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PLoS One. 2013;8(3):e58664. doi: 10.1371/journal.pone.0058664. Epub 2013 Mar 13.

Aggressive regimens for multidrug-resistant tuberculosis decrease all-cause mortality.

Author information

1
Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America. carole_mitnick@hms.harvard.edu

Abstract

RATIONALE:

A better understanding of the composition of optimal treatment regimens for multidrug-resistant tuberculosis (MDR-TB) is essential for expanding universal access to effective treatment and for developing new therapies for MDR-TB. Analysis of observational data may inform the definition of an optimized regimen.

OBJECTIVES:

This study assessed the impact of an aggressive regimen-one containing at least five likely effective drugs, including a fluoroquinolone and injectable-on treatment outcomes in a large MDR-TB patient cohort.

METHODS:

This was a retrospective cohort study of patients treated in a national outpatient program in Peru between 1999 and 2002. We examined the association between receiving an aggressive regimen and the rate of death.

MEASUREMENTS AND MAIN RESULTS:

In total, 669 patients were treated with individualized regimens for laboratory-confirmed MDR-TB. Isolates were resistant to a mean of 5.4 (SD 1.7) drugs. Cure or completion was achieved in 66.1% (442) of patients; death occurred in 20.8% (139). Patients who received an aggressive regimen were less likely to die (crude hazard ratio [HR]: 0.62; 95% CI: 0.44,0.89), compared to those who did not receive such a regimen. This association held in analyses adjusted for comorbidities and indicators of severity (adjusted HR: 0.63; 95% CI: 0.43,0.93).

CONCLUSIONS:

The aggressive regimen is a robust predictor of MDR-TB treatment outcome. TB policy makers and program directors should consider this standard as they design and implement regimens for patients with drug-resistant disease. Furthermore, the aggressive regimen should be considered the standard background regimen when designing randomized trials of treatment for drug-resistant TB.

PMID:
23516529
PMCID:
PMC3596279
DOI:
10.1371/journal.pone.0058664
[Indexed for MEDLINE]
Free PMC Article

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