Treatment and follow-up of HIV-negative multidrug-resistant tuberculosis patients in an infectious diseases reference hospital, Buenos Aires, Argentina.
METHODS
An Argentinean reference hospital specialising in infectious diseases.


OBJECTIVE
To assess the outcomes of all human immunodeficiency virus (HIV) negative multidrug-resistant tuberculosis (MDR-TB) patients referred to or diagnosed at Hospital Muñiz.


METHODS
Clinical study for the period 1996-1999, with follow-up until June 2002.


RESULTS
One hundred and forty-one adult patients (52.5% female) with resistance to two to seven drugs were studied. Fifty patients (35.5%) had not been treated previously. The most frequently used second-line drugs were 5-F-quinolones, cycloserine and ethionamide in susceptibility based individually tailored three- to five-drug regimens. Hospital admission was associated with treatment success. Forty-five episodes of severe toxicity occurred. Treatment was successful in 51.8% of cases, but follow-up of 73 patients yielded 11.9% relapse. The mortality rate was 19.1% and default was 19.9%. Logistic regression analysis was statistically significant for treatment success in relation to patient admission, residence and resistance pattern.


CONCLUSIONS
The burden of MDR-TB in this setting--prolonged infection, treatment cost and difficulties, low rates of cure and treatment adherence and high rates of fatality and relapse--can be improved by strengthening TB control programme activities and fighting against poverty and HIV/AIDS.
Palmero
D J
DJ
Department of Pneumonology, Hospital Muñiz, Buenos Aires, Argentina. djpalmero@intramed.net.ar
Ambroggi
M
M
Brea
A
A
De Lucas
M
M
Fulgenzi
A
A
Martínez
D
D
Mosca
C
C
Musella
R
R
Natiello
M
M
Gonzalez
C
C
Abbate
E
E
D017088:AIDS-Related Opportunistic Infections / Q000150:complications; D000995:Antitubercular Agents / Q000009:adverse effects / Q000494:pharmacology* / Q000627:therapeutic use; D001118:Argentina / Q000453:epidemiology; D003523:Cycloserine / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D004338:Drug Combinations; D005000:Ethionamide / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D018023:HIV Seronegativity; D006760:Hospitalization; D006782:Hospitals, Special; D006801:Humans; D016015:Logistic Models; D008297:Male; D008826:Microbial Sensitivity Tests; D009169:Mycobacterium tuberculosis / Q000187:drug effects* / Q000302:isolation & purification; D011379:Prognosis; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*
D000995:Antitubercular Agents; D004338:Drug Combinations; D003523:Cycloserine; D005000:Ethionamide