Applicability of the shorter 'Bangladesh regimen' in high multidrug-resistant tuberculosis settings.
In spite of the recent introduction of two new drugs (delamanid and bedaquiline) and a few repurposed compounds to treat multidrug-resistant and extensively drug-resistant tuberculosis (MDR- and XDR-TB), clinicians are facing increasing problems in designing effective regimens in severe cases. Recently a 9 to 12-month regimen (known as the 'Bangladesh regimen') proved to be effective in treating MDR-TB cases. It included an initial phase of 4 to 6 months of kanamycin, moxifloxacin, prothionamide, clofazimine, pyrazinamide, high-dose isoniazid, and ethambutol, followed by 5 months of moxifloxacin, clofazimine, pyrazinamide, and ethambutol. However, recent evidence from Europe and Latin America identified prevalences of resistance to the first-line drugs in this regimen (ethambutol and pyrazinamide) exceeding 60%, and of prothionamide exceeding 50%. Furthermore, the proportions of resistance to the two most important pillars of the regimen - quinolones and kanamycin - were higher than 40%. Overall, only 14 out of 348 adult patients (4.0%) were susceptible to all of the drugs composing the regimen, and were therefore potentially suitable for the 'shorter regimen'. A shorter, cheaper, and well-tolerated MDR-TB regimen is likely to impact the number of patients treated and improve adherence if prescribed to the right patients through the systematic use of rapid MTBDRsl testing.
Clinical Epidemiology and Medical Statistics Unit, Department of Biomedical Sciences, University of Sassari, Sassari, Italy; Medical Education and Professional Development Unit, AOU Sassari, Sassari, Italy.
Giovanni
G
Sotgiu
Division of Infection, Barts Health NHS Trust, Royal London Hospital, London, UK.
Simon
S
Tiberi
Maugeri Institute, IRCCS, Care and Research Institute, Via Roncaccio 16, 21049, Tradate, Italy.
Rosella
R
Centis
Maugeri Institute, IRCCS, Care and Research Institute, Via Roncaccio 16, 21049, Tradate, Italy; Public Health Consulting Group, Lugano, Switzerland.
Lia
L
D'Ambrosio
Department of Pulmonology Hospital Jose Ignacio Baldo, Caracas, Capital District, Venezuela.
Zhenia
Z
Fuentes
Centre for Clinical Microbiology, Division of Infection and Immunity, University College London and NIHR Biomedical Research Centre, UCL Hospitals NHS Foundation Trust, London, UK.
Alimuddin
A
Zumla
Maugeri Institute, IRCCS, Care and Research Institute, Via Roncaccio 16, 21049, Tradate, Italy. Electronic address: giovannibattista.migliori@fsm.it.
Giovanni Battista
GB
Migliori
D000995:Antitubercular Agents / Q000627:therapeutic use*; D002985:Clinical Protocols; D064687:Diarylquinolines; D004359:Drug Therapy, Combination; D004977:Ethambutol / Q000494:pharmacology; D024841:Fluoroquinolones; D006801:Humans; D007538:Isoniazid / Q000494:pharmacology; D000077266:Moxifloxacin; D009169:Mycobacterium tuberculosis / Q000187:drug effects; D009593:Nitroimidazoles; D010080:Oxazoles; D011718:Pyrazinamide / Q000627:therapeutic use; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy*; D014944:World Health Organization
D000995:Antitubercular Agents; D064687:Diarylquinolines; D024841:Fluoroquinolones; D009593:Nitroimidazoles; C516022:OPC-67683; D010080:Oxazoles; D011718:Pyrazinamide; C493870:bedaquiline; D004977:Ethambutol; D000077266:Moxifloxacin; D007538:Isoniazid
Efficacy; Impact; MDR-TB; Shorter regimen; Treatment duration; XDR-TB