Multidrug-resistant tuberculosis: long-term treatment outcome in the Netherlands.
METHODS
Tuberculosis units (Beatrixoord, Haren; and Dekkerswald, Groesbeek) in the Netherlands.


OBJECTIVE
To study the long-term treatment outcome of patients with multidrug-resistant tuberculosis (MDR-TB).


METHODS
Descriptive analysis of all consecutively admitted patients with MDR-TB between 1 January 1985 and 1 September 1998, with follow-up until 1 August 1999.


RESULTS
Of 44 patients (31 male) enrolled in the study, 33 were foreign born and none were human immunodeficiency virus positive. At diagnosis 38 patients had sputum-smear positive pulmonary TB, and converted culture negative after a mean of 6 weeks, while six converted to negative later (mean 69 weeks). Most patients had micro-organisms resistant to several antimycobacterial drugs (mean = median: 5), including resistance to isoniazid and rifampin. In-patient treatment lasted a mean of 164 days (range 31-481), and patients were treated with six drugs on average. Side effects were common. Treatment lasted for a mean of 608 days (range 268-1626); five patients are still on treatment. Four patients were operated for TB, and two others were operated for post-TB sequelae. During the follow-up period six patients died, of whom three had active TB; 33 (75%) were considered cured.


CONCLUSIONS
Mortality was only 14% after a mean follow-up period of 53 months. MDR-TB can be successfully treated, but requires much effort from both patients and carers, and the costs may be higher than is affordable in resource-poor countries.
Geerligs
W A
WA
Tuberculosis Units of Beatrixoord, Haren, The Netherlands.
Van Altena
R
R
De Lange WCM
Van Soolingen
D
D
Van Der Werf
T S
TS
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000995:Antitubercular Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D003365:Costs and Cost Analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007538:Isoniazid / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D012293:Rifampin / Q000009:adverse effects / Q000627:therapeutic use; D013183:Sputum / Q000382:microbiology; D016019:Survival Analysis; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy* / Q000401:mortality
D000995:Antitubercular Agents; D007538:Isoniazid; D012293:Rifampin