Of Testing and Treatment

Implications of Implementing New Regimens for Multidrug-Resistant Tuberculosis

David Wesley Dowdy, Grant Theron, Jeffrey Tornheim, Robin Warren, Emily Kendall

Research output: Contribution to journalArticle

Abstract

A novel, shorter-course regimen for treating multidrug-resistant (MDR) tuberculosis was recently recommended by the World Health Organization. However, the most appropriate use of drug susceptibility testing (DST) to support this regimen is less clear. Implementing countries must therefore often choose between using a standardized regimen despite high levels of underlying drug resistance or require more stringent DST prior to treatment initiation. The former carries a high likelihood of exposing patients to de facto monotherapy with a critical drug class (fluoroquinolones), whereas the latter could exclude large groups of patients from their most effective treatment option. We discuss the implications of this dilemma and argue for an approach that will integrate DST into the delivery of any novel antimicrobial regimen, without excessively stringent requirements. Such guidance could make the novel MDR tuberculosis regimen available to most patients while reducing the risk of generating additional drug resistance.

Original languageEnglish (US)
Pages (from-to)1206-1211
Number of pages6
JournalClinical Infectious Diseases
Volume65
Issue number7
DOIs
StatePublished - Oct 1 2017

Fingerprint

Multidrug-Resistant Tuberculosis
Drug Resistance
Pharmaceutical Preparations
Fluoroquinolones
Therapeutics

Keywords

  • drug resistance
  • microbial
  • microbial sensitivity tests
  • tuberculosis

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

Cite this

Of Testing and Treatment : Implications of Implementing New Regimens for Multidrug-Resistant Tuberculosis. / Dowdy, David Wesley; Theron, Grant; Tornheim, Jeffrey; Warren, Robin; Kendall, Emily.

In: Clinical Infectious Diseases, Vol. 65, No. 7, 01.10.2017, p. 1206-1211.

Research output: Contribution to journalArticle

@article{ec71d8def6af4c6b8602c9e5bef8a94f,
title = "Of Testing and Treatment: Implications of Implementing New Regimens for Multidrug-Resistant Tuberculosis",
abstract = "A novel, shorter-course regimen for treating multidrug-resistant (MDR) tuberculosis was recently recommended by the World Health Organization. However, the most appropriate use of drug susceptibility testing (DST) to support this regimen is less clear. Implementing countries must therefore often choose between using a standardized regimen despite high levels of underlying drug resistance or require more stringent DST prior to treatment initiation. The former carries a high likelihood of exposing patients to de facto monotherapy with a critical drug class (fluoroquinolones), whereas the latter could exclude large groups of patients from their most effective treatment option. We discuss the implications of this dilemma and argue for an approach that will integrate DST into the delivery of any novel antimicrobial regimen, without excessively stringent requirements. Such guidance could make the novel MDR tuberculosis regimen available to most patients while reducing the risk of generating additional drug resistance.",
keywords = "drug resistance, microbial, microbial sensitivity tests, tuberculosis",
author = "Dowdy, {David Wesley} and Grant Theron and Jeffrey Tornheim and Robin Warren and Emily Kendall",
year = "2017",
month = "10",
day = "1",
doi = "10.1093/cid/cix486",
language = "English (US)",
volume = "65",
pages = "1206--1211",
journal = "Clinical Infectious Diseases",
issn = "1058-4838",
publisher = "Oxford University Press",
number = "7",

}

TY - JOUR

T1 - Of Testing and Treatment

T2 - Implications of Implementing New Regimens for Multidrug-Resistant Tuberculosis

AU - Dowdy, David Wesley

AU - Theron, Grant

AU - Tornheim, Jeffrey

AU - Warren, Robin

AU - Kendall, Emily

PY - 2017/10/1

Y1 - 2017/10/1

N2 - A novel, shorter-course regimen for treating multidrug-resistant (MDR) tuberculosis was recently recommended by the World Health Organization. However, the most appropriate use of drug susceptibility testing (DST) to support this regimen is less clear. Implementing countries must therefore often choose between using a standardized regimen despite high levels of underlying drug resistance or require more stringent DST prior to treatment initiation. The former carries a high likelihood of exposing patients to de facto monotherapy with a critical drug class (fluoroquinolones), whereas the latter could exclude large groups of patients from their most effective treatment option. We discuss the implications of this dilemma and argue for an approach that will integrate DST into the delivery of any novel antimicrobial regimen, without excessively stringent requirements. Such guidance could make the novel MDR tuberculosis regimen available to most patients while reducing the risk of generating additional drug resistance.

AB - A novel, shorter-course regimen for treating multidrug-resistant (MDR) tuberculosis was recently recommended by the World Health Organization. However, the most appropriate use of drug susceptibility testing (DST) to support this regimen is less clear. Implementing countries must therefore often choose between using a standardized regimen despite high levels of underlying drug resistance or require more stringent DST prior to treatment initiation. The former carries a high likelihood of exposing patients to de facto monotherapy with a critical drug class (fluoroquinolones), whereas the latter could exclude large groups of patients from their most effective treatment option. We discuss the implications of this dilemma and argue for an approach that will integrate DST into the delivery of any novel antimicrobial regimen, without excessively stringent requirements. Such guidance could make the novel MDR tuberculosis regimen available to most patients while reducing the risk of generating additional drug resistance.

KW - drug resistance

KW - microbial

KW - microbial sensitivity tests

KW - tuberculosis

UR - http://www.scopus.com/inward/record.url?scp=85030694104&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85030694104&partnerID=8YFLogxK

U2 - 10.1093/cid/cix486

DO - 10.1093/cid/cix486

M3 - Article

VL - 65

SP - 1206

EP - 1211

JO - Clinical Infectious Diseases

JF - Clinical Infectious Diseases

SN - 1058-4838

IS - 7

ER -