Few eligible for the newly recommended short course MDR-TB regimen at a large Mumbai private clinic

Zarir F. Udwadia, Jeffrey Tornheim, Shashank Ganatra, Andrea Deluca, Camilla S. Rodrigues, Amita Gupta

Research output: Contribution to journalArticle

Abstract

Background: India has the world's highest tuberculosis burden, and Mumbai is particularly affected by multidrug resistant tuberculosis (MDR-TB). WHO recommends short, intensive treatment ("Short Course") for previously untreated pulmonary MDR-TB patients but does not require universal drug susceptibility testing (DST) before Short Course. DST would likely screen out many MDR-TB patients in places like Mumbai with significant drug resistance. Methods: MDR-TB patients at a private clinic were recruited for a prospective observational cohort. Short Course eligibility was evaluated by clinical criteria and DST results. Eligibility by DST was classified as rifampin monoresistance (as tested by Xpert MTB/RIF), rifampin, fluoroquinolones, and 2nd-line injectable drugs resistance (as tested by line probe assays) and resistance to other drugs. Results: Of 559 participants with MDR-TB, 33% met clinical eligibility for Short Course. DST for rifampin, fluoroquinolones, and 2nd-line injectable drugs excluded 74.7% of participants. Complete phenotypic DST excluded 96.6% of participants. Prior treatment with either 1st or 2nd-line drugs did not significantly affect eligibility. Conclusions: In a global MDR-TB hotspot, < 5% of participants with MDR-TB were appropriate for Short Course by clinical characteristics and DST results. Rapid molecular testing would not sufficiently identify drug resistance in this population. Eligibility rates were not significantly reduced by prior TB treatment.

Original languageEnglish (US)
Article number94
JournalBMC Infectious Diseases
Volume19
Issue number1
DOIs
Publication statusPublished - Jan 28 2019

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Keywords

  • Bangladesh regimen
  • Drug susceptibility testing
  • MDR-TB
  • Short course
  • TB treatment

ASJC Scopus subject areas

  • Infectious Diseases

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