title: Aggressive regimens for multidrug-resistant tuberculosis reduce recurrence.
abstract: BACKGROUND
  Recurrent tuberculosis disease occurs within 2 years in as few as 1% and as many as 29% of individuals successfully treated for multidrug-resistant (MDR) tuberculosis. A better understanding of treatment-related factors associated with an elevated risk of recurrent tuberculosis after cure is urgently needed to optimize MDR tuberculosis therapy.
  
  
  METHODS
  We conducted a retrospective cohort study among adults successfully treated for MDR tuberculosis in Peru. We used multivariable Cox proportional hazards regression analysis to examine whether receipt of an aggressive MDR tuberculosis regimen for ≥18 months following sputum conversion from positive to negative was associated with a reduced rate of recurrent tuberculosis.
  
  
  RESULTS
  Among 402 patients, the median duration of follow-up was 40.5 months (interquartile range, 21.2-53.4). Receipt of an aggressive MDR tuberculosis regimen for ≥18 months following sputum conversion was associated with a lower risk of recurrent tuberculosis (hazard ratio, 0.40 [95% confidence interval, 0.17-0.96]; P = .04). A baseline diagnosis of diabetes mellitus also predicted recurrent tuberculosis (hazard ratio, 10.47 [95% confidence interval, 2.17-50.60]; P = .004).
  
  
  CONCLUSIONS
  Individuals who received an aggressive MDR tuberculosis regimen for ≥18 months following sputum conversion experienced a lower rate of recurrence after cure. Efforts to ensure that an aggressive regimen is accessible to all patients with MDR tuberculosis, such as minimization of sequential ineffective regimens, expanded drug access, and development of new MDR tuberculosis compounds, are critical to reducing tuberculosis recurrence in this population. Patients with diabetes mellitus should be carefully managed during initial treatment and followed closely for recurrent disease.
authors.affiliation: Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Molly F
authors.initials: MF
authors.lastname: Franke
authors.forename: Sasha C
authors.initials: SC
authors.lastname: Appleton
authors.forename: Carole D
authors.initials: CD
authors.lastname: Mitnick
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Furin
authors.forename: Jaime
authors.initials: J
authors.lastname: Bayona
authors.forename: Katiuska
authors.initials: K
authors.lastname: Chalco
authors.forename: Sonya
authors.initials: S
authors.lastname: Shin
authors.forename: Megan
authors.initials: M
authors.lastname: Murray
authors.forename: Mercedes C
authors.initials: MC
authors.lastname: Becerra
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000008:administration & dosage*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D009169:Mycobacterium tuberculosis / Q000187:drug effects / Q000302:isolation & purification; D010568:Peru; D012189:Retrospective Studies; D055502:Secondary Prevention; D013183:Sputum / Q000382:microbiology; D013997:Time Factors; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy* / Q000382:microbiology; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents