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Clin Infect Dis. 2010 Jul 1;51(1):6-14. doi: 10.1086/653115.

Treatment outcomes among patients with extensively drug-resistant tuberculosis: systematic review and meta-analysis.

Author information

  • 1Division of Infectious Disease, Massachusetts General Hospital, Boston, Massachusetts 02114, USA. krjacobson@partners.org

Abstract

BACKGROUND:

. The treatment of extensively drug-resistant tuberculosis (XDR TB) presents a major challenge. Second-line antimycobacterial drugs are less effective, more toxic, and more costly than first-line agents, and XDR TB strains are, by definition, resistant to the most potent second-line options: the injectable agents and fluoroquinolones. We conducted a meta-analysis to assess XDR TB treatment outcomes and to identify therapeutic approaches associated with favorable responses.

METHODS:

We searched PubMed and EMBASE databases to identify studies conducted through May 2009 that report XDR TB treatment outcomes.

RESULTS:

The search yielded 13 observational studies covering 560 patients, of whom 43.7% (95% confidence interval, 32.8%-54.5%) experienced favorable outcomes, defined as either cure or treatment completion, and 20.8% (95% confidence interval, 14.2%-27.3%) died. Random effects meta-analysis and meta-regression showed that studies in which a higher proportion of patients received a later-generation fluoroquinolone reported a higher proportion of favorable treatment outcomes (P=.012).

CONCLUSIONS:

This meta-analysis provides the first empirical evidence that the use of later-generation fluoroquinolones for the treatment of XDR TB significantly improves treatment outcomes, even though drug-susceptibility testing demonstrates resistance to a representative fluoroquinolone. These results suggest that the addition of later-generation fluoroquinolones to XDR TB regimens may improve treatment outcomes and should be systematically evaluated in well-designed clinical studies.

PMID:
20504231
[PubMed - indexed for MEDLINE]
PMCID:
PMC4013786
Free PMC Article

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