First results of the introduction of bedaguiline for patients with multidrug resistens tuberculosis in Ukraine: recommendations for practical doctor resume
| Autor: | V.V. Davudenko, K.O. Gamazina, A.І. Barbova, O.P. Schebotar, М.V. Pogrebna, О.V. Pavlova, Yu.О. Senko, Yu.O. Patіuk, Nataliia Lytvynenko, O.L. Bororova, Yu.I. Feshchenko, L.V. Sherbakova |
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| Rok vydání: | 2018 |
| Předmět: | |
| Zdroj: | Tuberculosis, Lung Diseases, HIV Infection. :19-26 |
| ISSN: | 2522-1094 2220-5071 |
| DOI: | 10.30978/tb2018-4-19 |
| Popis: | Objective — to implement approaches for the proper use of new and reprogrammed drugs for the treatment of drug-resistant tuberculosis.Materials and methods. Such an implementation took place within the pilot project Challenge TB implemented in Ukraine by PATH in association with the KNCV (Royal Dutch Society for TB Control) and supported by USAID at the clinical base of the department of drug-resistant tuberculosis SO «National Institute of Phthisiology and Pulmonology named after F.G. Yanovsky of NAMS of Ukraine».The introduction of bedaguiline was carried out under the condition of the rapid detection of the XDR and modern principles of treatment of drug-resistant tuberculosis. The article describes: the characteristic of 144 patients with drug-resistant tuberculosis, which were included in the treatment with bedaguiline from 07.2017 to 09.2018, according to anamnestic, clinical and laboratory indicators; the process of treatment of these patients, which provided for the use of a modern algorithm for the step-by-step prescribing of antimycobacterial drugs, which was supposed to include at least 4 effective ones, and at least 2 — with bactericidal action.Results and discussion. Among the total number of patients, 134 (93.1 %) patients were treated or continued treatment with a positive effect and a forecast for treatment. Were received «death» in 4 (2.8 %) patients: non-curable TB process from the beginning of treatment– in 1 patient, severe concomitant pathology — in 1 patient; ІRIS — in 1 patient and 1 patient died at the ambulatory phase, not TB. Interrupted treatment were received in 5 (3.5 %) patients: low adherence to treatment– in 3 patients, critically ill of the concomitant diseases which not used antituberculosis drugs — in 2 patients; TB diagnosis was performed in 1 (0.7 %) patient.Conclusions. Before starting treatment for patients with new drugs, it is necessary to estimate the prognosis for treatment according to the criteria: preservation of reserves of antimycobacterial therapy; the developed adherence to treatment. In addition to this, treatment with new drugs can only be initiated provided: a sufficient supply of all antimycobacterial drugs, in the first place-re-profiled (linzolid, clophasimin, carbapenems), for the possibility of their course appointment to the patient; the availability of reliable laboratory data from laboratories that successfully undergo regular quality control studies; access to full-scale monitoring of the safety of treatment at any stage of the provision of medical care; at traction of different models of medical care provision, depending on needs and wishes of patients (priority — video-DOT); psychological support for all patients. |
| Databáze: | OpenAIRE |
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