title: Presumptive treatment of multidrug-resistant tuberculosis in household contacts.
abstract: METHODS
  Multidrug-resistant tuberculosis (MDR-TB) is a growing global health threat that often requires presumptive treatment in the absence of drug susceptibility testing (DST) results.
  
  
  OBJECTIVE
  To compare two approaches to the treatment of MDR-TB contacts with no DST results who develop TB disease.
  
  
  METHODS
  We conducted a retrospective cohort study of adults treated for TB disease who were contacts of patients living with MDR-TB. Subjects had been treated according to one of two presumptive treatment strategies: 1) regimens containing exclusively first-line drugs, and 2) regimens that included both first- and second-line drugs that were adjusted if and when DST results became available. The primary endpoint was a composite of death and treatment failure.
  
  
  RESULTS
  Household contacts of MDR-TB patients who developed TB disease and were treated with first-line regimens were significantly more likely to experience unfavorable end-of-treatment outcomes than those treated with presumptive MDR-TB regimens (RR 2.88, 95%CI 1.24-6.68).
  
  
  CONCLUSIONS
  Household contacts of MDR-TB patients who develop TB disease but have no DST results should receive regimens containing second-line drugs selected based on the infecting strain of the index patient. Regimens containing only first-line anti-tuberculosis drugs significantly increase the risk of unfavorable outcomes.
authors.affiliation: Division of Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, USA.
authors.forename: J B
authors.initials: JB
authors.lastname: Parr
authors.affiliation: Partners In Health, Boston, MA, USA; Lima, Peru; Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: M L
authors.initials: ML
authors.lastname: Rich
authors.affiliation: Partners In Health, Boston, MA, USA; Lima, Peru; Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: S
authors.initials: S
authors.lastname: Keshavjee
authors.affiliation: Partners In Health, Boston, MA, USA; Lima, Peru; Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: M F
authors.initials: MF
authors.lastname: Franke
authors.affiliation: Partners In Health, Boston, MA, USA, and Lima, Peru; Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: C D
authors.initials: CD
authors.lastname: Mitnick
authors.affiliation: Partners In Health, Boston, MA, USA, and Lima, Peru; Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: J
authors.initials: J
authors.lastname: Bayona
authors.affiliation: Partners In Health, Boston, MA, USA, and Lima, Peru; Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115, USA. mercedes_becerra@hms.harvard.edu.
authors.forename: M C
authors.initials: MC
authors.lastname: Becerra
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use*; D024901:Drug Resistance, Multiple, Bacterial; D023381:Endpoint Determination; D005191:Family Characteristics; D005260:Female; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D009169:Mycobacterium tuberculosis / Q000187:drug effects / Q000302:isolation & purification; D010865:Pilot Projects; D012189:Retrospective Studies; D012307:Risk Factors; D013183:Sputum / Q000382:microbiology; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy*; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents