Successful management of multidrug-resistant tuberculosis under programme conditions in the Dominican Republic
Abstract:SETTING: The Dominican Republic is a high-incidence area for multidrug-resistant tuberculosis (MDR-TB; 6.6% of initial cases). Standardised treatment regimens for MDR-TB may be a potential solution.
OBJECTIVE: To present the effectiveness of standard regimens under routine national conditions.
DESIGN: We reviewed all MDR-TB patients treated under routine conditions from 29 August 2006 to 30 June 2010, showing interim and final outcomes. Patients were treated with regimens that were standardised or individualised based on previously received second-line anti-tuberculosis drugs.
RESULTS: Population description and culture conversion data are reported for the 289 MDR-TB patients. The median patient age was 31 years. Most had failed first-line treatment (72.6%). Culture negativity was obtained within 4 months (median 2 months) in 78.6%. Among the 150 patients treated between 2006 and 2008, 74% had favourable results on standardised and 66% on individualised regimens (P = 0.211). The efficacy of the standardised and individualised regimens was respectively 92.8% and 81% (P = 0.056). The relapse rate was approximately 1%. A median of five drug side effects occurred per patient. More than 2 months to culture conversion and bilateral cavitation on chest X-ray were found to be unfavourable outcome risk factors.
CONCLUSIONS: Standardised MDR-TB regimens may be effective at the national level, even in resource-poor settings.
Document Type: Research Article
Affiliations: 1: Dominican Republic National Tuberculosis Programme, Santo Domingo, Dominican Republic 2: MDR-TB Unit, Department of Tuberculosis and HIV, International Union Against Tuberculosis and Lung Disease, Paris, France; and Departament de Pediatria, Ginecologia i Medicina Preventiva, Universitat Autònoma de Barcelona, Barcelona, Spain 3: MDR-TB Unit, Department of Tuberculosis and HIV, International Union Against Tuberculosis and Lung Disease, Paris, France; and Servicio de Neumología, Hospital General de Gran Canaria ‘Dr Negrin’, Las Palmas de Gran Canaria, Spain 4: Comité Nacional de Evaluación TB-MDR, Santo Domingo, Dominican Republic 5: Panamerican Health Organization, Washington DC, USA 6: Centros de Investigación Biomédica en Red de Epidemiología y Salud Pública, Barcelona, Spain; and Departament de Salut Pública, Universitat de Barcelona, Barcelona, Spain 7: Centros de Investigación Biomédica en Red de Epidemiología y Salud Pública, Barcelona, Spain
Publication date: 2013-04-01
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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