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Volume 12, Number 9—September 2006
Research

Multidrug-resistant Tuberculosis Management in Resource-limited Settings

Eva Nathanson*Comments to Author , Catharina Lambregts-van Weezenbeek†, Michael Rich‡, Rajesh Gupta*, Jaime Bayona‡§, Kai Blöndal†, José A. Caminero¶, J. Peter Cegielski#, Manfred Danilovits**, Marcos A. Espinal*, Vahur Hollo††, Ernesto Jaramillo*, Vaira Leimane‡‡, Carole D. Mitnick§§, Joia S. Mukherjee§§, Paul Nunn*, Alexander Pasechnikov‡¶¶, Thelma E. Tupasi##, Charles Wells#, and Mario C. Raviglione*
Author affiliations: *World Health Organization, Geneva, Switzerland; †KNCV Tuberculosis Foundation, The Hague, the Netherlands; ‡Partners In Health, Boston, Massachusetts, USA; §Socios En Salud, Lima, Peru; ¶International Union Against Tuberculosis and Lung Disease, Paris, France; #Centers for Disease Control and Prevention, Atlanta, Georgia, USA; **Tartu University Clinics, Tartu, Estonia; ††National TB Programme, Tallinn, Estonia; ‡‡State Centre of Tuberculosis and Lung Diseases of Latvia, Riga, Latvia; §§Harvard Medical School, Boston, Massachusetts, USA; ¶¶MDR-TB Project in Tomsk Oblast, Tomsk, Russian Federation; ##Makati Medical Center, Makati, the Philippines

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Table 1

Treatment outcome definitions for multidrug-resistant tuberculosis (MDRTB) patients (14)

Category Definition
Cure Completed treatment according to country protocol and been consistently culture-negative (>5 results) for final 12 mo of treatment. If only 1 positive culture is reported during that time with no concomitant clinical evidence of deterioration, patient may still be considered cured, provided that positive culture is followed by >3 consecutive negative cultures taken >30 d apart.
Treatment completed Completed treatment according to country protocol but does not meet definition for cure or treatment failure because of lack of bacteriologic results (i.e., <5 cultures were performed in the final 12 mo of therapy).
Death Died for any reason during the course of MDRTB treatment.
Treatment default Treatment was interrupted for >2 consecutive months for any reason.
Treatment failure >2 of 5 cultures recorded in the final 12 mo are positive or if any of the final 3 cultures is positive. Treatment will also be considered to have failed if a clinical decision has been made to terminate treatment early due to poor response or adverse events.
Transfer out Transferred to another reporting and recording unit and the treatment outcome is unknown.

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References
  1. World Health Organization/International Union Against Tuberculosis and Lung Disease. Anti-tuberculosis drug resistance in the world, third global report. Geneva: The Organization; 2003. Publication WHO/HTM/TB/2004.343. Available from http://www.who.int/tb/publications/who_htm_tb_2004_343/en/index.html
  2. Zignol  M, Hosseini  MS, Wright  A, Weezenbeek  CL, Nunn  P, Watt  CJ, Global incidence of multidrug-resistant tuberculosis. J Infect Dis. 2006;194:479–85. DOIPubMedGoogle Scholar
  3. World Health Organization. Treatment of tuberculosis: guidelines for national programmes. 3rd ed. Geneva: The Organization; 2003. Publication WHO/CDS/2003.313. Available from http://www.who.int/tb/publications/cds_tb_2003_313/en/index.html
  4. Coninx  R, Mathieu  C, Debacker  M, Mirzoev  F, Ismaelov  A, de Haller  R, First-line tuberculosis therapy and drug-resistant Mycobacterium tuberculosis in prisons. Lancet. 1999;353:969–73. DOIPubMedGoogle Scholar
  5. Espinal  MA, Kim  SJ, Suarez  PG, Kam  KM, Khomenko  AG, Migliori  GB, Standard short-course chemotherapy for drug-resistant tuberculosis: treatment outcome in 6 countries. JAMA. 2000;283:2537–45. DOIPubMedGoogle Scholar
  6. Migliori  GB, Espinal  M, Danilova  ID, Punga  VV, Grzemska  M, Raviglione  MC. Frequency of recurrence among MDR-TB cases ‘successfully' treated with standardised short-course chemotherapy. Int J Tuberc Lung Dis. 2002;6:858–64.PubMedGoogle Scholar
  7. Seung  KJ, Gelmanova  IE, Peremitin  GG, Golubchikova  VT, Pavlova  VE, Sirotkina  OB, The effect of initial drug resistance on treatment response and acquired drug resistance during standardized short-course chemotherapy for tuberculosis. Clin Infect Dis. 2004;39:1321–8. DOIPubMedGoogle Scholar
  8. van Deun  A, Salim  MA, Das  AP, Bastian  I, Portaels  F. Results of a standardised regimen for multidrug-resistant tuberculosis in Bangladesh. Int J Tuberc Lung Dis. 2004;8:560–7.PubMedGoogle Scholar
  9. Leimane  V, Riekstina  V, Holtz  TH, Zarovska  E, Skripconoka  V, Thorpe  LE, Clinical outcome of individualised treatment of multidrug-resistant tuberculosis in Latvia: a retrospective cohort study. Lancet. 2005;365:318–26.PubMedGoogle Scholar
  10. Mukherjee  JS, Rich  ML, Socci  AR, Joseph  JK, Viru  FA, Shin  SS, Programmes and principles in treatment of multidrug-resistant tuberculosis. Lancet. 2004;363:474–81. DOIPubMedGoogle Scholar
  11. World Health Organization. Guidelines for establishing DOTS-Plus pilot projects for the management of multidrug-resistant tuberculosis. Geneva: The Organization; 2000. Publication WHO/CDS/TB/2000.279. Available from http://www.who.int/docstore/gtb/publications/dotsplus/dotspluspilot-2000-279/english/index.htm
  12. Gupta  R, Kim  JY, Espinal  MA, Caudron  JM, Pecoul  B, Farmer  PE, Responding to market failures in tuberculosis control. Science. 2001;293:1049–51. DOIPubMedGoogle Scholar
  13. Gupta  R, Cegielski  JP, Espinal  MA, Henkens  M, Kim  JY, Lambregts-van Weezenbeek  CS, Increasing transparency in partnerships for health—introducing the Green Light Committee. Trop Med Int Health. 2002;7:970–6. DOIPubMedGoogle Scholar
  14. Laserson  KF, Thorpe  LE, Leimane  V, Weyer  K, Mitnick  C, Riekstina  V, Speaking the same language: treatment outcome definitions for multidrug-resistant tuberculosis. Int J Tuberc Lung Dis. 2005;9:640–5.PubMedGoogle Scholar
  15. Raviglione  MC, Uplekar  MW. WHO's new Stop TB Strategy. Lancet. 2006;367:952–5. DOIPubMedGoogle Scholar
  16. World Health Organization. Guidelines for surveillance of drug resistance in tuberculosis. Geneva: The Organization; 2003. Publication WHO/CDS/TB/2003.320. Available from http://www.who.int/docstore/gtb/publications/drugresistance/tb_2003_320/surveillance_guidelinespdf.pdf
  17. World Health Organization. Global tuberculosis control: surveillance, planning, financing. WHO report 2005. Geneva: The Organization; 2005. Publication WHO/HTM/2005.349. Available from http://www.who.int/tb/publications/global_report/2005/en/index.html
  18. Enarson  DA, Rieder  HL, Arnadottir  T, Trebucq  A. Management of tuberculosis: a guide for low income countries. Paris: International Union Against Tuberculosis and Lung Disease; 2000. Available from http://www.iuatld.org/pdf/en/guides_publications/management_of_tb.pdf
  19. World Health Organization. Guidelines for the management of drug-resistant tuberculosis. Geneva: The Organization; 1996. Publication WHO/TB/96.210. Available from http://www.who.int/docstore/gtb/publications/gmdrt/index.htm
  20. Suarez  PG, Floyd  K, Portocarrero  J, Alarcon  E, Rapiti  E, Ramos  G, Feasibility and cost-effectiveness of standardised second-line drug treatment for chronic tuberculosis patients: a national cohort study in Peru. Lancet. 2002;359:1980–9. DOIPubMedGoogle Scholar
  21. Turett  GS, Telzak  EE, Torian  LV, Blum  S, Alland  D, Weisfuse  I, Improved outcomes for patients with multidrug-resistant tuberculosis. Clin Infect Dis. 1995;21:1238–44. DOIPubMedGoogle Scholar
  22. Park  MM, Davis  AL, Schluger  NW, Cohen  H, Rom  WN. Outcome of MDR-TB patients, 1983–1993. Prolonged survival with appropriate therapy. Am J Respir Crit Care Med. 1996;153:317–24.PubMedGoogle Scholar
  23. Nathanson  E, Gupta  R, Huamani  P, Leimane  V, Pasechnikov  AD, Tupasi  TE, Adverse events in the treatment of multidrug-resistant tuberculosis: results from the DOTS-Plus initiative. Int J Tuberc Lung Dis. 2004;8:1382–4.PubMedGoogle Scholar
  24. Tupasi  TE, Gupta  R, Quelapio  ID, Orillaza  RB, Mira  NR, Mangubat  NV, Feasibility and cost-effectiveness of treating patients with multidrug-resistant tuberculosis using the DOTS-Plus strategy: a cohort study in the Philippines. PLoS Med. 2006. In press. DOIPubMedGoogle Scholar
  25. World Health Organization. The feasibility and efficiency of controlling MDR-TB using the DOTS-Plus strategy in the Russian Federation. Geneva: The Organization; 2005. Publication WHO/HTM/TB/2005.357C. Available from http://whqlibdoc.who.int/hq/2005/WHO_HTM_TB_2005.357_3_eng.pdf
  26. World Health Organization. Guidelines for the programmatic management of drug-resistant tuberculosis. Geneva: The Organization; 2006. Publication WHO/HTM/2006.361. Available from http://whqlibdoc.who.int/publications/2006/9241546956_eng.pdf
  27. Attaran  A, Barnes  KI, Curtis  C, d'Alessandro  U, Fanello  CI, Galinski  MR, WHO, the Global Fund, and medical malpractice in malaria treatment. Lancet. 2004;363:237–40. DOIPubMedGoogle Scholar
  28. Gupta  R, Irwin  A, Raviglione  MC, Kim  JY. Scaling up treatment for HIV/AIDS: lessons learned from multidrug-resistant tuberculosis. Lancet. 2004;363:320–4. DOIPubMedGoogle Scholar
  29. Farmer  P, Leandre  F, Mukherjee  JS, Claude  M, Nevil  P, Smith-Fawzi  MC, Community based approaches to HIV treatment in resource poor settings. Lancet. 2001;358:404–9. DOIPubMedGoogle Scholar

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Page created: November 17, 2011
Page updated: November 17, 2011
Page reviewed: November 17, 2011
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