Second line drug susceptibility testing to inform the treatment of rifampin-resistant tuberculosis: a quantitative perspective

Emily A. Kendall, Ted Cohen, Carole D. Mitnick, David W. Dowdy

Research output: Contribution to journalReview articlepeer-review

Abstract

Treatment failure and resistance amplification are common among patients with rifampin-resistant tuberculosis (TB). Drug susceptibility testing (DST) for second-line drugs is recommended for these patients, but logistical difficulties have impeded widespread implementation of second-line DST in many settings. To provide a quantitative perspective on the decision to scale up second-line DST, we synthesize literature on the prevalence of second-line drug resistance, the expected clinical and epidemiologic benefits of using second-line DST to ensure that patients with rifampin-resistant TB receive effective regimens, and the costs of implementing (or not implementing) second-line DST for all individuals diagnosed with rifampin-resistant TB. We conclude that, in most settings, second-line DST could substantially improve treatment outcomes for patients with rifampin-resistant TB, reduce transmission of drug-resistant TB, prevent amplification of drug resistance, and be affordable or even cost-saving. Given the large investment made in each patient treated for rifampin-resistant TB, these payoffs would come at relatively small incremental cost. These anticipated benefits likely justify addressing the real challenges faced in implementing second-line DST in most high-burden settings.

Original languageEnglish (US)
Pages (from-to)185-189
Number of pages5
JournalInternational Journal of Infectious Diseases
Volume56
DOIs
StatePublished - Mar 1 2017

Keywords

  • Cost effectiveness
  • Diagnostics
  • Drug resistance
  • Regimen selection
  • Treatment outcomes

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

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