outcomes in the United States: MDR-TB is bad enough

Details

• Alternative Title:
  Int J Tuberc Lung Dis
• Personal Author:
  Althomsons, S. P. ; Cegielski, J. P.
• Description:
  SETTING:
  
  The worldwide emergence of extensively drug-resistant tuberculosis (TB) has focused attention on treatment with second-line drugs (SLDs).
  
  OBJECTIVE:
  
  To determine the impact on outcomes of resistance to individual SLDs, we analyzed successful treatment completion and death among drug-resistant TB cases in the US national TB surveillance system, 1993–2007 (N = 195 518).
  
  DESIGN:
  
  We defined four combinations of first-line drug (FLD) resistance based on isoniazid (INH) and rifamycin, and three patterns of SLD resistance: fluoroquinolones, injectable SLDs and other oral SLDs. We compared treatment outcomes of cases by FLD resistance, with and without each pattern of SLD resistance. RESULTS: In all but one instance, cases with FLD resistance but no SLD resistance had better outcomes than cases with SLD resistance. Rifamycin resistance, alone or with INH, resulted in a greater decline in treatment completion and greater increase in deaths than resistance to SLDs. Among patients with multidrug-resistant TB, additional resistance to injectable SLDs was statistically significant. Outcomes were better for human immunodeficiency virus (HIV) negative than HIV-positive cases for all resistance patterns, but improved among HIV-infected cases after 1998, when highly active antiretroviral treatment became widely available.
  
  CONCLUSION:
  
  These results suggest that the effect of rifamycin resistance may outweigh the more modest effects of resistance to specific SLDs.
  
  
• Keywords:
  Antitubercular Agents Drug-resistant TB Drug Resistance, Bacterial Extensively Drug-Resistant Tuberculosis Humans Mycobacterium Tuberculosis Population Surveillance Retrospective Studies Second-line Resistance Treatment Outcome Treatment Outcomes United States

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• Source:
  Int J Tuberc Lung Dis. 16(10):1331-1334
• Pubmed ID:
  22863311
• Pubmed Central ID:
  PMC6415759
• Document Type:
  Journal Article
• Funding:
  CC999999/ImCDC/Intramural CDC HHSUnited States/
• Place as Subject:
  United States
• Volume:
  16
• Issue:
  10
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:ac6022ccf1dffb9d7623e0206578255452de2688af7862b7b0d86186a6d9ad3e
• Download URL:
  https://stacks.cdc.gov/view/cdc/76933/cdc_76933_DS1.pdf
• File Type:
  [PDF - 299.20 KB ]