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Int J Infect Dis. 2017 Mar;56:190-193. doi: 10.1016/j.ijid.2016.10.021. Epub 2016 Nov 2.

Applicability of the shorter 'Bangladesh regimen' in high multidrug-resistant tuberculosis settings.

Author information

1
Clinical Epidemiology and Medical Statistics Unit, Department of Biomedical Sciences, University of Sassari, Sassari, Italy; Medical Education and Professional Development Unit, AOU Sassari, Sassari, Italy.
2
Division of Infection, Barts Health NHS Trust, Royal London Hospital, London, UK.
3
Maugeri Institute, IRCCS, Care and Research Institute, Via Roncaccio 16, 21049, Tradate, Italy.
4
Maugeri Institute, IRCCS, Care and Research Institute, Via Roncaccio 16, 21049, Tradate, Italy; Public Health Consulting Group, Lugano, Switzerland.
5
Department of Pulmonology Hospital Jose Ignacio Baldo, Caracas, Capital District, Venezuela.
6
Centre for Clinical Microbiology, Division of Infection and Immunity, University College London and NIHR Biomedical Research Centre, UCL Hospitals NHS Foundation Trust, London, UK.
7
Maugeri Institute, IRCCS, Care and Research Institute, Via Roncaccio 16, 21049, Tradate, Italy. Electronic address: giovannibattista.migliori@fsm.it.

Abstract

In spite of the recent introduction of two new drugs (delamanid and bedaquiline) and a few repurposed compounds to treat multidrug-resistant and extensively drug-resistant tuberculosis (MDR- and XDR-TB), clinicians are facing increasing problems in designing effective regimens in severe cases. Recently a 9 to 12-month regimen (known as the 'Bangladesh regimen') proved to be effective in treating MDR-TB cases. It included an initial phase of 4 to 6 months of kanamycin, moxifloxacin, prothionamide, clofazimine, pyrazinamide, high-dose isoniazid, and ethambutol, followed by 5 months of moxifloxacin, clofazimine, pyrazinamide, and ethambutol. However, recent evidence from Europe and Latin America identified prevalences of resistance to the first-line drugs in this regimen (ethambutol and pyrazinamide) exceeding 60%, and of prothionamide exceeding 50%. Furthermore, the proportions of resistance to the two most important pillars of the regimen - quinolones and kanamycin - were higher than 40%. Overall, only 14 out of 348 adult patients (4.0%) were susceptible to all of the drugs composing the regimen, and were therefore potentially suitable for the 'shorter regimen'. A shorter, cheaper, and well-tolerated MDR-TB regimen is likely to impact the number of patients treated and improve adherence if prescribed to the right patients through the systematic use of rapid MTBDRsl testing.

KEYWORDS:

Efficacy; Impact; MDR-TB; Shorter regimen; Treatment duration; XDR-TB

PMID:
27816662
DOI:
10.1016/j.ijid.2016.10.021
[Indexed for MEDLINE]
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