Presumptive treatment of multidrug-resistant tuberculosis in household contacts.
Int J Tuberc Lung Dis
; 20(3): 370-5, 2016 Mar.
Article
in En
| MEDLINE
| ID: mdl-27046719
ABSTRACT
SETTING:
Multidrug-resistant tuberculosis (MDR-TB) is a growing global health threat that often requires presumptive treatment in the absence of drug susceptibility testing (DST) results.OBJECTIVE:
To compare two approaches to the treatment of MDR-TB contacts with no DST results who develop TB disease.DESIGN:
We conducted a retrospective cohort study of adults treated for TB disease who were contacts of patients living with MDR-TB. Subjects had been treated according to one of two presumptive treatment strategies 1) regimens containing exclusively first-line drugs, and 2) regimens that included both first- and second-line drugs that were adjusted if and when DST results became available. The primary endpoint was a composite of death and treatment failure.RESULTS:
Household contacts of MDR-TB patients who developed TB disease and were treated with first-line regimens were significantly more likely to experience unfavorable end-of-treatment outcomes than those treated with presumptive MDR-TB regimens (RR 2.88, 95%CI 1.24-6.68).CONCLUSION:
Household contacts of MDR-TB patients who develop TB disease but have no DST results should receive regimens containing second-line drugs selected based on the infecting strain of the index patient. Regimens containing only first-line anti-tuberculosis drugs significantly increase the risk of unfavorable outcomes.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Family Characteristics
/
Tuberculosis, Multidrug-Resistant
/
Antitubercular Agents
Type of study:
Etiology_studies
/
Observational_studies
/
Risk_factors_studies
Limits:
Adult
/
Female
/
Humans
/
Male
Language:
En
Journal:
Int J Tuberc Lung Dis
Year:
2016
Document type:
Article
Affiliation country:
United States