title: Comprehensive treatment of extensively drug-resistant tuberculosis.
abstract: 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.
authors.affiliation: Harvard Medical School, Boston, USA.
authors.forename: Carole D
authors.initials: CD
authors.lastname: Mitnick
authors.forename: Sonya S
authors.initials: SS
authors.lastname: Shin
authors.forename: Kwonjune J
authors.initials: KJ
authors.lastname: Seung
authors.forename: Michael L
authors.initials: ML
authors.lastname: Rich
authors.forename: Sidney S
authors.initials: SS
authors.lastname: Atwood
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Furin
authors.forename: Garrett M
authors.initials: GM
authors.lastname: Fitzmaurice
authors.forename: Felix A
authors.initials: FA
authors.lastname: Alcantara Viru
authors.forename: Sasha C
authors.initials: SC
authors.lastname: Appleton
authors.forename: Jaime N
authors.initials: JN
authors.lastname: Bayona
authors.forename: Cesar A
authors.initials: CA
authors.lastname: Bonilla
authors.forename: Katiuska
authors.initials: K
authors.lastname: Chalco
authors.forename: Sharon
authors.initials: S
authors.lastname: Choi
authors.forename: Molly F
authors.initials: MF
authors.lastname: Franke
authors.forename: Hamish S F
authors.initials: HS
authors.lastname: Fraser
authors.forename: Dalia
authors.initials: D
authors.lastname: Guerra
authors.forename: Rocio M
authors.initials: RM
authors.lastname: Hurtado
authors.forename: Darius
authors.initials: D
authors.lastname: Jazayeri
authors.forename: Keith
authors.initials: K
authors.lastname: Joseph
authors.forename: Karim
authors.initials: K
authors.lastname: Llaro
authors.forename: Lorena
authors.initials: L
authors.lastname: Mestanza
authors.forename: Joia S
authors.initials: JS
authors.lastname: Mukherjee
authors.forename: Maribel
authors.initials: M
authors.lastname: Muñoz
authors.forename: Eda
authors.initials: E
authors.lastname: Palacios
authors.forename: Epifanio
authors.initials: E
authors.lastname: Sanchez
authors.forename: Alexander
authors.initials: A
authors.lastname: Sloutsky
authors.forename: Mercedes C
authors.initials: MC
authors.lastname: Becerra
mesh_terms: 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
chemical_list: D000995:Antitubercular Agents