RT Journal Article SR Electronic T1 Resistance to fluoroquinolones and second-line injectable drugs: impact on multidrug-resistant TB outcomes JF European Respiratory Journal JO Eur Respir J FD European Respiratory Society SP 156 OP 168 DO 10.1183/09031936.00134712 VO 42 IS 1 A1 Dennis Falzon A1 Neel Gandhi A1 Giovanni B. Migliori A1 Giovanni Sotgiu A1 Helen S. Cox A1 Timothy H. Holtz A1 Maria-Graciela Hollm-Delgado A1 Salmaan Keshavjee A1 Kathryn DeRiemer A1 Rosella Centis A1 Lia D'Ambrosio A1 Christoph G. Lange A1 Melissa Bauer A1 Dick Menzies YR 2013 UL http://erj.ersjournals.com/content/42/1/156.abstract AB A meta-analysis for response to treatment was undertaken using individual data of multidrug-resistant tuberculosis (MDR-TB) (resistance to isoniazid and rifampicin) patients from 26 centres. The analysis assessed the impact of additional resistance to fluoroquinolones and/or second-line injectable drugs on treatment outcome. Compared with treatment failure, relapse and death, treatment success was higher in MDR-TB patients infected with strains without additional resistance (n=4763; 64%, 95% CI 57–72%) or with resistance to second-line injectable drugs only (n=1130; 56%, 95% CI 45–66%), than in those having resistance to fluoroquinolones alone (n=426; 48%, 95% CI 36–60%) or to fluoroquinolones plus second-line injectable drugs (extensively drug resistant (XDR)-TB) (n=405; 40%, 95% CI 27–53%). In XDR-TB patients, treatment success was highest if at least six drugs were used in the intensive phase (adjusted OR 4.9, 95% CI 1.4–16.6; reference fewer than three drugs) and four in the continuation phase (OR 6.1, 95% CI 1.4–26.3). The odds of success in XDR-TB patients was maximised when the intensive phase reached 6.6–9.0 months duration and the total duration of treatment 20.1–25.0 months. In XDR-TB patients, regimens containing more drugs than those recommended in MDR-TB but given for a similar duration were associated with the highest odds of success. All data were from observational studies and methodologies varied between centres, therefore, the bias may be substantial. Better quality evidence is needed to optimise regimens.