Results of a standardised regimen for multidrug-resistant tuberculosis in Bangladesh.
METHODS
Individualised regimens based on drug susceptibility test results, generally used to treat multidrug-resistant tuberculosis (MDR-TB), require often unavailable expertise and resources.


OBJECTIVE
To evaluate a standardised regimen based on the susceptibility profiles of locally prevalent MDR-TB strains.


METHODS
The activities of a successful DOTS programme in Bangladesh were complemented by offering treatment with a standardised 21-month regimen to patients with laboratory-confirmed MDR-TB disease. The regimen contained kanamycin, ofloxacin, prothionamide, pyrazinamide, ethambutol, isoniazid and clofazimine. Clinical and bacteriological progress was monitored quarterly until treatment completion, then 6 monthly for 2 years.


RESULTS
The status at the end of treatment of this cohort of 58 documented MDR-TB patients was as follows: eight (14%) deaths, seven (12%) defaults, three (5%) failures and 40 (69%) cures. One bacteriologically-confirmed relapse was recognised. Frequent and sometimes serious side effects proved to be the main problem, suggesting the need for a better tolerated but equally effective regimen.


CONCLUSIONS
A standardised approach may provide a reasonable alternative to individualised treatment of MDR-TB in resource-poor settings. However, DOTS-plus programmes in resource-poor settings may confront significant difficulties in the enrolment, diagnosis and management of MDR-TB patients.
Van Deun
A
A
Mycobacteriology Unit, Institute of Tropical Medicine, Antwerp, Belgium. avandeun@iuatld.org
Salim
M A Hamid
MA
Das
A P Kumar
AP
Bastian
I
I
Portaels
F
F
D000293:Adolescent; D000328:Adult; D000995:Antitubercular Agents / Q000008:administration & dosage*; D001459:Bangladesh; D002985:Clinical Protocols; D023801:Directly Observed Therapy / Q000379:methods*; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D006295:Health Resources / Q000600:supply & distribution; D006801:Humans; D008297:Male; D008875:Middle Aged; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis / Q000188:drug therapy*; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000188:drug therapy*
D000995:Antitubercular Agents