Multidrug-resistant tuberculosis treatment outcomes in Karakalpakstan, Uzbekistan: treatment complexity and XDR-TB among treatment failures
A pilot programme to treat multidrug-resistant TB (MDR-TB) was implemented in Karakalpakstan, Uzbekistan in 2003. This region has particularly high levels of MDR-TB, with 13% and 40% among new and previously treated cases, respectively. This study describes the treatment process and outcomes for the...
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| Veröffentlicht in: | PloS one 2007-11, Vol.2 (11), p.e1126-e1126 |
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| creator | Cox, Helen S Kalon, Stobdan Allamuratova, Sholpan Sizaire, Vinciane Tigay, Zinaida N Rüsch-Gerdes, Sabine Karimovich, Hamraev A Kebede, Yared Mills, Clair |
| description | A pilot programme to treat multidrug-resistant TB (MDR-TB) was implemented in Karakalpakstan, Uzbekistan in 2003. This region has particularly high levels of MDR-TB, with 13% and 40% among new and previously treated cases, respectively.
This study describes the treatment process and outcomes for the first cohort of patients enrolled in the programme, between October 2003 and January 2005. Confirmed MDR-TB cases were treated with an individualised, second-line drug regimen based on drug susceptibility test results, while suspected MDR-TB cases were treated with a standardised regimen pending susceptibility results.
Of 108 MDR-TB patients, 87 were started on treatment during the study period. Of these, 33 (38%) were infected with strains resistant to at least one second-line drug at baseline, but none had initial ofloxacin resistance. Treatment was successful for 54 (62%) patients, with 13 (15%) dying during treatment, 12 (14%) defaulting and 8 (8%) failing treatment. Poor clinical condition and baseline second-line resistance contributed to treatment failure or death. Treatment regimens were changed in 71 (82%) patients due to severe adverse events or drug resistance. Adverse events were most commonly attributed to cycloserine, ethionamide and p-aminosalicylic acid. Extensively drug resistant TB (XDR-TB) was found among 4 of the 6 patients who failed treatment and were still alive in November 2006.
While acceptable treatment success was achieved, the complexity of treatment and the development of XDR-TB among treatment failures are important issues to be addressed when considering scaling up MDR-TB treatment. |
| doi_str_mv | 10.1371/journal.pone.0001126 |
| format | Article |
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This study describes the treatment process and outcomes for the first cohort of patients enrolled in the programme, between October 2003 and January 2005. Confirmed MDR-TB cases were treated with an individualised, second-line drug regimen based on drug susceptibility test results, while suspected MDR-TB cases were treated with a standardised regimen pending susceptibility results.
Of 108 MDR-TB patients, 87 were started on treatment during the study period. Of these, 33 (38%) were infected with strains resistant to at least one second-line drug at baseline, but none had initial ofloxacin resistance. Treatment was successful for 54 (62%) patients, with 13 (15%) dying during treatment, 12 (14%) defaulting and 8 (8%) failing treatment. Poor clinical condition and baseline second-line resistance contributed to treatment failure or death. Treatment regimens were changed in 71 (82%) patients due to severe adverse events or drug resistance. Adverse events were most commonly attributed to cycloserine, ethionamide and p-aminosalicylic acid. Extensively drug resistant TB (XDR-TB) was found among 4 of the 6 patients who failed treatment and were still alive in November 2006.
While acceptable treatment success was achieved, the complexity of treatment and the development of XDR-TB among treatment failures are important issues to be addressed when considering scaling up MDR-TB treatment.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0001126</identifier><identifier>PMID: 17987113</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Acid resistance ; Adolescent ; Adult ; Aged ; Aminosalicylic acids ; Antitubercular Agents - therapeutic use ; Care and treatment ; Childrens health ; Clinical outcomes ; Cohort Studies ; Complexity ; Cycloserine ; Directly Observed Therapy ; Disease control ; Drug resistance ; Ethionamide ; Failure ; Female ; Humans ; Infectious Diseases/Antimicrobials and Drug Resistance ; Infectious Diseases/Epidemiology and Control of Infectious Diseases ; Infectious Diseases/Respiratory Infections ; Laboratories ; Male ; Medical research ; Microbial drug resistance ; Middle Aged ; Multidrug resistance ; Multidrug resistant organisms ; Ofloxacin ; Patient outcomes ; Patients ; Pilot Projects ; Population ; Public health ; Public Health and Epidemiology/Infectious Diseases ; Rural areas ; Scaling ; Task forces ; Treatment Outcome ; Tuberculosis ; Tuberculosis, Multidrug-Resistant - drug therapy ; Uzbekistan</subject><ispartof>PloS one, 2007-11, Vol.2 (11), p.e1126-e1126</ispartof><rights>COPYRIGHT 2007 Public Library of Science</rights><rights>2007 Cox et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Cox et al. 2007</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c644t-be76763903269e8ed101faa2ed081baf9fc44d0bb85c23a7a34199d7f71a87243</citedby><cites>FETCH-LOGICAL-c644t-be76763903269e8ed101faa2ed081baf9fc44d0bb85c23a7a34199d7f71a87243</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC2040509/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC2040509/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,724,777,781,861,882,2096,2915,23847,27905,27906,53772,53774,79349,79350</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17987113$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Zaas, Aimee</contributor><creatorcontrib>Cox, Helen S</creatorcontrib><creatorcontrib>Kalon, Stobdan</creatorcontrib><creatorcontrib>Allamuratova, Sholpan</creatorcontrib><creatorcontrib>Sizaire, Vinciane</creatorcontrib><creatorcontrib>Tigay, Zinaida N</creatorcontrib><creatorcontrib>Rüsch-Gerdes, Sabine</creatorcontrib><creatorcontrib>Karimovich, Hamraev A</creatorcontrib><creatorcontrib>Kebede, Yared</creatorcontrib><creatorcontrib>Mills, Clair</creatorcontrib><title>Multidrug-resistant tuberculosis treatment outcomes in Karakalpakstan, Uzbekistan: treatment complexity and XDR-TB among treatment failures</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>A pilot programme to treat multidrug-resistant TB (MDR-TB) was implemented in Karakalpakstan, Uzbekistan in 2003. This region has particularly high levels of MDR-TB, with 13% and 40% among new and previously treated cases, respectively.
This study describes the treatment process and outcomes for the first cohort of patients enrolled in the programme, between October 2003 and January 2005. Confirmed MDR-TB cases were treated with an individualised, second-line drug regimen based on drug susceptibility test results, while suspected MDR-TB cases were treated with a standardised regimen pending susceptibility results.
Of 108 MDR-TB patients, 87 were started on treatment during the study period. Of these, 33 (38%) were infected with strains resistant to at least one second-line drug at baseline, but none had initial ofloxacin resistance. Treatment was successful for 54 (62%) patients, with 13 (15%) dying during treatment, 12 (14%) defaulting and 8 (8%) failing treatment. Poor clinical condition and baseline second-line resistance contributed to treatment failure or death. Treatment regimens were changed in 71 (82%) patients due to severe adverse events or drug resistance. Adverse events were most commonly attributed to cycloserine, ethionamide and p-aminosalicylic acid. Extensively drug resistant TB (XDR-TB) was found among 4 of the 6 patients who failed treatment and were still alive in November 2006.
While acceptable treatment success was achieved, the complexity of treatment and the development of XDR-TB among treatment failures are important issues to be addressed when considering scaling up MDR-TB treatment.</description><subject>Acid resistance</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aminosalicylic acids</subject><subject>Antitubercular Agents - therapeutic use</subject><subject>Care and treatment</subject><subject>Childrens health</subject><subject>Clinical outcomes</subject><subject>Cohort Studies</subject><subject>Complexity</subject><subject>Cycloserine</subject><subject>Directly Observed Therapy</subject><subject>Disease control</subject><subject>Drug resistance</subject><subject>Ethionamide</subject><subject>Failure</subject><subject>Female</subject><subject>Humans</subject><subject>Infectious Diseases/Antimicrobials and Drug Resistance</subject><subject>Infectious Diseases/Epidemiology and Control of Infectious Diseases</subject><subject>Infectious Diseases/Respiratory Infections</subject><subject>Laboratories</subject><subject>Male</subject><subject>Medical research</subject><subject>Microbial drug resistance</subject><subject>Middle Aged</subject><subject>Multidrug resistance</subject><subject>Multidrug resistant organisms</subject><subject>Ofloxacin</subject><subject>Patient outcomes</subject><subject>Patients</subject><subject>Pilot Projects</subject><subject>Population</subject><subject>Public health</subject><subject>Public Health and Epidemiology/Infectious Diseases</subject><subject>Rural areas</subject><subject>Scaling</subject><subject>Task forces</subject><subject>Treatment Outcome</subject><subject>Tuberculosis</subject><subject>Tuberculosis, Multidrug-Resistant - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Cox, Helen S</au><au>Kalon, Stobdan</au><au>Allamuratova, Sholpan</au><au>Sizaire, Vinciane</au><au>Tigay, Zinaida N</au><au>Rüsch-Gerdes, Sabine</au><au>Karimovich, Hamraev A</au><au>Kebede, Yared</au><au>Mills, Clair</au><au>Zaas, Aimee</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Multidrug-resistant tuberculosis treatment outcomes in Karakalpakstan, Uzbekistan: treatment complexity and XDR-TB among treatment failures</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2007-11-07</date><risdate>2007</risdate><volume>2</volume><issue>11</issue><spage>e1126</spage><epage>e1126</epage><pages>e1126-e1126</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>A pilot programme to treat multidrug-resistant TB (MDR-TB) was implemented in Karakalpakstan, Uzbekistan in 2003. This region has particularly high levels of MDR-TB, with 13% and 40% among new and previously treated cases, respectively.
This study describes the treatment process and outcomes for the first cohort of patients enrolled in the programme, between October 2003 and January 2005. Confirmed MDR-TB cases were treated with an individualised, second-line drug regimen based on drug susceptibility test results, while suspected MDR-TB cases were treated with a standardised regimen pending susceptibility results.
Of 108 MDR-TB patients, 87 were started on treatment during the study period. Of these, 33 (38%) were infected with strains resistant to at least one second-line drug at baseline, but none had initial ofloxacin resistance. Treatment was successful for 54 (62%) patients, with 13 (15%) dying during treatment, 12 (14%) defaulting and 8 (8%) failing treatment. Poor clinical condition and baseline second-line resistance contributed to treatment failure or death. Treatment regimens were changed in 71 (82%) patients due to severe adverse events or drug resistance. Adverse events were most commonly attributed to cycloserine, ethionamide and p-aminosalicylic acid. Extensively drug resistant TB (XDR-TB) was found among 4 of the 6 patients who failed treatment and were still alive in November 2006.
While acceptable treatment success was achieved, the complexity of treatment and the development of XDR-TB among treatment failures are important issues to be addressed when considering scaling up MDR-TB treatment.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>17987113</pmid><doi>10.1371/journal.pone.0001126</doi><tpages>e1126</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2007-11, Vol.2 (11), p.e1126-e1126 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_1950342082 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Public Library of Science (PLoS); PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Acid resistance Adolescent Adult Aged Aminosalicylic acids Antitubercular Agents - therapeutic use Care and treatment Childrens health Clinical outcomes Cohort Studies Complexity Cycloserine Directly Observed Therapy Disease control Drug resistance Ethionamide Failure Female Humans Infectious Diseases/Antimicrobials and Drug Resistance Infectious Diseases/Epidemiology and Control of Infectious Diseases Infectious Diseases/Respiratory Infections Laboratories Male Medical research Microbial drug resistance Middle Aged Multidrug resistance Multidrug resistant organisms Ofloxacin Patient outcomes Patients Pilot Projects Population Public health Public Health and Epidemiology/Infectious Diseases Rural areas Scaling Task forces Treatment Outcome Tuberculosis Tuberculosis, Multidrug-Resistant - drug therapy Uzbekistan |
| title | Multidrug-resistant tuberculosis treatment outcomes in Karakalpakstan, Uzbekistan: treatment complexity and XDR-TB among treatment failures |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-18T05%3A43%3A26IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Multidrug-resistant%20tuberculosis%20treatment%20outcomes%20in%20Karakalpakstan,%20Uzbekistan:%20treatment%20complexity%20and%20XDR-TB%20among%20treatment%20failures&rft.jtitle=PloS%20one&rft.au=Cox,%20Helen%20S&rft.date=2007-11-07&rft.volume=2&rft.issue=11&rft.spage=e1126&rft.epage=e1126&rft.pages=e1126-e1126&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0001126&rft_dat=%3Cgale_plos_%3EA472238123%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1289137941&rft_id=info:pmid/17987113&rft_galeid=A472238123&rft_doaj_id=oai_doaj_org_article_2f6ed3e12934463f8ac92e341e712d99&rfr_iscdi=true |