Comprehensive treatment of extensively drug-resistant tuberculosis.
BACKGROUND
Extensively drug-resistant tuberculosis has been reported in 45 countries, including countries with limited resources and a high burden of tuberculosis. We describe the management of extensively drug-resistant tuberculosis and treatment outcomes among patients who were referred for individualized outpatient therapy in Peru.


METHODS
A total of 810 patients were referred for free individualized therapy, including drug treatment, resective surgery, adverse-event management, and nutritional and psychosocial support. We tested isolates from 651 patients for extensively drug-resistant tuberculosis and developed regimens that included five or more drugs to which the infecting isolate was not resistant.


RESULTS
Of the 651 patients tested, 48 (7.4%) had extensively drug-resistant tuberculosis; the remaining 603 patients had multidrug-resistant tuberculosis. The patients with extensively drug-resistant tuberculosis had undergone more treatment than the other patients (mean [+/-SD] number of regimens, 4.2+/-1.9 vs. 3.2+/-1.6; P<0.001) and had isolates that were resistant to more drugs (number of drugs, 8.4+/-1.1 vs. 5.3+/-1.5; P<0.001). None of the patients with extensively drug-resistant tuberculosis were coinfected with the human immunodeficiency virus (HIV). Patients with extensively drug-resistant tuberculosis received daily, supervised therapy with an average of 5.3+/-1.3 drugs, including cycloserine, an injectable drug, and a fluoroquinolone. Twenty-nine of these patients (60.4%) completed treatment or were cured, as compared with 400 patients (66.3%) with multidrug-resistant tuberculosis (P=0.36).


CONCLUSIONS
Extensively drug-resistant tuberculosis can be cured in HIV-negative patients through outpatient treatment, even in those who have received multiple prior courses of therapy for tuberculosis.
Mitnick
Carole D
CD
Harvard Medical School, Boston, USA.
Shin
Sonya S
SS
Seung
Kwonjune J
KJ
Rich
Michael L
ML
Atwood
Sidney S
SS
Furin
Jennifer J
JJ
Fitzmaurice
Garrett M
GM
Alcantara Viru
Felix A
FA
Appleton
Sasha C
SC
Bayona
Jaime N
JN
Bonilla
Cesar A
CA
Chalco
Katiuska
K
Choi
Sharon
S
Franke
Molly F
MF
Fraser
Hamish S F
HS
Guerra
Dalia
D
Hurtado
Rocio M
RM
Jazayeri
Darius
D
Joseph
Keith
K
Llaro
Karim
K
Mestanza
Lorena
L
Mukherjee
Joia S
JS
Muñoz
Maribel
M
Palacios
Eda
E
Sanchez
Epifanio
E
Sloutsky
Alexander
A
Becerra
Mercedes C
MC
D000328:Adult; D000553:Ambulatory Care; D000995:Antitubercular Agents / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D023801:Directly Observed Therapy; D004359:Drug Therapy, Combination; D054908:Extensively Drug-Resistant Tuberculosis / Q000188:drug therapy* / Q000601:surgery / Q000628:therapy; D005260:Female; D018023:HIV Seronegativity; D006801:Humans; D008297:Male; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D010568:Peru; D012189:Retrospective Studies; D012944:Social Support; D013183:Sputum / Q000382:microbiology; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy
D000995:Antitubercular Agents