title: Successful management of multidrug-resistant tuberculosis under programme conditions in the Dominican Republic.
abstract: METHODS
  The Dominican Republic is a high-incidence area for multidrug-resistant tuberculosis (MDR-TB; 6.6% of initial cases). Standardised treatment regimens for MDR-TB may be a potential solution.
  
  
  OBJECTIVE
  To present the effectiveness of standard regimens under routine national conditions.
  
  
  METHODS
  We reviewed all MDR-TB patients treated under routine conditions from 29 August 2006 to 30 June 2010, showing interim and final outcomes. Patients were treated with regimens that were standardised or individualised based on previously received second-line anti-tuberculosis drugs.
  
  
  RESULTS
  Population description and culture conversion data are reported for the 289 MDR-TB patients. The median patient age was 31 years. Most had failed first-line treatment (72.6%). Culture negativity was obtained within 4 months (median 2 months) in 78.6%. Among the 150 patients treated between 2006 and 2008, 74% had favourable results on standardised and 66% on individualised regimens (P = 0.211). The efficacy of the standardised and individualised regimens was respectively 92.8% and 81% (P = 0.056). The relapse rate was approximately 1%. A median of five drug side effects occurred per patient. More than 2 months to culture conversion and bilateral cavitation on chest X-ray were found to be unfavourable outcome risk factors.
  
  
  CONCLUSIONS
  Standardised MDR-TB regimens may be effective at the national level, even in resource-poor settings.
authors.affiliation: Dominican Republic National Tuberculosis Programme, Santo Domingo, Dominican Republic.
authors.forename: M
authors.initials: M
authors.lastname: Rodriguez
authors.forename: I
authors.initials: I
authors.lastname: Monedero
authors.forename: J A
authors.initials: JA
authors.lastname: Caminero
authors.forename: M
authors.initials: M
authors.lastname: Encarnación
authors.forename: Y
authors.initials: Y
authors.lastname: Dominguez
authors.forename: I
authors.initials: I
authors.lastname: Acosta
authors.forename: E
authors.initials: E
authors.lastname: Muñoz
authors.forename: E
authors.initials: E
authors.lastname: Camilo
authors.forename: S
authors.initials: S
authors.lastname: Martinez-Selmo
authors.forename: S
authors.initials: S
authors.lastname: de los Santos
authors.forename: M
authors.initials: M
authors.lastname: del Granado
authors.forename: M
authors.initials: M
authors.lastname: Casals
authors.forename: J
authors.initials: J
authors.lastname: Cayla
authors.forename: B
authors.initials: B
authors.lastname: Marcelino
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000009:adverse effects / Q000627:therapeutic use*; D003906:Developing Countries; D004293:Dominican Republic / Q000453:epidemiology; D024901:Drug Resistance, Multiple, Bacterial; D004359:Drug Therapy, Combination; D005260:Female; D006295:Health Resources; D006801:Humans; D015994:Incidence; D008297:Male; D008826:Microbial Sensitivity Tests; D009169:Mycobacterium tuberculosis / Q000187:drug effects / Q000302:isolation & purification; D011237:Predictive Value of Tests; D015397:Program Evaluation; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology
chemical_list: D000995:Antitubercular Agents