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Initiation treatment on treatment outcome MDR TB

André N H Bulabula, Jenna A Nelson, Eric M Musafiri, Rhoderick Machekano, Nadia A Sam-Agudu, Andreas H Diacon, Maunank Shah, Jacob Creswell, Grant Theron, Robin M Warren, Karen R Jacobson, Jean-Paul Chirambiza, Dieudonné Kalumuna, Bertin C Bisimwa, Patrick D M C Katoto, Michel K Kaswa, Freddy M Birembano, Liliane Kitete, Martin P Grobusch, Zacharie M Kashongwe, Jean B Nachega
Background: Multidrug-resistant tuberculosis (MDR-TB) jeopardizes global TB control. The prevalence and predictors of Rifampicin-resistant (RR) TB, a proxy for MDR-TB, and the treatment outcomes with standard and shortened regimens have not been assessed in post-conflict regions, such as the South Kivu province in the eastern Democratic Republic of the Congo (DRC). We aimed to fill this knowledge gap and to inform the DRC National TB Program. Methods: of adults and children evaluated for pulmonary TB by sputum smear microscopy and Xpert MTB/RIF (Xpert) from February 2012 to June 2017...
February 13, 2019: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Chih-Bin Lin, Hung-Chieh Sun, Chen-Yuan Chiang, Che-Wei Wu, Hsu-Wen Chou, Tao-Qian Tang, Jen-Jyh Lee
Objectives: The objective of this study is to evaluate the treatment outcomes of patients with multidrug-resistant tuberculosis (MDR-TB) under special programmatic management in Eastern Taiwan over the past 10 years. Materials and Methods: All newly diagnosed MDR-TB patients and MDR-TB patients enrolled previously with persistent positive cultures were included in this study, from May 2007 to April 2017, in Eastern Taiwan. A panel of pulmonologists designed the initial MDR-TB regimens...
January 2019: Ci Ji Yi Xue za Zhi, Tzu-chi Medical Journal
Kamila Romanowski, Jonathon R Campbell, Olivia Oxlade, Federica Fregonese, Dick Menzies, James C Johnston
INTRODUCTION: Isoniazid-resistant, rifampin susceptible tuberculosis (INHR-TB) is the most common form of drug resistant TB globally. Treatment of INHR-TB with standard first-line therapy is associated with high rates of multidrug resistant TB (MDR-TB). We modelled the potential impact of INHR-TB detection and appropriate treatment on MDR-TB prevalence. METHODS: A decision analysis model was developed to compare three different strategies for the detection of TB (AFB smear, Xpert MTB/RIF, and Line-Probe Assays (LPA)), combined with appropriate treatment...
2019: PloS One
Justin Arockiaraj, Rajiv Karthik, Joy Sarojini Michael, Rohit Amritanand, Kenny Samuel David, Venkatesh Krishnan, Gabriel David Sundararaj
Study Design: Retrospective study. Purpose: To report the prevalence of patients with multidrug-resistant (MDR) tubercular spondylodiscitis and their outcomes. Additionally, to assess the role of the Xpert MTB/RIF assay in early detection of MDR tuberculosis. Overview of Literature: MDR tuberculosis is increasing globally. The World Health Organization (WHO) has strongly recommended Xpert MTB/RIF assay for early detection of tuberculosis. Methods: From 2006 to 2015, a retrospective study was conducted on patients treated for MDR tuberculosis of the spine...
January 24, 2019: Asian Spine Journal
Myungsun Lee, Jeongha Mok, Deog Kyeom Kim, Tae Sun Shim, Won-Jung Koh, Doosoo Jeon, Taehoon Lee, Seung Heon Lee, Ju Sang Kim, Jae Seuk Park, Ji Yeon Lee, Song Yee Kim, Jae Ho Lee, Kyung-Wook Jo, Byung Woo Jhun, Young Ae Kang, Joong Hyun Ahn, Chang-Ki Kim, Soyoun Shin, Taeksun Song, Sung Jae Shin, Young Ran Kim, Heejung Ahn, Seokyung Hahn, Ho Jeong Won, Ji Yeon Jang, Sang Nae Cho, Jae-Joon Yim
BACKGROUND: Treatment success rates of multidrug-resistant tuberculosis (MDR-TB) remain unsatisfactory, and long-term use of second-line anti-TB drugs is accompanied by the frequent occurrence of adverse events, low treatment compliance, and high costs. The development of new efficient regimens with shorter treatment durations for MDR-TB will solve these issues and improve treatment outcomes. METHODS: This study is a phase II/III, multicenter, randomized, open-label clinical trial of non-inferiority design comparing a new regimen to the World Health Organization-endorsed conventional regimen for fluoroquinolone-sensitive MDR-TB...
January 16, 2019: Trials
Oluwatosin J Akinsola, Oyindamola B Yusuf, Olusoji Mayowa Ige, Patrick E Okonji
Background: Multi-drug resistant tuberculosis (MDR-TB) develops due to problems such as irregular drug supply, poor drug quality, inappropriate prescription, and poor adherence to treatment. These factors allow the development and subsequent transmission of resistant strains of the pathogen. However, due to the chronic nature of MDR-TB, cure models allow us to investigate the covariates that are associated with the long-term effects of time-to-sputum conversion among multi-drug resistant (MDR-TB) tuberculosis individuals...
2018: Frontiers in Public Health
Meredith B Brooks, Salmaan Keshavjee, Irina Gelmanova, Nataliya A Zemlyanaya, Carole D Mitnick, Justin Manjourides
BACKGROUND: Multidrug-resistant tuberculosis (MDR-TB) cohorts often lack long-term survival data, and are summarized instead by initial treatment outcomes. When using Cox proportional hazards models to analyze these cohorts, this leads to censoring subjects at the time of the initial treatment outcome, instead of them providing full survival data. This may violate the non-informative censoring assumption of the model and may produce biased effect estimates. To address this problem, we develop a tool to predict vital status at the end of a cohort period using the initial treatment outcome and assess its ability to reduce bias in treatment effect estimates...
December 11, 2018: BMC Medical Research Methodology
Selena Ferrian, Melinda Ross, Francesca Conradie, Shaheed Vally Omar, Nazir Ismail, Francesca Little, Gilla Kaplan, Dorothy Fallows, Clive M Gray
Identifying a blood circulating cellular biomarker that can be used to assess severity of disease and predict the time to culture conversion (TCC) in patients with multidrug resistant tuberculosis (MDR-TB) would facilitate monitoring response to treatment and may be of value in the design of future drug trials. We report on the frequency of blood Ki67+ HLA-DR- CD4+ T regulatory (Treg) cells in predicting microbiological outcome before initiating second-line treatment for MDR-TB. Fifty-one patients with MDR-TB were enrolled and followed over 18 months; a subset of patients was sputum culture (SC) negative at baseline ( n = 9)...
2018: Frontiers in Immunology
M Verdecchia, K Keus, S Blankley, D Vambe, C Ssonko, T Piening, E C Casas
INTRODUCTION: Since 2011 Médecins sans Frontières together with the eSwatini Ministry of Health have been managing patients with multi-drug resistant tuberculosis (MDR-TB) at Matsapha and Mankayane in Manzini region. This analysis describes the model of care and outcomes of patients receiving a 20 months MDR-TB treatment regimen between 2011 and 2013. METHOD: We conducted a retrospective observational cohort study of MDR-TB patients enrolled for treatment between May 2011 and December 2013...
2018: PloS One
Lina Davies Forsman, Katarina Niward, Yi Hu, Rongrong Zheng, Xubin Zheng, Ran Ke, Weiping Cai, Chao Hong, Yang Li, Yazhou Gao, Jim Werngren, Jakob Paues, Johanna Kuhlin, Ulrika S H Simonsson, Erik Eliasson, Jan-Willem Alffenaar, Mikael Mansjö, Sven Hoffner, Biao Xu, Thomas Schön, Judith Bruchfeld
INTRODUCTION: Individualised treatment through therapeutic drug monitoring (TDM) may improve tuberculosis (TB) treatment outcomes but is not routinely implemented. Prospective clinical studies of drug exposure and minimum inhibitory concentrations (MICs) in multidrug-resistant TB (MDR-TB) are scarce. This translational study aims to characterise the area under the concentration-time curve of individual MDR-TB drugs, divided by the MIC for Mycobacterium tuberculosis isolates, to explore associations with markers of treatment progress and to develop useful strategies for clinical implementation of TDM in MDR-TB...
October 4, 2018: BMJ Open
Patrick G T Cudahy, Joshua L Warren, Ted Cohen, Douglas Wilson
HIV-positive adults on treatment for multi drug-resistant tuberculosis (MDR-TB) experience high mortality. Biomarkers of HIV/MDR-TB treatment response may enable earlier treatment modifications that improve outcomes. To determine whether changes in C-reactive protein (CRP), D-dimer, and fibrinogen were associated with treatment outcome among those with HIV/MDR-TB coinfection, we studied 20 HIV-positive participants for the first 16 weeks of MDR-TB therapy. Serum CRP, fibrinogen, and D-dimer were measured at baseline and serially while on treatment...
November 2018: American Journal of Tropical Medicine and Hygiene
Nafees Ahmad, Shama D Ahuja, Onno W Akkerman, Jan-Willem C Alffenaar, Laura F Anderson, Parvaneh Baghaei, Didi Bang, Pennan M Barry, Mayara L Bastos, Digamber Behera, Andrea Benedetti, Gregory P Bisson, Martin J Boeree, Maryline Bonnet, Sarah K Brode, James C M Brust, Ying Cai, Eric Caumes, J Peter Cegielski, Rosella Centis, Pei-Chun Chan, Edward D Chan, Kwok-Chiu Chang, Macarthur Charles, Andra Cirule, Margareth Pretti Dalcolmo, Lia D'Ambrosio, Gerard de Vries, Keertan Dheda, Aliasgar Esmail, Jennifer Flood, Gregory J Fox, Mathilde Fréchet-Jachym, Geisa Fregona, Regina Gayoso, Medea Gegia, Maria Tarcela Gler, Sue Gu, Lorenzo Guglielmetti, Timothy H Holtz, Jennifer Hughes, Petros Isaakidis, Leah Jarlsberg, Russell R Kempker, Salmaan Keshavjee, Faiz Ahmad Khan, Maia Kipiani, Serena P Koenig, Won-Jung Koh, Afranio Kritski, Liga Kuksa, Charlotte L Kvasnovsky, Nakwon Kwak, Zhiyi Lan, Christoph Lange, Rafael Laniado-Laborín, Myungsun Lee, Vaira Leimane, Chi-Chiu Leung, Eric Chung-Ching Leung, Pei Zhi Li, Phil Lowenthal, Ethel L Maciel, Suzanne M Marks, Sundari Mase, Lawrence Mbuagbaw, Giovanni B Migliori, Vladimir Milanov, Ann C Miller, Carole D Mitnick, Chawangwa Modongo, Erika Mohr, Ignacio Monedero, Payam Nahid, Norbert Ndjeka, Max R O'Donnell, Nesri Padayatchi, Domingo Palmero, Jean William Pape, Laura J Podewils, Ian Reynolds, Vija Riekstina, Jérôme Robert, Maria Rodriguez, Barbara Seaworth, Kwonjune J Seung, Kathryn Schnippel, Tae Sun Shim, Rupak Singla, Sarah E Smith, Giovanni Sotgiu, Ganzaya Sukhbaatar, Payam Tabarsi, Simon Tiberi, Anete Trajman, Lisa Trieu, Zarir F Udwadia, Tjip S van der Werf, Nicolas Veziris, Piret Viiklepp, Stalz Charles Vilbrun, Kathleen Walsh, Janice Westenhouse, Wing-Wai Yew, Jae-Joon Yim, Nicola M Zetola, Matteo Zignol, Dick Menzies
BACKGROUND: Treatment outcomes for multidrug-resistant tuberculosis remain poor. We aimed to estimate the association of treatment success and death with the use of individual drugs, and the optimal number and duration of treatment with those drugs in patients with multidrug-resistant tuberculosis. METHODS: In this individual patient data meta-analysis, we searched MEDLINE, Embase, and the Cochrane Library to identify potentially eligible observational and experimental studies published between Jan 1, 2009, and April 30, 2016...
September 8, 2018: Lancet
Ying Zhao, Tamaryn Fox, Kathryn Manning, Annemie Stewart, Nicki Tiffin, Ntokozo Khomo, Joshua Leslie, Andrew Boulle, Vanessa Mudaly, Yulene Kock, Graeme Meintjes, Sean Wasserman
Background: Bedaquiline is used as a substitute for second-line injectable (SLI) intolerance in the treatment of multidrug-resistant tuberculosis (MDR-TB), but the efficacy and safety of this strategy is unknown. Methods: We performed a retrospective cohort study to evaluate treatment outcomes for MDR-TB patients who substituted bedaquiline for SLIs. Adults receiving bedaquiline substitution for MDR-TB therapy, plus a matched control group who did not receive bedaquiline, were identified from the electronic TB register in the Western Cape Province, South Africa...
August 24, 2018: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Sophan Sam, Adrienne E Shapiro, Thim Sok, Sokhan Khann, Rassi So, Sopheap Khem, Sokhem Chhun, Sarith Noun, Bonamy Koy, Prum Chhom Sayouen, Chun Im Sin, Heng Bunsieth, Tan Eang Mao, Anne E Goldfeld
Introduction: Prolonged inpatient multidrug-resistant tuberculosis (MDR-TB) treatment for all patients is not sustainable for high-burden settings, but there is limited information on community-based treatment programme outcomes for MDR-TB. Methods: The Cambodian Health Committee, a non-governmental organisation (NGO), launched the Cambodian MDR-TB programme in 2006 in cooperation with the National Tuberculosis Program (NTP) including a community-based treatment option as a key programme component...
2018: BMJ Open Respiratory Research
Denny John, Prabir Chatterjee, Shruti Murthy, Ramesh Bhat, Baba Maiyaki Musa
BACKGROUND: In India, multidrug-resistant tuberculosis (MDR-TB) patients are usually treated in hospitals. Decentralised care model, however, has been suggested as a possible alternative by the World Health Organization (WHO). In the "End TB Strategy", the WHO highlights, as one of the key targets for 2035, that 'no TB-affected families should face catastrophic hardship due to the tuberculosis'. Removal of financial barriers to health-care access and mitigation of catastrophic expenditures are therefore considered vital to achieve the universal health coverage (UHC) goal...
July 2018: Indian Journal of Tuberculosis
Manjeet S Jangra, Manik Chhabra
INTRODUCTION: Cycloserine and Kanamycin are approved for treatment of multidrug-resistant tuberculosis with good tolerability in Tuberculosis patients and have various labeled adverse reactions but the neuropsychiatric adverse drug reactions with cycloserine are rarely explained. CASE REPORT: We present a case report on Cycloserine induced Suicidal tendencies and Kanamycin induced decrease in hearing sensation in Indian MDR-TB patient. A 55-year-old male patient who was diagnosed with MDR-TB was prescribed with category IV anti-tubercular therapy...
2018: Current Drug Safety
Y-M Fan, S-P Ding, Z-J Bao, L-M Wu, L-B Zhen, Q Xia, M Zhu
OBJECTIVE: To examine the clinical outcomes and associated prognostic factors among patients with multidrug-resistant tuberculosis (MDR-TB) in China. METHODS: This retrospective study involved 243 patients with MDR-TB. All patients received standard regimens containing para-amino salicylic acid (PAS) and/or cycloserine (CS). The demographic, social and clinical characteristics of patients were recorded and the patients were followed up for 24 months. RESULTS: Treatment success was closely associated with young age, non-farming occupations, shorter history or smoking, normal urine results, initial MDR-TB treatment regimen, increased haemoglobin, direct bilirubin, uric acid and thyroid stimulating hormone (TSH) levels, and lower white blood cell, neutrophil and blood platelet counts (all P < 0...
March 1, 2018: International Journal of Tuberculosis and Lung Disease
Christelle Géneviève Jouego, Valirie Ndip Agbor, Juergen Noeske, Ndo Akono Manuel, Leo Njock Ayuk
BACKGROUND: Tuberculosis remains a major cause of morbidity and mortality worldwide, especially in developing countries. The diagnosis and treatment of multi-drug resistant tuberculosis (MDR-TB) in children remain a major limitation in this setting, largely due to difficulties in isolating Mycobacterium tuberculosis from pediatric specimens, management with toxic second line drugs, and practically the inexistence of contact tracing. In 2016, the World Health Organization (WHO) recommended a standardized 9-month regimen for adults and children in zones which are highly endemic for the human immunodeficiency virus (HIV)...
January 22, 2018: BMC Research Notes
Pyae Phyo Wai, Hemant Deepak Shewade, Nang Thu Thu Kyaw, Khine Wut Yee Kyaw, Saw Thein, Aung Si Thu, Myo Minn Oo, Pyae Sone Htwe, Moe Myint Theingi Tun, Htet Myet Win Maung, Kyaw Thu Soe, Si Thu Aung
BACKGROUND: The community-based MDR-TB care (CBMDR-TBC) project was implemented in 2015 by The Union in collaboration with national TB programme (NTP) in 33 townships of upper Myanmar to improve treatment outcomes among patients with MDR-TB registered under NTP. They received community-based support through the project staff, in addition to the routine domiciliary care provided by NTP staff. Each project township had a project nurse exclusively for MDR-TB and a community volunteer who provided evening directly observed therapy (in addition to morning directly observed therapy by NTP)...
2017: PloS One
Wenjie Wu, Jingtong Lyu, Peng Cheng, Yuan Cheng, Zehua Zhang, Litao Li, Yonghong Zheng, Jianzhong Xu
There has been limited research on the therapeutic efficacy of molecular diagnosis of spinal tuberculosis. We attempted to determine whether the utilization of molecular diagnosis to detect multidrug-resistant spinal tuberculosis can improve clinical outcomes. A multicenter retrospective study was conducted from February 2009 to June 2015. Ninety-two consecutive culture-confirmed multidrug-resistant tuberculosis (MDR-TB) patients with spinal tuberculosis who were diagnosed clinically and by imaging were enrolled in the study...
November 8, 2017: Emerging Microbes & Infections
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