바로가기메뉴

본문 바로가기 주메뉴 바로가기

Tuberculosis & Respiratory Diseases

Article Contents

Prev Next
e-Submission

Vol.66 No.3
Citation Share

Acquired Drug Resistance during Standardized Treatment with First-line Drugs in Patients with Multidrug-Resistant Tuberculosis

Tuberculosis & Respiratory Diseases / Tuberculosis & Respiratory Diseases,
2009, v.66 no.3, pp.198-204







& (2009). Acquired Drug Resistance during Standardized Treatment with First-line Drugs in Patients with Multidrug-Resistant Tuberculosis. Tuberculosis & Respiratory Diseases, 66(3), 198-204.
  • Downloaded
  • Viewed
PDF Download

Abstract

Background: First-line drugs, if sensitive, are the most potent drugs in the treatment of multidrug-resistant tuberculosis (MDR-TB). This study examined the frequency and risk factors associated with acquired drug resistance to first-line drugs during a standardized treatment using first-line drugs in patients with MDR-TB. Methods: This study included patients who were diagnosed with MDR-TB at the National Masan Tuberculosis Hospital between January 2004 and May 2008, treated with standardized first-line drugs, and for whom the preand post-treatment results of the drug susceptibility test were available. Their medical records were reviewed retrospectively. Results: Of 41 MDR-TB patients, 14 (34.1%) acquired additional resistance to ethambutol (EMB) or pyrazinamide (PZA). Of 11 patients initially resistant to isoniazid (INH) and rifampicin (RFP), 3 (27.3%) acquired additional resistance to both EMB and PZA, and 3 (27.3%) to PZA. Of 18 patients initially resistant to INH, RFP and EMB, 6 (33.3%) acquired additional resistance to PZA. Of 6 patients initially resistant to INH, RFP and PZA, 2 (33.3%) acquired additional resistance to EMB. Ten of the 41 MDR-TB patients (24.4%) changed from resistant to susceptible. No statistically significant risk factors associated with acquired resistance could be found. Conclusion: First-line drugs should be used cautiously in the treatment of MDR-TB in Korea considering the potential acquisition of drug resistance.

keywords
Tuberculosis, Multidrug resistance, Drug resistance

Reference

1.

Kim HJ, Hong YP, Kim SJ, Lew WJ, Lee EG. Ambulatory treatment of multidrug-resistant pulmonary tuberculosis patients at a chest clinic. Int J Tuberc Lung Dis 2001;5:1129-36.

2.

Park SK, Lee WC, Lee DH, Mitnick CD, Han L, Seung KJ. Self-administered, standardized regimens for multidrug- resistant tuberculosis in South Korea. Int J Tuberc Lung Dis 2004;8:361-8.

3.

Kim HR, Hwang SS, Kim HJ, Lee SM, Yoo CG, Kim YW, et al. Impact of extensive drug resistance on treatment outcomes in non-HIV-infected patients with multidrug-resistant tuberculosis. Clin Infect Dis 2007;45:1290-5.

4.

Kwon YS, Kim YH, Suh GY, Chung MP, Kim H, Kwon OJ, et al. Treatment outcomes for HIV-uninfected patients with multidrug-resistant and extensively drug-resistant tuberculosis. Clin Infect Dis 2008;47:496-502.

5.

Kim DH, Kim HJ, Park SK, Kong SJ, Kim YS, Kim TH, et al. Treatment outcomes and long-term survival in patients with extensively drug-resistant tuberculosis. Am J Respir Crit Care Med 2008;178:1075-82.

6.

Mukherjee JS, Rich ML, Socci AR, Joseph JK, Virú FA, Shin SS, et al. Programmes and principles in treatment of multidrug-resistant tuberculosis. Lancet 2004;363:474-81.

7.

World Health Organization. Guidelines for the programmatic management of drug-resistant tuberculosis: emergency update 2008. Geneva: World Health Organization; 2008.

8.

Migliori GB, Besozzi G, Girardi E, Kliiman K, Lange C, Toungoussova OS, et al. Clinical and operational value of the extensively drug-resistant tuberculosis definition. Eur Respir J 2007;30:623-6.

9.

Joh JS, Lee CH, Lee JE, Park YK, Bai GH, Kim EC, et al. The interval between initiation of anti-tuberculosis treatment in patients with culture-positive pulmonary tuberculosis and receipt of drug-susceptibility test results. J Korean Med Sci 2007;22:26-9.

10.

Kim MN, Lee SH, Yang SE, Pai CH. Mycobacterial testing in hospital laboratories in Korea: results of a survey of 40 university or tertiary-care hospitals. Korean J Clin Pathol 1999;19:86-91.

11.

National Tuberculosis Association. Diagnostic standards and classification of tuberculosis. 11th ed. New York: National Tuberculosis Assoication; 1961.

12.

American Thoracic Society, Centers for Disease Control and Prevention, Infectious Diseases Society of America. American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America: controlling tuberculosis in the United States. Am J Respir Crit Care Med 2005;172:1169-227.

13.

Mitchison DA. How drug resistance emerges as a result of poor compliance during short course chemotherapy for tuberculosis. Int J Tuberc Lung Dis 1998;2:10-5.

14.

Farmer P, Bayona J, Becerra M, Furin J, Henry C, Hiatt H, et al. The dilemma of MDR-TB in the global era. Int J Tuberc Lung Dis 1998;2:869-76.

15.

Umubyeyi A, Shamputa IC, Rigouts L, Dediste A, Struelens M, Portaels F. Evidence of 'amplifier effect' in pulmonary multidrug-resistant tuberculosis: report of three cases. Int J Infect Dis 2007;11:508-12.

16.

Quy HT, Lan NT, Borgdorff MW, Grosset J, Linh PD, Tung LB, et al. Drug resistance among failure and relapse cases of tuberculosis: is the standard re-treatment regimen adequate? Int J Tuberc Lung Dis 2003;7:631-6.

17.

Yoshiyama T, Yanai H, Rhiengtong D, Palittapongarnpim P, Nampaisan O, Supawitkul S, et al. Development of acquired drug resistance in recurrent tuberculosis patients with various previous treatment outcomes. Int J Tuberc Lung Dis 2004;8:31-8.

18.

Temple B, Ayakaka I, Ogwang S, Nabanjja H, Kayes S, Nakubulwa S, et al. Rate and amplification of drug resistance among previously-treated patients with tuberculosis in Kampala, Uganda. Clin Infect Dis 2008;47:1126-34.

19.

Seung KJ, Gelmanova IE, Peremitin GG, Golubchikova VT, Pavlova VE, Sirotkina OB, et al. The effect of initial drug resistance on treatment response and acquired drug resistance during standardized short-course chemotherapy for tuberculosis. Clin Infect Dis 2004;39:1321-8.

20.

Han LL, Sloutsky A, Canales R, Naroditskaya V, Shin SS, Seung KJ, et al. Acquisition of drug resistance in multidrug-resistant Mycobacterium tuberculosis during directly observed empiric retreatment with standardized regimens. Int J Tuberc Lung Dis 2005;9:818-21.

21.

Cox HS, Niemann S, Ismailov G, Doshetov D, Orozco JD, Blok L, et al. Risk of acquired drug resistance during short-course directly observed treatment of tuberculosis in an area with high levels of drug resistance. Clin Infect Dis 2007;44:1421-7.

22.

Tenover FC, Crawford JT, Huebner RE, Geiter LJ, Horsburgh CR Jr, Good RC. The resurgence of tuberculosis: is your laboratory ready? J Clin Microbiol 1993;31:767-70.

23.

Oh SH, Kim YJ, Park SK, Hwang SH, Kim HH, Lee EY, et al. Comparison of anti-mycobacterial drug susceptibility test results by institutes and methods. Korean J Clin Microbiol 2008;11:43-8.

Tuberculosis & Respiratory Diseases

e-Submission OA Policy