Artikel
Highly individualized treatment for XDR-/MDR-tuberculosis: case series from single centre
Individualisierte Therapie der XDR-/MDR-Tuberkulose: eine monozentrische Fallstudie
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Veröffentlicht: | 2. Juni 2010 |
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Objective: Treatment options for patients with extensively resistant (XDR) or multi-drug resistant (MDR) tuberculosis (TB) are highly limited. Individualized treatment using WHO group II, IV or V tuberculostatic substances may improve outcomes.
Goal: To determine the clinical and microbiological outcomes of patients with confirmed MDR- or XDR-TB.
Patients and Methods: Retrospective analysis of all MDR- und XDR-TB cases in a single tertiary referral centre. Outcomes were correlated with underlying conditions, treatment schedules, duration of treatment and microbiological treatment response.
Results: From 2006 to 2009 eleven patients with either XDR (n=5) or MDR-TB (n=6) were recorded. Pulmonary manifestations were present in 10/11, one patient had only extrapulmonary tuberculosis (pleural, mammary and lymph node involvement). Disseminated disease involving lung, liver, spleen, lymph nodes or central nervous system was found in three patients. Eight out of eleven patients were from Eastern Europe (Russia, Ukraine, Georgia) two from Asia (Iran, Afghanistan), and one from Africa (Cameroon). Underlying condition were found in four (HIV infection, n=1; HCV infection, n=2, HIV/HCV co-infection, n=1). Nearly all (10/11) had at least one incomplete tuberculostatic pre-treatment (duration 3 months to five years, in all cases non-compliance was documented). Isolated strains were resistant to a median of five antituberculous drugs (range 3–8). Treatment regimens provided by DOT in every patient included mainly WHO group IV and V drugs with at least three drugs selected by susceptibility testing (median 3, range 3–5). Two patients underwent surgery (lung surgery, n=1; pleurectomy, n=1). Microbiological, radiological and clinical cure was documented in 8/11 (72.7%) and improvement with ongoing treatment in 2/11 (18.2%). One patient died after upper lobe resection because of pulmonary thromboembolism.
Conclusions: Prognosis in patients having at least three effective substances left is favourable. Complete cure can be achieved by implementing DOT strategies for the long-term therapy. Drug compliance history is crucial for estimating prognosis and guides the management of patients especially with XDR-TB.
Conflict of Interest: None.