title: Epidemiology and clinical management of XDR-TB: a systematic review by TBNET.
abstract: Extensively drug-resistant tuberculosis (XDR-TB) is present in all regions and poses serious challenges for public health and clinical management. Laboratory diagnosis is difficult and little evidence exists to guide clinicians in treating people with XDR-TB effectively. To summarise the available data on diagnosis and treatment, the current authors performed a systematic review on 13 recent studies of the epidemiology and clinical management of XDR-TB. Studies that met inclusion criteria were reviewed, in order to assess methodology, treatment regimens and treatment outcomes. Meta-analysis of currently available data is not possible because of inconsistent definitions and methodologies. Data show that XDR-TB can be successfully treated in up to 65% of patients, particularly those who are not co-infected with HIV. However, treatment duration is longer and outcomes are in general poorer than for non-XDR TB patients. To strengthen the evidence for extensively drug-resistant tuberculosis diagnosis, treatment and prevention, future studies should: 1) be prospective in design; 2) adopt standardised, internationally accepted definitions; 3) use quality-assured laboratory testing for all first- and second-line drugs; and 4) collect data on an agreed-upon set of standard variables, allowing for comparisons across studies. Early diagnosis and aggressive management of extensively drug-resistant tuberculosis provide the best chance of positive outcome, but prevention is still paramount.
authors.affiliation: Hygiene and Preventive Medicine Institute, University of Sassari, Sassari, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Sotgiu
authors.forename: G
authors.initials: G
authors.lastname: Ferrara
authors.forename: A
authors.initials: A
authors.lastname: Matteelli
authors.forename: M D
authors.initials: MD
authors.lastname: Richardson
authors.forename: R
authors.initials: R
authors.lastname: Centis
authors.forename: S
authors.initials: S
authors.lastname: Ruesch-Gerdes
authors.forename: O
authors.initials: O
authors.lastname: Toungoussova
authors.forename: J-P
authors.initials: JP
authors.lastname: Zellweger
authors.forename: A
authors.initials: A
authors.lastname: Spanevello
authors.forename: D
authors.initials: D
authors.lastname: Cirillo
authors.forename: C
authors.initials: C
authors.lastname: Lange
authors.forename: G B
authors.initials: GB
authors.lastname: Migliori
mesh_terms: D000995:Antitubercular Agents / Q000627:therapeutic use*; D054908:Extensively Drug-Resistant Tuberculosis / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D014943:Global Health; D006801:Humans
chemical_list: D000995:Antitubercular Agents