thioacetazone and Tuberculosis--Multidrug-Resistant

The role of so-called "group 5" second-line drugs as a part of antibiotic therapy for multidrug-resistant tuberculosis (MDR-TB) is widely debated. We performed an individual patient data meta-analysis to evaluate the effectiveness of several group 5 drugs including amoxicillin/clavulanic acid, thioacetazone, the macrolide antibiotics, linezolid, clofazimine and terizidone for treatment of patients with MDR-TB.Detailed individual patient data were obtained from 31 published cohort studies of MDR-TB therapy. Pooled treatment outcomes for each group 5 drug were calculated using a random effects meta-analysis. Primary analyses compared treatment success to a combined outcome of failure, relapse or death.Among 9282 included patients, 2191 received at least one group 5 drug. We found no improvement in treatment success among patients taking clofazimine, amoxicillin/clavulanic acid or macrolide antibiotics, despite applying a number of statistical approaches to control confounding. Thioacetazone was associated with increased treatment success (OR 2.6, 95% CI 1.1-6.1) when matched controls were selected from studies in which the group 5 drugs were not used at all, although this result was heavily influenced by a single study.The development of more effective antibiotics to treat drug-resistant TB remains an urgent priority.

Topics: Adult; Amoxicillin; Antitubercular Agents; Clofazimine; Cohort Studies; Drug Therapy, Combination; Female; Humans; Isoxazoles; Linezolid; Logistic Models; Macrolides; Male; Microbial Sensitivity Tests; Middle Aged; Multivariate Analysis; Oxazolidinones; Thioacetazone; Treatment Outcome; Tuberculosis, Multidrug-Resistant; Young Adult

A 30 years-old-male was referred to our hospital for surgical treatment of multidrug-resistant tuberculosis in April 1998, three years after diagnosis of tuberculosis. All first-line anti-tuberculosis drugs and second-line anti-tuberculosis drugs were resistant on drug susceptibility tests by Ogawa medium. The right upper lobectomy was done because of massive hemoptysis and enlargement of cavitary lesion in June 1998, but this surgical operation was complicated with, bronchial fistula and chronic empyema. Open drainage surgical treatment for chronic empyema was done one month after lobectomy. Sputum culture for M. tuberculosis converted 4 months after the lobectomy, but bacteriological relapse occurred 17 months after initial operation. The new cavitary lesion on middle left lung field developed and sputum smear and culture were continuously positive. Immunotherapy with interferon-gamma via aerosol didn't show any clinical effect. Thiacetazone, sparfloxcin, pyrazinamide, cycloserine was prescribed after 21 months of the initial operation. Four months after changing the regimen sputum smear and culture converted to negative. Chemotherapy was terminated in June 2003, two years after negative conversion. Three years after the termination of treatment no relapse occurred. We considered thiacetazone was effective in this case, because all of the drugs was companied with thiacetazone were resistant by the drug susceptibility tests and were previously used.

Topics: Adult; Antitubercular Agents; Humans; Male; Pneumonectomy; Thioacetazone; Tuberculosis, Multidrug-Resistant; Tuberculosis, Pulmonary

Topics: Acetamides; Adult; AIDS-Related Opportunistic Infections; Amoxicillin; Anti-Bacterial Agents; Anti-Infective Agents; Antiretroviral Therapy, Highly Active; Antitubercular Agents; Clavulanic Acid; Drug Resistance, Microbial; Drug Resistance, Multiple; Drug Therapy, Combination; Humans; Isoniazid; Linezolid; Mycobacterium bovis; Oxazolidinones; Thioacetazone; Tuberculosis, Multidrug-Resistant; Tuberculosis, Pulmonary

Topics: Antitubercular Agents; Drug Administration Schedule; Drug Therapy, Combination; Ethambutol; Humans; Isoniazid; Pyrazinamide; Rifampin; Streptomycin; Thioacetazone; Tuberculosis, Multidrug-Resistant; Tuberculosis, Pulmonary; World Health Organization

To evaluate the current prevalence of initial and acquired resistance to the main antituberculosis drugs in Yaounde, isolates of M. tuberculosis complex obtained from sputum cultures of 602 adult patients with pulmonary tuberculosis (516 new cases and 86 old cases) consecutively admitted into the tuberculosis centre of Hôpital JAMOT from July 1994 to December 1995 were studied. The susceptibility of isolates to the major antituberculosis drugs was tested by the indirect proportion method. The overall resistance rate (1 or more drugs) was 35.2%, with initial resistance 31.8% (164 of 516) and acquired resistance 55.8% (48 of 86). Initial resistance to streptomycin was the most frequent (20.5%), followed by isoniazid 12.4%), thiacetazone (5.6%), rifampicine (0.8%) and ethambutol (0.4%). Initial resistance was noted as 25% to 1 drug, 5.8% to 2 drugs, 0.8% to 3 drugs and 0.2% to 4 drugs. Acquired resistance to isoniazid was the most frequent (45.3%), followed by streptomycin (40.7%), rifampicine (30.2%), thiacetazone (10.5%) and ethambutol (9.3%). Acquired resistance was found as 13.9% to one drug, 19.8% to 2 drugs, 12.8% to 3 drugs and 9.3% to 4 drugs. A combined resistance to rifampicine and isoniazid in the same patient was noted in 0.8% of the new cases and in 26.7% of the old cases. These high rates af antituberculosis drug resistance in Yaounde underline the urgent need to reestablish a tuberculosis control programme in Cameroon.

Topics: Adolescent; Adult; Antitubercular Agents; Cameroon; Drug Resistance, Microbial; Drug Resistance, Multiple; Ethambutol; Female; Humans; Isoniazid; Male; Middle Aged; Mycobacterium tuberculosis; Rifampin; Sputum; Streptomycin; Thioacetazone; Tuberculosis, Multidrug-Resistant; Tuberculosis, Pulmonary

To obtain current, representative information on current drug resistance patterns in Addis Ababa, Ethiopia.. A cross-sectional study whereby 167 isolates were tested for susceptibility to the anti-tuberculosis drugs commonly used in the country (isoniazid, thiacetazone, rifampicin, streptomycin and ethambutol). All hospitals, health centres and 6 of the 9 clinics in Addis Ababa were included in the study.. Overall primary drug resistance was found to be 15.6% (26/167). Primary resistance to two or more drugs was 7.2% (12/167). The highest rate of primary resistance was to streptomycin (10.2%) followed by isoniazid (8.4%). Resistance to rifampicin was low (1.8%, 3/167) and to ethambutol nil. Multiple drug resistance in combinations with rifampicin was low.. To prevent further development and spread of resistance, universal use of standard treatment protocol, control of the circulation of anti-tuberculosis drugs, training of health workers, expansion of strictly supervised short-course treatment and establishing a nation-wide and regular surveillance system are recommended.

Topics: Antitubercular Agents; Cross-Sectional Studies; Developing Countries; Drug Resistance, Multiple; Drug Therapy, Combination; Ethambutol; Ethiopia; Humans; Isoniazid; Microbial Sensitivity Tests; Multicenter Studies as Topic; Mycobacterium tuberculosis; Prevalence; Rifampin; Streptomycin; Thioacetazone; Tuberculosis, Multidrug-Resistant