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Volume 12, Number 9—September 2006

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 2

Description of MDRTB control programs*

Factor Estonia Latvia Lima Manila Tomsk
Start of enrollment 1 Aug 2001 1 Jan 2001 1 Feb 1999 15 Apr 1999 12 Sep 2000
Project size Country Country Region District Region
Project population 1,364,101 2,350,000 7,748,258 9,930,000 1,032,400
Prisons included? Yes Yes Yes (1 prison) No Yes
% MDRTB, new cases (2002) 11.9 9.8 NA† NA† 13.7
% MDRTB, previously treated cases (2002) 29.3 26.7 NA† NA† 43.6
Voluntary HIV counseling/testing? Yes Yes Yes No Yes
Empiric regimen?‡ No Yes Yes No Yes
Surgery used? Yes Yes Yes No Yes
DOT (days per wk) 7 hosp, 6 amb 7 hosp, 5–6 amb 6 6 6
Incentives to patients? Yes Yes Yes No Yes
Incentives to providers? Yes No Yes No Yes
Culture monitoring Monthly Monthly Monthly Monthly Monthly
X-ray monitoring Every 3 mo Every 3 mo Every 6 mo Every 6 mo Every 3 mo
Drugs for which DST is performed§ H, R, E, S, Z, Amk, Cm, Eth, Km, Ofx, Pth H, R, E, S, Z, Cm, Cs, Eth, Km, Ofx, Pas, T H, R, E, S, Z, Amk, Cfx, Cm, Cs, Eth, Km H, R, E, S, Z, Amc,§ Amk, Km, Cfx, Clr,§ Lfx, Ofx H, R, E, S, Z, Cm, Cs, Km, Ofx, Pas, Pth

*MDRTB, multidrug-resistant tuberculosis; NA, not applicable; DOT, directly observed treatment; hosp, hospital; amb, ambulatory; DST, drug susceptibility testing; H, isoniazid; R, rifampin; E, ethambutol; S, streptomycin; Z, pyrazinamide; Amk, amikacin; Cm, capreomycin; Eth, ethionamide; Km, kanamycin; Ofx, ofloxacin; Pth, prothionamide; Cs, cycloserine; Pas, p-aminosalicylic acid; T, thiacetazone; Cfx, ciprofloxacin; Amc, amoxicillin–clavulanic acid; Clr, clarithromycin; Lfx, levofloxacin.
†Lima and Manila do not perform routine drug resistance surveillance.
‡Use of treatment regimens based on the history of drugs used by the patient while awaiting DST results.
§Amc and Clr and are not included on the World Health Organization Model List of Essential Drugs and are therefore not purchased through the Green Light Committee. However, each project used additional drugs at its discretion.

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