RT Journal Article
SR Electronic
T1 Treatment outcomes of extensively-drug resistant tuberculosis (XDR-TB) patients in 20 countries
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP 4287
VO 40
IS Suppl 56
A1 Dennis Falzon
A1 Matteo Zignol
A1 Ernesto Jaramillo
A1 Fraser Wares
A1 Susanne Carai
A1 Tauhid Islam
A1 Paul Nunn
YR 2012
UL http://erj.ersjournals.com/content/40/Suppl_56/4287.abstract
AB Background: tuberculosis patients who are resistant to rifampicin, isoniazid, fluoroquinolones and second-line injectable drugs present a serious challenge to TB treatment programmes. In 2006, the World Health Organization (WHO) started surveillance for this condition, defined as extensive drug resistance (XDR-TB). We describe outcomes of XDR-TB patients started on treatment in 2008.Methods: we used the latest data reported by countries to WHO by December 2011. Treatment regimens were known to differ between countries. Standardized definitions for outcomes were widely applied.Results: 20 countries reported outcomes for a total of 641 XDR-TB cases. Most cases were reported by South Africa (345), Peru (70), Romania (53), Georgia (49), Brazil (45) and Namibia (20), with other countries reporting a median of two cases each (range 1-19). Overall treatment success was 23%, 34% of cases died, 22% failed treatment, 12% defaulted and 9% were not evaluated. Success of 50% or more was only achieved by countries managing 1-3 cases. In countries with >20 cases, deaths were highest in Namibia (90%) and South Africa (40%), and failures peaked in Brazil (80%) and Romania (55%). More than half the cases in Peru were either not evaluated or defaulted.Conclusions: national data reported to WHO show less favourable outcomes for XDR-TB patients than have, to date, been published in the literature, and are similar to untreated tuberculosis. The high mortality in southern African countries may be associated with HIV co-morbidity and low access to anti-retroviral agents. Better optimization of regimens and support to potential defaulters is recommended.