Multidisciplinary management of difficult-to-treat drug resistant tuberculosis: a review of cases presented to the national consilium in Uganda.
Multidisciplinary management of difficult-to-treat drug resistant tuberculosis: a review of cases presented to the national consilium in Uganda.
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DOI：
10.1186/s12890-021-01597-1
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发表时间：
2021-07-10
影响因子：
3.1
通讯作者：
Bongomin F
中科院分区：
文献类型：
--
作者：
Baluku JB;Katuramu R;Naloka J;Kizito E;Nabwana M;Bongomin F
Patients with drug resistant tuberculosis (DR-TB) with comorbidities and drug toxicities are difficult to treat. Guidelines recommend such patients to be managed in consultation with a multidisciplinary team of experts (the “TB consilium”) to optimise treatment regimens. We describe characteristics and treatment outcomes of DR-TB cases presented to the national DR-TB consilium in Uganda between 2013 and 2019. We performed a secondary analysis of data from a nation-wide retrospective cohort of DR-TB patients with poor prognostic indicators in Uganda. Patients had a treatment outcome documented between 2013 and 2019. Characteristics and treatment outcomes were compared between cases reviewed by the consilium with those that were not reviewed. Of 1,122 DR-TB cases, 189 (16.8%) cases from 16 treatment sites were reviewed by the consilium, of whom 86 (45.5%) were reviewed more than once. The most frequent inquiries (N = 308) from DR-TB treatment sites were construction of a treatment regimen (38.6%) and management of side effects (24.0%) while the most frequent consilium recommendations (N = 408) were a DR-TB regimen (21.7%) and “observation while on current regimen” (16.6%). Among the cases reviewed, 152 (80.4%) were from facilities other than the national referral hospital, 113 (61.1%) were aged ≥ 35 years, 72 (40.9%) were unemployed, and 26 (31.0%) had defaulted antiretroviral therapy. Additionally, 141 (90.4%) had hepatic injury, 55 (91.7%) had bilateral hearing loss, 20 (4.8%) had psychiatric symptoms and 14 (17.7%) had abnormal baseline systolic blood pressure. Resistance to second-line drugs (SLDs) was observed among 9 (4.8%) cases while 13 (6.9%) cases had previous exposure to SLDs. Bedaquiline (13.2%, n = 25), clofazimine (28.6%, n = 54), high-dose isoniazid (22.8%, n = 43) and linezolid (6.7%, n = 13) were more frequently prescribed among cases reviewed by the consilium than those not reviewed. Treatment success was observed among 126 (66.7%) cases reviewed. Cases reviewed by the consilium had several comorbidities, drug toxicities and a low treatment success rate. Consilia are important “gatekeepers” for new and repurposed drugs. There is need to build capacity of lower health facilities to construct DR-TB regimens and manage adverse effects.
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DOI：
10.12659/msm.904682
发表时间：
2017-05-18
期刊：
Medical science monitor : international medical journal of experimental and clinical research
影响因子：
--
作者：
Zhang Y;Wu S;Xia Y;Wang N;Zhou L;Wang J;Fang R;Sun F;Chen M;Zhan S
通讯作者：
Zhan S
影响因子：
7.5
作者：
Pontali, Emanuele;Raviglione, Mario C.;Migliori, Giovanni Battista;Akkerman, Onno W.;Alffenaar, Jan-Willem;Blanc, Francois Xavier;Borisov, Sergey;Cirillo, Daniela Maria;Dalcolmo, Margareth;Dheda, Keertan;Kritski, Afranio L.;Lienhardt, Christian;Olliaro, Piero;Tadolini, Marina;Tiberi, Simon;Udwadia, Zarir
通讯作者：
Udwadia, Zarir
影响因子：
24.3
作者：
Kliiman, K.;Altraja, A.
通讯作者：
Altraja, A.
影响因子：
3.7
作者：
van de Water, Brittney J.;Silva, Susan G.;Farley, Jason E.
通讯作者：
Farley, Jason E.
影响因子：
8.1
作者：
Kibret KT;Moges Y;Memiah P;Biadgilign S
通讯作者：
Biadgilign S