This week WAidid suggests to read an article entitled "Proposal for a standardised treatment regimen to manage pre- and extensively drug-resistant tuberculosis cases", published on The European Respiratory Journal in 2017.
The World Health Organization reports that the number of patients suffering from TB with resistance to rifampicin (RR-TB), or multidrug-resistant TB increases alarmingly each year.
The treatment success rates achieved globally are sub-optimal, barely exceeding 50%. A proportion decreasing to 25% in patients with XDR-TB and to <20% when the drug resistance profile is beyond XDR. The outcomes observed suggest that specific patients achieve treatment success, the impact on the RR-/MDR-TB epidemic being rather limited.
WHO has recently recommended the so called ‘shorter regimens’ (9-12 months) for patients with RR-/MDR-TB who are susceptible to FQs and SLIs, or who have not previously received these two groups of drugs. These ‘shorter regimens’ have achieved relapse-free success rates on 85-90% of the MDR-TB patients treated. While an impact on the MDR-TB epidemic is forecasted by scaling-up the use of these regimens, this does not work automatically for XDR- or pre-XDR-TB cases.
The aim of this article is to discuss the possibility of designing a standardised regimen which, ideally supported by the use of rapid diagnostic methods to identify eligible patients, would be potentially effective in the majority of cases affected by pre-XDR- and XDR-TB. However, even without access to these rapid diagnostic methods, or waiting for their results, this regimen could work in patients failing the shorter or conventional standardized MDR-TB regimens. Therefore, the target of this regimen would be most of the patients with pre-XDR- and XDR-TB. This regimen would complement the existing set of available standard regimens for new cases and MDR-TB cases (the WHO-recommended ‘shorter’ regimen).
AUTHORS: Jose A. Caminero, Alberto Piubello, Anna Scardigli and Giovanni Battista Migliori.
Read the full article here: erj.ersjournals.com/content/50/1/1700648