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Successful '9-month Bangladesh regimen' for multidrug-resistant tuberculosis among over 500 consecutive patients

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dc.contributor.author Aung, K. J.
dc.contributor.author Van Deun, A.
dc.contributor.author Declercq, E.
dc.contributor.author Sarker, M. R.
dc.contributor.author Das, P. K.
dc.contributor.author Hossain, M. A.
dc.contributor.author Rieder, H. L.
dc.date.accessioned 2014-12-03T15:42:14Z
dc.date.available 2014-12-03T15:42:14Z
dc.date.issued 2014
dc.identifier.issn 1027-3719
dc.identifier.doi http://dx.doi.org/10.5588/ijtld.14.0100
dc.identifier.other ITG-B2A
dc.identifier.other DBM
dc.identifier.other U-MYCOB
dc.identifier.other JIF
dc.identifier.other DOI
dc.identifier.other Abstract
dc.identifier.other UPD57
dc.identifier.uri http://hdl.handle.net/10390/8157
dc.description.abstract SETTING: Tuberculosis (TB) program, Damien Foundation Projects, Bangladesh. OBJECTIVE: To summarize the outcome and its determinants of the first treatment for multidrug-resistant TB using a standardized regimen consisting of a minimum 9 months. DESIGN: This was a prospective, observational study of a gatifloxacin (GFX) based directly observed regimen, mainly with initial hospitalization. The 4-month intensive phase was extended until sputum smear conversion. Patients were monitored using culture for up to 2 years after treatment completion. RESULTS: Of the 515 patients who met the study inclusion criteria and were successively enrolled from 2005 to 2011, 84.4% had a bacteriologically favorable outcome. Due to extensive disease with delayed sputum conversion, only half of the patients completed treatment within 9 months; however, 95% were able to complete treatment within 12 months. Eleven patients failed or relapsed, and 93.1% of the 435 patients who were successfully treated completed at least 12 months post-treatment follow-up. The strongest risk factor for a bacteriologically unfavorable outcome was high-level fluoroquinolone (FQ) resistance, particularly when compounded by initial pyrazinamide (PZA) resistance. Low-level FQ resistance had no unfavorable effect on treatment outcome. Amplification of drug resistance occurred only once, in a patient strain that was initially only susceptible to kanamycin and clofazimine. CONCLUSION: The excellent outcome of the Bangladesh regimen was largely maintained. Bacteriological treatment failures and relapses were rare, except among patients with high-level GFX resistance, notably in the presence of PZA resistance. en_US
dc.language English en_US
dc.subject Bacterial diseases en_US
dc.subject Tuberculosis en_US
dc.subject Mycobacterium tuberculosis en_US
dc.subject Multidrug resistance en_US
dc.subject Treatment outcomes en_US
dc.subject Regimens en_US
dc.subject Hospitalization en_US
dc.subject Sputum smear en_US
dc.subject Conversion en_US
dc.subject Monitoring en_US
dc.subject Standardization en_US
dc.subject Fluoroquinolones en_US
dc.subject Pyrazinamide en_US
dc.subject Bangladesh en_US
dc.subject Asia, South en_US
dc.title Successful '9-month Bangladesh regimen' for multidrug-resistant tuberculosis among over 500 consecutive patients en_US
dc.type Article en_US
dc.citation.issue 10 en_US
dc.citation.jtitle International Journal of Tuberculosis and Lung Disease en_US
dc.citation.volume 18 en_US
dc.citation.pages 1180-1187 en_US
dc.identifier.pmid http://www.ncbi.nlm.nih.gov/pubmed/25216831
dc.citation.jabbreviation Int J Tuberc Lung Dis en_US


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