Treatment outcomes among patients with extensively drug-resistant tuberculosis: systematic review and meta-analysis.

نویسندگان

  • Karen R Jacobson
  • Dylan B Tierney
  • Christie Y Jeon
  • Carole D Mitnick
  • Megan B Murray
چکیده

BACKGROUND . The treatment of extensively drug-resistant tuberculosis (XDR TB) presents a major challenge. Second-line antimycobacterial drugs are less effective, more toxic, and more costly than first-line agents, and XDR TB strains are, by definition, resistant to the most potent second-line options: the injectable agents and fluoroquinolones. We conducted a meta-analysis to assess XDR TB treatment outcomes and to identify therapeutic approaches associated with favorable responses. METHODS We searched PubMed and EMBASE databases to identify studies conducted through May 2009 that report XDR TB treatment outcomes. RESULTS The search yielded 13 observational studies covering 560 patients, of whom 43.7% (95% confidence interval, 32.8%-54.5%) experienced favorable outcomes, defined as either cure or treatment completion, and 20.8% (95% confidence interval, 14.2%-27.3%) died. Random effects meta-analysis and meta-regression showed that studies in which a higher proportion of patients received a later-generation fluoroquinolone reported a higher proportion of favorable treatment outcomes (P=.012). CONCLUSIONS This meta-analysis provides the first empirical evidence that the use of later-generation fluoroquinolones for the treatment of XDR TB significantly improves treatment outcomes, even though drug-susceptibility testing demonstrates resistance to a representative fluoroquinolone. These results suggest that the addition of later-generation fluoroquinolones to XDR TB regimens may improve treatment outcomes and should be systematically evaluated in well-designed clinical studies.

برای دانلود رایگان متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

منابع مشابه

Treatment outcomes from community-based drug resistant tuberculosis treatment programs: a systematic review and meta-analysis

BACKGROUND There is increasing evidence that community-based treatment of drug resistant tuberculosis (DRTB) is a feasible and cost-effective alternative to centralized, hospital-based care. Although several large programs have reported favourable outcomes from community-based treatment, to date there has been no systematic assessment of community-based DRTB treatment program outcomes. The obje...

متن کامل

Community-based management versus traditional hospitalization in treatment of drug-resistant tuberculosis: a systematic review and meta-analysis

Background Multidrug drug resistant Tuberculosis (MDR-TB) and extensively drug resistant Tuberculosis (XDR-TB) have emerged as significant public health threats worldwide. This systematic review and meta-analysis aimed to investigate the effects of community-based treatment to traditional hospitalization in improving treatment success rates among MDR-TB and XDR-TB patients in the 27 MDR-TB High...

متن کامل

A 10-year survey on prevalence and occurrence rate of multi-drug resistant Mycobacterium tuberculosis in Latin American and Mediterranean Families: A Systematic review and meta-analysis

Introduction: Latin American and Mediterranean (LAM) is a family of Mycobacterium tuberculosis (M. tuberculosis). Drug resistant in M. tuberculosis LAM family is a major problem in the world population. Our objective of this study was to determine the prevalence of M. tuberculosis LAM family with multi-drug resistant (MDR) in the worldwide by a meta-analysis and systematic review. Materials an...

متن کامل

Epidemiology and clinical management of XDR-TB: a systematic review by TBNET.

Extensively drug-resistant tuberculosis (XDR-TB) is present in all regions and poses serious challenges for public health and clinical management. Laboratory diagnosis is difficult and little evidence exists to guide clinicians in treating people with XDR-TB effectively. To summarise the available data on diagnosis and treatment, the current authors performed a systematic review on 13 recent st...

متن کامل

Systematic review of clofazimine for the treatment of drug-resistant tuberculosis.

The increased incidence of drug-resistant tuberculosis has created an urgent necessity for the development of new and effective anti-tuberculosis drugs and for alternative therapeutic regimens. Clofazimine (CFZ) is a fat-soluble riminophenazine dye used in the treatment of leprosy worldwide. CFZ has also been used as a Group 5 drug in the treatment of tuberculosis (TB). A large cohort study fro...

متن کامل

ذخیره در منابع من


  با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید

عنوان ژورنال:
  • Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

دوره 51 1  شماره 

صفحات  -

تاریخ انتشار 2010