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

¹ Hygiene and Preventive Medicine Institute, University of Sassari, Sassari, Italy
² University of Perugia, Internal Medicine, Section of Respiratory Diseases, Perugia, Italy
³ Institute of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy
⁴ HIV/TB Global Program, PATH, Seattle, Washington, USA
⁵ WHO Collaborating Centre for TB and Lung Diseases, Fondazione S. Maugeri, Care and Research Institute, Tradate, Italy
⁶ Supranational Reference Laboratory, Research Centre Borstel, Borstel, Germany
⁷ Fondazione S. Maugeri, Care and Research Institute, Cassano delle Murge, Italy
⁸ TB Clinic, Department of ambulatory care and community medicine, University of Lausanne, Switzerland;
⁹ Supranational Reference Laboratory, S. Raffaele Institute, Milano, Italy
¹⁰ Division of Clinical Infectious Diseases, Medical Clinic, Research Centre Borstel, Borstel, Germany

^* To whom correspondence should be addressed. E-mail: giovannibattista.migliori{at}fsm.it.

	Abstract

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 summarize the available data on diagnosis and treatment, we performed a systematic review on 13 recent studies of the epidemiology and clinical management of XDR-TB.

Studies that met inclusion criteria were reviewed 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 XDR-TB diagnosis, treatment and prevention, future studies should: i) be prospective in design, ii) adopt standardized, internationally accepted definitions, iii) use quality-assured laboratory testing for all first-and second-line drugs, and iv) collect data on an agreed-upon set of standard variables allowing for comparisons across studies. Early diagnosis and aggressive management of XDR-TB provide the best chance of positive outcome, but prevention is still paramount.

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