期刊
EUROPEAN RESPIRATORY JOURNAL
卷 42, 期 1, 页码 156-168出版社
EUROPEAN RESPIRATORY SOC JOURNALS LTD
DOI: 10.1183/09031936.00134712
关键词
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资金
- Stop TB Department of the World Health Organization through USAID
- State of California from the Centers for Disease Control and Prevention Cooperative Agreement Funds
- in Mexico (Veracruz) from the Mexican Secretariat of Health
- National Institutes of Health of the United States [A135969, K01TW000001]
- Wellcome Trust [176W009]
- Howard Hughes Medical Institute [55000632]
- Mexican Council of Science [176W009]
- Mexican Council of Science and Technology [SEP 2004-001-47499, FOSSIS 2005-2 (14475), 87332]
- in South Africa from the South African Medical Research Council
- Fonds de Recherche en Saut de Quebec
- Canadian Institutes of Health Research
- Doris Duke Charitable Foundation
- European Community [FP7-223681]
A meta-analysis for response to treatment was undertaken using individual data of multidrug-resistant tuberculosis (MDR-TB) (resistance to isoniazid and rifampicin) patients from 26 centres. The analysis assessed the impact of additional resistance to fluoroquinolones and/or second-line injectable drugs on treatment outcome. Compared with treatment failure, relapse and death, treatment success was higher in MDR-TB patients infected with strains without additional resistance (n=4763; 64%, 95% CI 57-72%) or with resistance to second-line injectable drugs only (n=1130; 56%, 95% CI 45-66%), than in those having resistance to fluoroquinolones alone (n=426; 48%, 95% CI 36-60%) or to fluoroquinolones plus second-line injectable drugs (extensively drug resistant (XDR)-TB) (n=405; 40%, 95% CI 27-53%). In XDR-TB patients, treatment success was highest if at least six drugs were used in the intensive phase (adjusted OR 4.9, 95% CI 1.4-16.6; reference fewer than three drugs) and four in the continuation phase (OR 6.1, 95% CI 1.4-26.3). The odds of success in XDR-TB patients was maximised when the intensive phase reached 6.6-9.0 months duration and the total duration of treatment 20.1-25.0 months. In XDR-TB patients, regimens containing more drugs than those recommended in MDR-TB but given for a similar duration were associated with the highest odds of success. All data were from observational studies and methodologies varied between centres, therefore, the bias may be substantial. Better quality evidence is needed to optimise regimens.
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