Authors: Van Deun A.¹; Hamid Salim M.A.²; Kumar Das A.P.²; Bastian I.³; Portaels F.¹

Source: The International Journal of Tuberculosis and Lung Disease, Volume 8, Number 5, May 2004 , pp. 560-567(8)

Publisher: International Union Against Tuberculosis and Lung Disease

Abstract:

SETTING: Individualised regimens based on drug susceptibility test results, generally used to treat multidrug-resistant tuberculosis (MDR-TB), require often unavailable expertise and resources.

OBJECTIVE: To evaluate a standardised regimen based on the susceptibility profiles of locally prevalent MDR-TB strains.

DESIGN: The activities of a successful DOTS programme in Bangladesh were complemented by offering treatment with a standardised 21-month regimen to patients with laboratory-confirmed MDR-TB disease. The regimen contained kanamycin, ofloxacin, prothionamide, pyrazinamide, ethambutol, isoniazid and clofazimine. Clinical and bacteriological progress was monitored quarterly until treatment completion, then 6 monthly for 2 years.

RESULTS: The status at the end of treatment of this cohort of 58 documented MDR-TB patients was as follows: eight (14%) deaths, seven (12%) defaults, three (5%) failures and 40 (69%) cures. One bacteriologically-confirmed relapse was recognised. Frequent and sometimes serious side effects proved to be the main problem, suggesting the need for a better tolerated but equally effective regimen.

CONCLUSION: A standardised approach may provide a reasonable alternative to individualised treatment of MDR-TB in resource-poor settings. However, DOTS-plus programmes in resource-poor settings may confront significant difficulties in the enrolment, diagnosis and management of MDR-TB patients.

Keywords: multi-drug resistance; treatment; control; tuberculosis

Document Type: Regular paper

Affiliations: 1: Mycobacteriology Unit, Institute of Tropical Medicine, Antwerp, Belgium 2: Damien Foundation Bangladesh, Dhaka, Bangladesh 3: Institute of Medical & Veterinary Science, Adelaide, Australia

Publication date: 2004-05-01

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• The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

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