Abstract
We conducted a systematic review and meta-analysis to assess the evidence for the postulation that inappropriate tuberculosis (TB) regimens are a risk for development of multidrug-resistant (MDR)-TB.
MEDLINE, EMBASE and other databases were searched for relevant articles in January 2011. Cohort studies including TB patients who received treatment were selected and data on treatment regimen, drug susceptibility testing results and genotyping results before treatment and at failure or relapse were abstracted from the articles.
Four studies were included in the systematic review and two were included in the meta-analysis. In these two studies the risk of developing MDR-TB in patients who failed treatment and used an inappropriate treatment regimen was increased 27-fold (RR 26.7, 95% CI 5.0–141.7) when compared with individuals who received an appropriate treatment regimen.
This review provides evidence that supports the general opinion that the development of MDR-TB can be caused by inadequate treatment, given the drug susceptibility pattern of the Mycobacterium tuberculosis bacilli. It should be noted that only two studies provided data for the meta-analysis. The information can be used to advocate for adequate treatment for patients based on drug resistance profiles.
Footnotes
Previous articles in this series: No. 1: Langendam MW, van der Werf MJ, Huitric E, et al. Prevalence of inappropriate tuberculosis treatment regimens: a systematic review. Eur Respir J 2012; 39: 1012–1020. No. 2: van der Werf MJ, Langendam MW, Huitric E, et al. Knowledge of tuberculosis-treatment prescription of health workers: a systematic review. Eur Respir J 2012; 39: 1248–1255.
Support Statement
The study reported in this manuscript was financially supported by an ECDC Direct Service Contract (Publication Reference: OJ/2010/07/12-PROC/2010/034).
Statement of Interest
None declared.
This article was modified in April 2016 to correct errors in the licence information.
- Received July 22, 2011.
- Accepted September 21, 2011.
- ©ERS 2012
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