Applicability of the shorter 'Bangladesh regimen' in high multidrug-resistant tuberculosis settings. (March 2017)

• Record Type: Journal Article
• Authors: Sotgiu, Giovanni; Tiberi, Simon; Centis, Rosella; D'Ambrosio, Lia; Fuentes, Zhenia; Zumla, Alimuddin; Migliori, Giovanni Battista
• Is Part Of: International journal of infectious diseases. Volume 56(2017:Mar.)
• Page Start: 190
• Page End: 193
• Publication Date: 2017-03
• Subjects: MDR-TB -- XDR-TB -- Shorter regimen -- Treatment duration -- Efficacy -- Impact; Communicable diseases -- Periodicals; Communicable Diseases -- Periodicals; Communicable diseases; Periodicals; Electronic journals; 616.9
• DOI: 10.1016/j.ijid.2016.10.021
• Languages: English
• ISSNs: 1201-9712

Abstract

Highlights: Multidrug-resistant and extensively drug-resistant tuberculosis (MDR- and XDR-TB) is considered a serious threat to TB control and elimination. The World Health Organization recommends a new shorter MDR-TB regimen in its 2016 MDR-TB guidelines. The shorter MDR-TB regimen is likely to impact the number of patients treated and improve adherence. Recent evidence from Europe and Latin America identified the prevalence of resistance to the drugs composing the shorter MDR-TB regimen. The shorter MDR-TB regimen could be prescribed to the correct patients through the systematic use of rapid MTBDRsl testing. Summary: 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.