Potentially high number of ineffective drugs with the standard shorter course regimen for multidrug-resistant tuberculosis treatment in Haiti

Kathleen F. Walsh, Ariadne Souroutzidis, Stalz Charles Vilbrun, Miranda Peeples, Guy Joissaint, Sobieskye Delva, Pamphile Widmann, Gertrude Royal, Jake Pry, Heejung Bang, Jean W. Pape, Serena P. Koenig

Research output: Contribution to journalArticle

3 Scopus citations

Abstract

Multidrug-resistant tuberculosis (MDR-TB) outcomes are poor partly because of the long treatment duration; the World Health Organization conditionally recommends a shorter course regimen to potentially improve treatment outcomes. Here,we describe the drug susceptibility patterns of a cohort ofMDR-TBpatients inHaiti and determine the number of likely effective drugs if they were treated with the recommended shorter course regimen. We retrospectively examined drug susceptibility patterns of adults initiatingMDR-TBtreatment between 2008 and 2015 at the HaitianGroup for the Study of Kaposi's Sarcoma andOpportunistic Infections in Port-au-Prince, Haiti. First- and second-line drug susceptibility testing (DST) was analyzed and used to determine the number of presumed effective drugs. Of the 239 patients analyzed, 226 (95%), 183 (77%), 135 (57%), and 38 (16%) isolates were resistant to high-dose isoniazid, ethambutol, pyrazinamide, and ethionamide, respectively. Eight patients (3%) had resistance to either a fluoroquinolone or a second-line injectable and none had extensively resistant TB. Of the 239 patients, 132 (55%) would have fewer than five likely effective drugs in the intensive phase of the recommended shorter course regimen and121 (51%)would have two or fewer likely effective drugs in the continuation phase.Because of the high rates of resistance to first-line TBmedications, about 50%ofMDR-TB patients would be left with only two effective drugs in the continuation phase of the recommended shorter course regimen, raising concerns about the effectiveness of this regimen in Haiti and the importance of using DST to guide treatment.

Original languageEnglish (US)
Pages (from-to)392-398
Number of pages7
JournalAmerican Journal of Tropical Medicine and Hygiene
Volume100
Issue number2
DOIs
StatePublished - Jan 1 2019
Externally publishedYes

ASJC Scopus subject areas

  • Parasitology
  • Infectious Diseases
  • Virology

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    Walsh, K. F., Souroutzidis, A., Vilbrun, S. C., Peeples, M., Joissaint, G., Delva, S., Widmann, P., Royal, G., Pry, J., Bang, H., Pape, J. W., & Koenig, S. P. (2019). Potentially high number of ineffective drugs with the standard shorter course regimen for multidrug-resistant tuberculosis treatment in Haiti. American Journal of Tropical Medicine and Hygiene, 100(2), 392-398. https://doi.org/10.4269/ajtmh.18-0493