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Bull World Health Organ. 2012 Jan 1;90(1):63-6. doi: 10.2471/BLT.11.092320. Epub 2011 Nov 24.

Eliminating the category II retreatment regimen from national tuberculosis programme guidelines: the Georgian experience.

Author information

1
School of Medicine, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, United States of America. jenniferfurin@gmail.com

Abstract

PROBLEM:

The category II retreatment regimen for management of tuberculosis in previously treated patients was first introduced in the early 1990s. It consists of 8 months of total therapy with the addition of streptomycin to standard first-line medications. A review of 6500 patients on category II therapy in Georgia showed poor outcomes and high rates of streptomycin resistance.

APPROACH:

The National Tuberculosis Program used an evidence-based analysis of national data to convince policy-makers that category II therapy should be eliminated from national guidelines in Georgia.

LOCAL SETTING:

The World Health Organization tuberculosis case-notification rate in Georgia is 102 per 100,000 population. All patients receive culture and drug susceptibility testing as a standard part of tuberculosis diagnosis. In 2009, routine surveillance found multidrug-resistant tuberculosis in 10.6% of newly diagnosed patients and 32.5% of previously treated cases.

RELEVANT CHANGES:

Category II retreatment regimen is no longer used in Georgia. Treatment is guided by results of drug susceptibility testing--using rapid, molecular tests where possible--for all previously treated tuberculosis patients.

LESSONS LEARNT:

There was little resistance to policy change because the review was initiated and led by the National Tuberculosis Program. This experience can serve as a successful model for other countries to make informed decisions about the use of category II therapy.

PMID:
22271966
PMCID:
PMC3260578
DOI:
10.2471/BLT.11.092320
[Indexed for MEDLINE]
Free PMC Article

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