Free Content Representative drug susceptibility patterns for guiding design of retreatment regimens for MDR-TB

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Abstract:

BACKGROUND: There is no gold standard on how national tuberculosis programs should design retreatment regimens. Often drug susceptibility testing (DST) is not available for all patients, and representative DST patterns in patient populations are used to guide therapy.

OBJECTIVES: To examine DST patterns in different patient populations based on previous treatment and to estimate the number of effective anti-tuberculosis agents in several retreatment regimens.

METHODS: We reviewed DST results from patients treated with individualized regimens in Peru between January 1998 and July 2004. We stratified patients into four groups based on previous treatment exposure from Group 1 who had failed only one regimen to Group 4 who had failed three regimens. We compared resistance frequencies across the four groups. In Groups 1 and 3, the number of likely effective agents under six possible retreatment regimen scenarios was estimated.

RESULTS: Resistance to second-line drugs was significantly higher in groups with more previous courses of treatment. A few retreatment regimens could be identified that would allow at least 80% of patients to receive at least four likely effective drugs.

CONCLUSION: Because it is associated with resistance frequencies, previous treatment exposure can serve to guide the design of non-individualized MDR-TB regimens.

Keywords: MDR-TB; drug resistance; individualized; retreatment; standardized; tuberculosis

Document Type: Regular Paper

Affiliations: 1: Partners In Health, Boston, Massachusetts, USA; Socios En Salud Sucursal Perú, Lima, Peru; and Division of Social Medicine and Health Inequalities, Brigham and Women's Hospital, Boston, Massachusetts, USA 2: Partners In Health, Boston, Massachusetts, USA; Socios En Salud Sucursal Perú, Lima, Peru; and Department of Social Medicine, Harvard Medical School, Boston, Massachusetts, USA 3: Division of Social Medicine and Health Inequalities, Brigham and Women's Hospital, Boston, Massachusetts, USA; and Department of Social Medicine, Harvard Medical School, Boston, Massachusetts, USA 4: Partners In Health, Boston, Massachusetts, USA; and Division of Social Medicine and Health Inequalities, Brigham and Women's Hospital, Boston, Massachusetts, USA 5: National Tuberculosis Control Program, Ministry of Health, Lima, Peru 6: Partners In Health, Boston, Massachusetts, USA; and Socios En Salud Sucursal Perú, Lima, Peru

Publication date: March 1, 2006

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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.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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