Comparison of two different cohort of patients to evaluate treatments against multidrug-resistant tuberculosis

MORCILLO N; IMPERIALE B; PONTINO M; DI GIULIO B; BODON A; KURIGER A; CHIRICO C

Munich

Congreso; 16 Congreso Anual de la Sociedad Europea de Medicina Respiratoria (ERS); 2006

Sociedad Europea de Medicina Respiratoria (ERS)

Multidrug-resistant tuberculosis (MDR-TB) is considered an emergent disease as well as the final product of a bad therapy application. Usefulness of treatments based on in vitro drug susceptibility testing results under DOTS-plus strategy was explored by evaluating two cohorts of patients, “A” (1982-1997) composed by 78 cases and “B” (1998-2003) by 59, with 4.6 and 11.6 cases per year respectively. Drug-susceptibility testing to first and second line drugs was performed by proportion method on Lowenstein-Jensen, MGIT960 (BD Argentina) and a microplate colorimetric based method. Rifampicin-resistance was confirmed by “rifoligotyping” (reverse line blot hybridisation technique). Treatments in cohort “A” were self-administered, always containing isoniazid and rifampin while secondline drugs were frequently added as monotherapy. People in cohort “B” received 5 to 6 drug schemes according to second-line drug susceptibility testing results. These two years long schemes were mostly administered under DOTS-plus strategy and generally composed by p-aminosalycilic acid, fluoroquinolones, aminoglycosides, ethionamide, cycloserine. Cohort “A” results showed that only 5 (6.4%) patients were cured, 39 (50.0%) died and 34 (43.6%) were missing cases. Cohort “B” showed that 19 (38.8%) died, 34 (58.6%) cured, 3 (5.1%) were missing cases and 2 (3.4%) were still under treatment after relapse. Efficacious therapy of MDR-TB cases is mandatory for clinical, public health and socio-economic reasons. Our results suggest that drug susceptibility testing and DOTS-plus strategy are the rational way of designing and administering appropriate treatments to fight against MDRTB.