Successful management of multidrug-resistant tuberculosis under programme conditions in the Dominican Republic
Successful management of multidrug-resistant tuberculosis under programme conditions in the Dominican Republic
复制标题
DOI：
10.5588/ijtld.12.0481
复制
发表时间：
2013-04-01
影响因子：
4
通讯作者：
Marcelino, B.
中科院分区：
文献类型：
--
作者：
Rodriguez, M.;Monedero, I.;Marcelino, B.
背景：多米尼加共和国是耐多药结核病（MDR-TB，占初始病例的6.6%）的高发地区。耐多药结核病的标准化治疗方案可能是一个潜在的解决方案。目的：考察标准方案在常规国情下的有效性。设计：我们回顾了2006年8月29日至2010年6月30日在常规条件下治疗的所有耐多药结核病患者，显示了中期和最终结果。患者在先前接受的二线抗结核药物的基础上接受标准化或个体化的治疗方案。结果：报告了289例耐多药结核病患者的人群描述和培养转化数据。患者年龄中位数为31岁。大多数患者的一线治疗失败（72.6%）。4个月内（中位2个月）培养阴性者占78.6%。在2006年至2008年间接受治疗的150名患者中，74%的患者对标准化治疗方案满意，66%的患者对个体化治疗方案满意（P = 0.211）。标准化方案和个体化方案的有效率分别为92.8%和81% （P = 0.056）。复发率约为1%。平均每个患者发生5个药物副作用。超过2个月的培养转化和胸部x线双侧空化被发现是不利结果的危险因素。结论：标准化的耐多药结核病治疗方案在国家层面可能是有效的，即使在资源贫乏的环境中也是如此。
SETTING: The Dominican Republic is a high-incidence area for multidrug-resistant tuberculosis (MDR-TB; 6.6% of initial cases). Standardised treatment regimens for MDR-TB may be a potential solution.OBJECTIVE: To present the effectiveness of standard regimens under routine national conditions.DESIGN: We reviewed all MDR-TB patients treated under routine conditions from 29 August 2006 to 30 June 2010, showing interim and final outcomes. Patients were treated with regimens that were standardised or individualised based on previously received second-line anti-tuberculosis drugs.RESULTS: Population description and culture conversion data are reported for the 289 MDR-TB patients. The median patient age was 31 years. Most had failed first-line treatment (72.6%). Culture negativity was obtained within 4 months (median 2 months) in 78.6%. Among the 150 patients treated between 2006 and 2008, 74% had favourable results on standardised and 66% on individualised regimens (P = 0.211). The efficacy of the standardised and individualised regimens was respectively 92.8% and 81% (P = 0.056). The relapse rate was approximately 1%. A median of five drug side effects occurred per patient. More than 2 months to culture conversion and bilateral cavitation on chest X-ray were found to be unfavourable outcome risk factors.CONCLUSIONS: Standardised MDR-TB regimens may be effective at the national level, even in resource-poor settings.