XDR-TB can be managed with aggressive treatment
A highly aggressive treatment that reduces deaths and prevents further transmission of XDR-TB has been developed by scientists in Russia and the US.
The study was published online in The Lancet. Success is maximized by individually assessing drug susceptibility in each patient, and making sure they follow their individually designed treatment programme which ideally includes at least five drugs to which their particular strain of TB is susceptible.
The normal treatment for TB is a course of four standard, or first-line, anti TB drugs. If these are misused or not managed correctly (for instance interruption or failure to complete the course), the result can be that non-resistant TB mutates into multidrug-resistant TB (MDR-TB). This form takes longer to treat with second-line drugs, which cost more and have more side effects.
If the second-line drugs are also misused or mismanaged, then the MDR TB can turn into XDR TB, the most drug-resistant form of the disease. It is therefore important that TB control is managed properly to prevent the rise of resistant forms.
For this retrospective cohort study, Keshavjee and colleagues looked at 608 patients with MDR TB in Tomsk, Russia, who were treated in civilian or prison health centres between 2000 and 2004. Their treatment followed the protocol recommended by WHO.
Drug susceptibility testing (DST) on all patients showed that 4.8 per cent (29 patients) had XDR TB, while the rest has non-XDR TB. Each patient was given an individually designed treatment programme based on the result of their DST and any treatments they had been given before. The aim was to give each patient at least five drugs to which their particular strain of TB was susceptible.
If the doctors could not get hold of five effective drugs for a patient, they considered using drugs to which resistance was known, especially if that patient had no history of exposure to them.
The results showed that treatment failure was more common in XDR TB patients than non-XDR TB patients, (31 versus 9 per cent failure respectively). 48% of XDR TB patients and 67 per cent of non-XDR TB patients were either cured or completed their programme.
Frequency and management of adverse events were the same in both XDR and non-XDR TB patients.
