Few eligible for the newly recommended short course MDR-TB regimen at a large Mumbai private clinic

Autor: Zarir F. Udwadia, Jeffrey A. Tornheim, Shashank Ganatra, Andrea DeLuca, Camilla S. Rodrigues, Amita Gupta
Jazyk: angličtina
Rok vydání: 2019
Předmět:
Zdroj: BMC Infectious Diseases, Vol 19, Iss 1, Pp 1-9 (2019)
Druh dokumentu: article
ISSN: 1471-2334
DOI: 10.1186/s12879-019-3726-8
Popis: Abstract Background India has the world’s highest tuberculosis burden, and Mumbai is particularly affected by multidrug resistant tuberculosis (MDR-TB). WHO recommends short, intensive treatment (“Short Course”) for previously untreated pulmonary MDR-TB patients but does not require universal drug susceptibility testing (DST) before Short Course. DST would likely screen out many MDR-TB patients in places like Mumbai with significant drug resistance. Methods MDR-TB patients at a private clinic were recruited for a prospective observational cohort. Short Course eligibility was evaluated by clinical criteria and DST results. Eligibility by DST was classified as rifampin monoresistance (as tested by Xpert MTB/RIF), rifampin, fluoroquinolones, and 2nd-line injectable drugs resistance (as tested by line probe assays) and resistance to other drugs. Results Of 559 participants with MDR-TB, 33% met clinical eligibility for Short Course. DST for rifampin, fluoroquinolones, and 2nd-line injectable drugs excluded 74.7% of participants. Complete phenotypic DST excluded 96.6% of participants. Prior treatment with either 1st or 2nd-line drugs did not significantly affect eligibility. Conclusions In a global MDR-TB hotspot,
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