Treatment outcomes of pre- and extensively drug-resistant tuberculosis in Johannesburg, South Africa
| Autor: | X Padanilam, Alan Karstaedt, R Louw, J Nkurunziza |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Adult
Male 0301 basic medicine Pulmonary and Respiratory Medicine medicine.medical_specialty Tuberculosis Adolescent Extensively Drug-Resistant Tuberculosis 030106 microbiology Antitubercular Agents HIV Infections Microbial Sensitivity Tests Clofazimine Sputum culture South Africa Young Adult 03 medical and health sciences 0302 clinical medicine Internal medicine Humans Medicine 030212 general & internal medicine Retrospective Studies medicine.diagnostic_test business.industry Medical record Linezolid Sputum Extensively drug-resistant tuberculosis Tropical disease Retrospective cohort study Middle Aged medicine.disease Treatment Outcome Infectious Diseases Female medicine.symptom business Fluoroquinolones medicine.drug |
| Zdroj: | The International Journal of Tuberculosis and Lung Disease. 22:1469-1474 |
| ISSN: | 1027-3719 |
| DOI: | 10.5588/ijtld.18.0205 |
| Popis: | BACKGROUND Extensively drug-resistant tuberculosis (XDR-TB) has a poor treatment success rate and high mortality. Multidrug-resistant TB (MDR-TB) has worse outcomes when there is added resistance to second-line injectable drugs (pre-XDR-TBSLID) or fluoroquinolones (pre-XDR-TBFQ). OBJECTIVES Treatment outcomes in patients with pre-XDR-TB and XDR-TB in a high HIV prevalence area were compared. METHODS A retrospective medical record review was conducted of patients with pulmonary pre-XDR-TB and XDR-TB managed from 2008 to 2010 at Sizwe Tropical Disease Hospital, Johannesburg, South Africa. Standardised MDR-TB treatment was instituted and was subsequently individualised when further second-line susceptibility results became available. RESULTS Of 86 patients studied, 95% were sputum smear-positive at baseline, 73% had sputum culture conversion, and 65% were human immunodeficiency virus (HIV) infected, with a median CD4 count of 201 cells/mm³. Of 53 patients with XDR-TB, 26 with pre-XDR-TBFQ and 7 with pre-XDR-TBSLID, respectively 13%, 12% and 29% were cured, 21%, 23% and 57% had a favourable outcome, and 26%, 23% and 14% died. Clofazimine (P < 0.001) and linezolid (P = 0.044) impacted on favourable outcomes. CONCLUSION Patients with pre-XDR-TBFQ did not have better outcomes than those with XDR-TB. In countries with standardised regimens for resistant TB, patients with pre-XDR-TBFQ may need to receive XDR-TB treatment. |
| Databáze: | OpenAIRE |
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