Sotgiu, G;
Tiberi, S;
Centis, R;
D'Ambrosio, L;
Fuentes, Z;
Zumla, A;
Migliori, GB;
(2016)
Applicability of the shorter 'Bangladesh regimen' in high multidrug-resistant tuberculosis settings.
International Journal of Infectious Diseases
, 56
pp. 190-193.
10.1016/j.ijid.2016.10.021.
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Abstract
In spite of the recent introduction of two new drugs (delamanid and bedaquiline) and a few repurposed compounds to treat multidrug-resistant and extensively drug-resistant tuberculosis (MDR- and XDR-TB), clinicians are facing increasing problems in designing effective regimens in severe cases. Recently a 9 to 12-month regimen (known as the 'Bangladesh regimen') proved to be effective in treating MDR-TB cases. It included an initial phase of 4 to 6 months of kanamycin, moxifloxacin, prothionamide, clofazimine, pyrazinamide, high-dose isoniazid, and ethambutol, followed by 5 months of moxifloxacin, clofazimine, pyrazinamide, and ethambutol. However, recent evidence from Europe and Latin America identified prevalences of resistance to the first-line drugs in this regimen (ethambutol and pyrazinamide) exceeding 60%, and of prothionamide exceeding 50%. Furthermore, the proportions of resistance to the two most important pillars of the regimen - quinolones and kanamycin - were higher than 40%. Overall, only 14 out of 348 adult patients (4.0%) were susceptible to all of the drugs composing the regimen, and were therefore potentially suitable for the 'shorter regimen'. A shorter, cheaper, and well-tolerated MDR-TB regimen is likely to impact the number of patients treated and improve adherence if prescribed to the right patients through the systematic use of rapid MTBDRsl testing.
Type: | Article |
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Title: | Applicability of the shorter 'Bangladesh regimen' in high multidrug-resistant tuberculosis settings |
Open access status: | An open access version is available from UCL Discovery |
DOI: | 10.1016/j.ijid.2016.10.021 |
Publisher version: | http://dx.doi.org/10.1016/j.ijid.2016.10.021 |
Language: | English |
Additional information: | © 2016 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by- nc-nd/4.0/). |
Keywords: | MDR-TB; XDR-TB; Shorter regimen; Treatment duration; Efficacy; Impact |
UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Infection and Immunity |
URI: | https://discovery-pp.ucl.ac.uk/id/eprint/1538732 |
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