title: Eliminating the category II retreatment regimen from national tuberculosis programme guidelines: the Georgian experience.
abstract: OBJECTIVE
  The category II retreatment regimen for management of tuberculosis in previously treated patients was first introduced in the early 1990s. It consists of 8 months of total therapy with the addition of streptomycin to standard first-line medications. A review of 6500 patients on category II therapy in Georgia showed poor outcomes and high rates of streptomycin resistance.
  
  
  METHODS
  The National Tuberculosis Program used an evidence-based analysis of national data to convince policy-makers that category II therapy should be eliminated from national guidelines in Georgia.
  
  
  METHODS
  The World Health Organization tuberculosis case-notification rate in Georgia is 102 per 100,000 population. All patients receive culture and drug susceptibility testing as a standard part of tuberculosis diagnosis. In 2009, routine surveillance found multidrug-resistant tuberculosis in 10.6% of newly diagnosed patients and 32.5% of previously treated cases.
  
  
  RESULTS
  Category II retreatment regimen is no longer used in Georgia. Treatment is guided by results of drug susceptibility testing--using rapid, molecular tests where possible--for all previously treated tuberculosis patients.
  
  
  CONCLUSIONS
  There was little resistance to policy change because the review was initiated and led by the National Tuberculosis Program. This experience can serve as a successful model for other countries to make informed decisions about the use of category II therapy.
authors.affiliation: School of Medicine, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, United States of America. jenniferfurin@gmail.com
authors.forename: Jennifer
authors.initials: J
authors.lastname: Furin
authors.forename: Medea
authors.initials: M
authors.lastname: Gegia
authors.forename: Carole
authors.initials: C
authors.lastname: Mitnick
authors.forename: Michael
authors.initials: M
authors.lastname: Rich
authors.forename: Sonya
authors.initials: S
authors.lastname: Shin
authors.forename: Mercedes
authors.initials: M
authors.lastname: Becerra
authors.forename: Peter
authors.initials: P
authors.lastname: Drobac
authors.forename: Paul
authors.initials: P
authors.lastname: Farmer
authors.forename: Rocio
authors.initials: R
authors.lastname: Hurtado
authors.forename: J Keith
authors.initials: JK
authors.lastname: Joseph
authors.forename: Salmaan
authors.initials: S
authors.lastname: Keshavjee
authors.forename: Iagor
authors.initials: I
authors.lastname: Kalandadze
mesh_terms: D000995:Antitubercular Agents / Q000627:therapeutic use; D003657:Decision Making; D005846:Georgia (Republic) / Q000453:epidemiology; D006291:Health Policy / Q000639:trends*; D006801:Humans; D011159:Population Surveillance; D017410:Practice Guidelines as Topic; D015397:Program Evaluation; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*
chemical_list: D000995:Antitubercular Agents