Figures
- FIGURE 1
Availability of selected drugs and treatment regimen. HRZE: isoniazid, rifampicin, pyrazinamide, ethambutol; SL-inj: second-line injection; FQ: fluoroquinolone; PAS: para-aminosalicylic acid; MDR: multidrug resistant; XDR: extensively drug resistant.
- FIGURE 2
Affordability of treatment regimens. GDP: gross domestic product. Square: preferred regimen; circle: alternative regimen; black: pan-sensitive; green: multidrug resistant; red: extensively drug resistant (XDR); blue: pre-XDRinj TB (multidrug-resistant tuberculosis with additional resistance to second-line injectable); purple: pre-XDRfq TB (multidrug-resistant tuberculosis with additional resistance to fluoroquninolone); H: high incidence (>100 per 100 000 people); M: medium incidence (15–100 per 100 000 people); L: low incidence (<15 per 100 000 people).
Tables
- TABLE 1 Preferred and alternative treatment regimens by resistance pattern
Drug resistance Preference Duration (months) Regimen Type Pattern Sensitive None Preferred 2 HRZE 4 HR MDR Isoniazid and rifampicin Preferred 8 SL-inj, FQ, Pto/Eto, Cs/Trd, E, Z 12 FQ, Pto/Eto, Cs/Trd, E, Z Alternative 8 SL-inj, FQ, PAS, Cs/Trd, E, Z 12 FQ, PAS, Cs/Trd, E, Z Pre-XDRinj MDR + resistance against SL-inj Preferred 20 FQ, Pto/Eto, Cs/Trd, Lzd, E, Z Alternative 20 FQ, PAS, Cs/Trd, Lzd, E, Z Pre-XDRfq MDR + resistance against FQs Preferred 8 SL-inj, Pto/Eto, Cs/Trd, Lzd, Cfz, E, Z 12 Pto/Eto, Cs/Trd, Lzd, Cfz, E, Z Alternative 8 SL-inj, PAS, Cs/Trd, Lzd, Cfz, E, Z 12 PAS, Cs/Trd, Lzd, Cfz, E, Z XDR MDR + resistance against SL-inj + FQs Preferred 20 Pto/Eto, Cs/Trd, Lzd, Cfz, Amx-Clav, Mero, E, Z Alternative 20 PAS, Cs/Trd, Lzd, Cfz, Amx-Clv, Mero, E, Z -
MDR: multidrug-resistant; pre-XDRinj: MDR tuberculosis with additional resistance to second-line injectable; pre-XDRfq: MDR tuberculosis with aditional resistance to fluoroquinolone; H: isoniazid; R: rifampicin; Z: pyrazinamide; E: ethambutol; SL-inj: second-line injectable; FQ: fluoroquinolone; Pto/Eto: prothionamide/ethionamide; Cs/Trd: cycloserine/terizidone; PAS: para-aminosalicylic acid; Lzd: linezolid; Cfz: clofazimine; Amx–Clav: amoxicillin–clavulanic acid; Mero: meropenem.
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- TABLE 2 Average price per day treatment for individual drugs
Treatment group Drug name (route) Dose mg·day−1 Cost Euro I$ Mean Min Max Mean Min Max Group 1 Isoniazid (orally) 300 0.40 0.01 3.12 0.56 0.01 4.52 Rifampicin (orally) 600 0.89 0.09 3.79 1.18 0.25 3.40 Ethambutol (orally) 1200 0.87 0.07 4.72 1.15 0.17 5.76 Pyrazinamide (orally) 2000 0.74 0.06 3.63 1.00 0.14 3.60 Group 2 Streptomycin (i.v./intramuscular) 1000 2.87 0.12 21.96 4.26 0.33 26.78 Amikacin (i.v.) 750 17.76 0.60 131.89 21.49 1.81 141.82 Capreomycin (i.v.) 1000 45.95 2.67 172.55 66.15 4.67 218.42 Kanamycin (i.v.) 1000 2.88 0.17 15.98 5.35 0.52 30.73 Group 3 Levofloxacin (orally) 1000 4.18 0.15 26.88 6.34 0.32 40.21 Moxifloxacin (orally) 400 3.86 1.10 14.06 6.54 1.41 16.63 Group 4 Para-aminosalicylate acid (orally) 12000 15.48 0.32 34.51 25.55 0.79 103.00 Prothionamide/ethionamide (orally) 750 6.36 0.09 23.81 9.43 0.19 39.31 Cycloserine/terizidone (orally) 750 13.33 0.58 39.50 19.02 1.27 57.29 Group 5 Clofazimine (orally) 100 1.60 0.12 4.31 2.38 0.17 9.76 Linezolid (orally) 600 58.66 4.50 108.10 90.23 8.55 244.82 Amoxicillin-clavulanic acid (orally) 1750/250 2.06 0.24 15.67 3.23 0.31 23.04 Meropenem (i.v.) 3000 48.69 14.61 150.79 72.88 17.56 237.34 - TABLE 3 Average drug costs per full treatment regimen where available
Resistance Regimen Countries n Cost Euro I$ Mean Min Max Mean Min Max Pan-sensitive Preferred 37 334 41 1299 448 93 1164 MDR Preferred 30 23 272 2112 77 354 31 715 4565 79 247 MDR Alternative 23 23 398 3136 72 618 34 656 6781 78 083 Pre-XDRinj Preferred 24 54 523 24 344 96 458 78 047 46 257 181 739 Alternative 19 58 373 18 571 98 271 85 171 35 287 188 517 Pre-XDRfq Preferred 16 67 346 35 507 106 730 88 199 61 261 207 152 Alternative 11 71 506 29 734 104 023 95 275 56 498 213 930 XDR Preferred 14 93 962 56 028 180 237 123 936 75 587 329 104 Alternative 9 90 657 65 031 148 312 124 887 82 317 335 882 -
MDR: multidrug resistant; pre-XDRinj: MDR tuberculosis with additional resistance to second-line injectable; pre-XDRfq: MDR tuberculosis with aditional resistance to fluoroquinolone.
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