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Home / The International Journal of Tuberculosis and Lung Disease, Volume 13, Number 10

Tuberculosis retreatment category predicts resistance in hospitalized retreatment patients in a high HIV prevalence area

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SETTING: Rates of multidrug-resistant tuberculosis (MDR-TB) are currently as high as 7.7% in retreatment cases in KwaZulu-Natal, South Africa. MDR-TB prevalence is known to be high in patients categorized as treatment failures. Recent reports have questioned the effectiveness of the World Health Organization (WHO) Category II regimen in retreatment TB cases.

OBJECTIVE: To determine whether treatment category predicts susceptibility patterns and outcomes in a hospitalized population of retreatment TB cases.

DESIGN: Retrospective cohort of 197 pulmonary retreatment cases.

RESULTS: Retreatment cases treated with the standard retreatment regimen had a high in-hospital mortality (19.8%), or poor outcome (26.4%) and a high rate of MDR-TB (16.2%). The ‘treatment failure’ category predicted resistance, with 57.1% of patients exhibiting any resistance compared to other treatment categories (P = 0.02); 53.8% of patients with any resistance experienced poor outcomes, compared to 16.6% of pan-susceptible cases (P = 0.02). There was a trend towards poor outcome in the treatment failure category (42.9%, P = 0.13).

CONCLUSION: The retreatment category ‘treatment failure’ is associated with a high prevalence of resistance in an area of high human immunodeficiency virus (HIV) prevalence. The ‘treatment failure’ category should be used to identify patients who may benefit from alternative regimens using directed, intensified therapy or second-line agents instead of the current standard retreatment regimen.

Keywords: Category II regimen; multidrug-resistant tuberculosis; outcome; retreatment; treatment category

Document Type: Regular Paper

Affiliations: 1: Ottawa Health Research Institute, University of Ottawa at The Ottawa Hospital, Ottawa, Ontario, Canada 2: Harvard Medical School, Boston, Massachusetts, USA 3: University of KwaZulu Natal at Edendale Hospital and Doris Goodwin Hospital, Pietermaritzburg, KwaZulu Natal, South Africa 4: Harvard School of Public Health, Boston, Massachusetts, USA

Publication date: 01 October 2009

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  • The International Journal of Tuberculosis and Lung Disease (IJTLD) is for clinical research and epidemiological studies on lung health, including articles on TB, TB-HIV and respiratory diseases such as COVID-19, asthma, COPD, child lung health and the hazards of tobacco and air pollution. Individuals and institutes can subscribe to the IJTLD online or in print – simply email us at [email protected] for details.

    The IJTLD is dedicated to understanding lung disease and to the dissemination of knowledge leading to better lung health. To allow us to share scientific research as rapidly as possible, the IJTLD is fast-tracking the publication of certain articles as preprints prior to their publication. Read fast-track articles.

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