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Outcome of pulmonary multidrug-resistant tuberculosis: a 6-yr follow-up study

¹ International Union Against Tuberculosis and Lung Disease, Paris, France. ² Taipei Medical University-Municipal Wan Fang Hospital, Taipei, and ³ Chest Hospital, Dept of Health, Tainan, Taiwan, and ⁴ National Tuberculosis Association, Taipei, China.

CORRESPONDENCE: D. A. Enarson, International Union Against Tuberculosis and Lung Disease, 68 Boulevard Saint-Michel 75006, Paris, France. Fax: 33 886225771501. E-mail: denarson{at}iuatld.org

Keywords: Death, follow-up, multidrug resistant, relapse, tuberculosis

Received: October 27, 2005
Accepted June 23, 2006

A retrospective study was performed to determine factors associated with the outcome of pulmonary multidrug-resistant tuberculosis (MDR-TB) in Taipei, Taiwan.

All patients newly diagnosed with pulmonary MDR-TB in a referral centre from 1992–1996 were enrolled and their outcome over the subsequent 6 yrs was determined.

A total of 299 patients were identified, comprising 215 (71.9%) males and 84 (28.1%) females with a mean age of 47.3 yrs. The patients received a mean of 3.7 effective drugs. Out of the 299 patients, 153 (51.2%) were cured, 31 (10.4%) failed, 28 (9.4%) died and 87 (29.1%) defaulted. Of the 125 patients receiving second-line drugs with ofloxacin, 74 (59.2%) were cured. Those who received ofloxacin had a lower risk of relapse than those receiving only first-line drugs (hazard ratio (HR) 0.16, 95% confidence interval (CI) 0.03–0.81) and a lower risk of TB-related death than those receiving second-line drugs but not ofloxacin (adjusted HR 0.50, 95% CI 0.31–0.82).

In conclusion, multidrug-resistant tuberculosis patients who received ofloxacin were more likely to be cured, and were less likely to die, fail or relapse. The utility of new-generation fluoroquinolones, such as moxifloxacin, in the treatment of multidrug-resistant tuberculosis needs to be evaluated. Default from treatment is a major challenge in the treatment of multidrug-resistant tuberculosis.

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