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Epidemiology and clinical management of XDR-TB: a systematic review by TBNET

For affiliations, please see the Acknowledgements section.

CORRESPONDENCE: G. B. Migliori, WHO Collaborating Centre for TB and Lung Diseases, Fondazione S. Maugeri, Care and Research Institute, TBNET Secretariat (Tuberculosis Network European Trials Group), Via Roncaccio 16, 21049, Tradate, Italy. Fax: 39 0331829402. E-mail: giovannibattista.migliori{at}fsm.it

Keywords: Extensively drug-resistant tuberculosis, microbiological diagnosis, outcomes, systematic review, treatment efficacy

Received: November 6, 2008
Accepted January 12, 2009

Extensively drug-resistant tuberculosis (XDR-TB) is present in all regions and poses serious challenges for public health and clinical management. Laboratory diagnosis is difficult and little evidence exists to guide clinicians in treating people with XDR-TB effectively. To summarise the available data on diagnosis and treatment, the current authors performed a systematic review on 13 recent studies of the epidemiology and clinical management of XDR-TB.

Studies that met inclusion criteria were reviewed, in order to assess methodology, treatment regimens and treatment outcomes.

Meta-analysis of currently available data is not possible because of inconsistent definitions and methodologies. Data show that XDR-TB can be successfully treated in up to 65% of patients, particularly those who are not co-infected with HIV. However, treatment duration is longer and outcomes are in general poorer than for non-XDR TB patients.

To strengthen the evidence for extensively drug-resistant tuberculosis diagnosis, treatment and prevention, future studies should: 1) be prospective in design; 2) adopt standardised, internationally accepted definitions; 3) use quality-assured laboratory testing for all first- and second-line drugs; and 4) collect data on an agreed-upon set of standard variables, allowing for comparisons across studies. Early diagnosis and aggressive management of extensively drug-resistant tuberculosis provide the best chance of positive outcome, but prevention is still paramount.

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