A 10-year review of isoniazid-resistant TB management in Uzbekistan 2009-2020
BACKGROUND: Isoniazid (INH, H) resistance is the most common drug-resistant TB pattern, with treatment success rates lower than those in drug-susceptible TB. The WHO recommends a 6-month regimen of rifampicin (RIF, R), ethambutol (EMB, E), pyrazinamide (PZA, Z), and levofloxacin (Lfx) (6REZLfx) for...
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International Union Against Tuberculosis and Lung Disease (The Union)
2024-07-01
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| author | M.L. Rekart P. Thit M. Oluya S. Moe T. Hasan N. Parpieva K. Safaev A. Khristusev T. Zinaida J. Singh S. Allamuratova I. Azamat C.G. Restrepo N. Sitali J. Achar J.L. Alvaraez A. Sinha |
| author_facet | M.L. Rekart P. Thit M. Oluya S. Moe T. Hasan N. Parpieva K. Safaev A. Khristusev T. Zinaida J. Singh S. Allamuratova I. Azamat C.G. Restrepo N. Sitali J. Achar J.L. Alvaraez A. Sinha |
| author_sort | M.L. Rekart |
| collection | DOAJ |
| description | BACKGROUND: Isoniazid (INH, H) resistance is the most common drug-resistant TB pattern, with treatment success rates lower than those in drug-susceptible TB. The WHO recommends a 6-month regimen of rifampicin (RIF, R), ethambutol (EMB, E), pyrazinamide (PZA, Z), and levofloxacin (Lfx) (6REZLfx) for INH-resistant, RIF-susceptible TB (HRRS-TB). Uzbekistan has a high burden of TB (62/100,000 population) and multidrug-resistant TB (12/100,000 population). METHODS: We conducted a retrospective, descriptive study of microbiologically confirmed HRRS-TB using routinely collected programmatic data from 2009 to 2020. RESULTS: We included 854 HRRS-TB cases. Treatment success was 80.2% overall. For REZLfx, the treatment success rate was 92.0% over a short treatment duration, with no amplifications to RIF or second-line anti-TB drug resistance. We documented 46 regimens with REZLfx plus linezolid (success 87.0%) and 539 regimens using kanamycin or capreomycin (success 76.6%). We identified 37 treatment failures (4.3%), 30 deaths (3.5%), 25 resistance amplifications (2.9%), including eight to RIF (0.9%), and 99 lost to follow-up (LTFU) cases (11.6%). Unsuccessful outcomes were more common with older age, diabetes, chest X-ray cavities, smear positivity, smear-positive persistence, and male sex. LTFU was more common with injection-containing regimens. CONCLUSIONS: REZLfx is a safe and effective first-line treatment for INH-resistant, RIF-susceptible TB. Treatment success was lower and LTFU was higher for injection-containing regimens. |
| format | Article |
| id | doaj-art-f8ccff5dab3c476c8c68f86d9954afb5 |
| institution | Kabale University |
| issn | 3005-7590 |
| language | English |
| publishDate | 2024-07-01 |
| publisher | International Union Against Tuberculosis and Lung Disease (The Union) |
| record_format | Article |
| series | IJTLD Open |
| spelling | doaj-art-f8ccff5dab3c476c8c68f86d9954afb52025-01-22T12:12:38ZengInternational Union Against Tuberculosis and Lung Disease (The Union)IJTLD Open3005-75902024-07-011728529110.5588/ijtldopen.23.05332A 10-year review of isoniazid-resistant TB management in Uzbekistan 2009-2020M.L. Rekart0P. Thit1M. Oluya2S. Moe3T. Hasan4N. Parpieva5K. Safaev6A. Khristusev7T. Zinaida8J. Singh9S. Allamuratova10I. Azamat11C.G. Restrepo12N. Sitali13J. Achar14J.L. Alvaraez15A. Sinha16Médecins Sans Frontières (MSF), Amsterdam, The Netherlands;MSF, Tashkent, Uzbekistan;MSF, Tashkent, Uzbekistan;MSF, Tashkent, Uzbekistan;MSF, Tashkent, Uzbekistan;Republican Specialized Scientific and Practical Medical Center of Tuberculosis and Pulmonology, Tashkent, Uzbekistan;Republican Specialized Scientific and Practical Medical Center of Tuberculosis and Pulmonology, Tashkent, Uzbekistan;MSF, Tashkent, Uzbekistan;Republican Center of Tuberculosis and Pulmonology, Nukus, Uzbekistan;MSF, Tashkent, Uzbekistan;MSF, Tashkent, Uzbekistan;MSF, Tashkent, Uzbekistan;MSF, Tashkent, Uzbekistan;MSF, Berlin, Germany;Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden;MSF, London, UKMSF, London, UKBACKGROUND: Isoniazid (INH, H) resistance is the most common drug-resistant TB pattern, with treatment success rates lower than those in drug-susceptible TB. The WHO recommends a 6-month regimen of rifampicin (RIF, R), ethambutol (EMB, E), pyrazinamide (PZA, Z), and levofloxacin (Lfx) (6REZLfx) for INH-resistant, RIF-susceptible TB (HRRS-TB). Uzbekistan has a high burden of TB (62/100,000 population) and multidrug-resistant TB (12/100,000 population). METHODS: We conducted a retrospective, descriptive study of microbiologically confirmed HRRS-TB using routinely collected programmatic data from 2009 to 2020. RESULTS: We included 854 HRRS-TB cases. Treatment success was 80.2% overall. For REZLfx, the treatment success rate was 92.0% over a short treatment duration, with no amplifications to RIF or second-line anti-TB drug resistance. We documented 46 regimens with REZLfx plus linezolid (success 87.0%) and 539 regimens using kanamycin or capreomycin (success 76.6%). We identified 37 treatment failures (4.3%), 30 deaths (3.5%), 25 resistance amplifications (2.9%), including eight to RIF (0.9%), and 99 lost to follow-up (LTFU) cases (11.6%). Unsuccessful outcomes were more common with older age, diabetes, chest X-ray cavities, smear positivity, smear-positive persistence, and male sex. LTFU was more common with injection-containing regimens. CONCLUSIONS: REZLfx is a safe and effective first-line treatment for INH-resistant, RIF-susceptible TB. Treatment success was lower and LTFU was higher for injection-containing regimens.https://www.ingentaconnect.com/contentone/iuatld/ijtldo/2024/00000001/00000007/art00002inh resistancecentral asia6rezlfxdrug-resistant tbdr-tb |
| spellingShingle | M.L. Rekart P. Thit M. Oluya S. Moe T. Hasan N. Parpieva K. Safaev A. Khristusev T. Zinaida J. Singh S. Allamuratova I. Azamat C.G. Restrepo N. Sitali J. Achar J.L. Alvaraez A. Sinha A 10-year review of isoniazid-resistant TB management in Uzbekistan 2009-2020 IJTLD Open inh resistance central asia 6rezlfx drug-resistant tb dr-tb |
| title | A 10-year review of isoniazid-resistant TB management in Uzbekistan 2009-2020 |
| title_full | A 10-year review of isoniazid-resistant TB management in Uzbekistan 2009-2020 |
| title_fullStr | A 10-year review of isoniazid-resistant TB management in Uzbekistan 2009-2020 |
| title_full_unstemmed | A 10-year review of isoniazid-resistant TB management in Uzbekistan 2009-2020 |
| title_short | A 10-year review of isoniazid-resistant TB management in Uzbekistan 2009-2020 |
| title_sort | 10 year review of isoniazid resistant tb management in uzbekistan 2009 2020 |
| topic | inh resistance central asia 6rezlfx drug-resistant tb dr-tb |
| url | https://www.ingentaconnect.com/contentone/iuatld/ijtldo/2024/00000001/00000007/art00002 |
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