More research needed on the best treatment options for multidrug-resistant TB

August 28, 2012

The use of newer drugs, a greater number of effective drugs, and a longer treatment regimen may be associated with improved survival of patients with multidrug resistant tuberculosis (MDR-TR), according to a large study by a team of international researchers published in this week's PLOS Medicine.

Global efforts to control tuberculosis are being challenged by the emergence of strains that are resistant to several antibiotics including isoniazid and rifampicin, the two most powerful, first-line (standard) anti-tuberculosis drugs—so-called multidrug (MDR-TB). The treatment of MDR-TB is lengthy, toxic, expensive, and has mostly resulted in poor outcomes for patients. Importantly, the optimal treatment regimens for MDR-TB have not been determined and, to date, there have been no of treatments for MDR-TB.

In this study, a large group of international researchers (the Collaborative Group for Meta-Analysis of Individual in MDR-TB) combined data on outcomes of 9153 patients from 32 centers to find out more about the best way of treating MDR-TB. The researchers found that the use of certain drugs, the use of four or more effective drugs, and the duration of treatment were associated with successful .

The authors conclude: "This individual patient data meta-analysis of 9,153 patients suggests that of MDR-TB should include a later generation quinolone, and ethionamide or prothionamide. In patients who have not received second-line drugs before, the optimal number of likely effective drugs appears to be at least four in the initial intensive phase, and at least three in the continuation phase. The duration of therapy associated with highest odds of success was 7-8.5 months for the initial intensive phase, and 25-27 months for total duration."

However, these findings should be interpreted with caution because of the limitations in the methods and type of data used in the study. The authors say: "In view of the serious limitations of these observational data, these findings should be considered to have highlighted several important questions for future clinical trials.

These questions include the role and choice of injectables (medications that have to be given by injection), the optimal duration of an injectable and total therapy, and the potential value of later generation quinolones as well as certain group 4 and group 5 drugs."

Explore further: Management of TB cases falls short of international standards

More information: Ahuja SD, Ashkin D, Avendano M, Banerjee R, Bauer M, et al. (2012) Multidrug Resistant Pulmonary Tuberculosis Treatment Regimens and Patient Outcomes: An Individual Patient Data Meta-analysis of 9,153 Patients. PLoS Med 9(8): e1001300. doi:10.1371/journal.pmed.1001300

Related Stories

Management of TB cases falls short of international standards

February 9, 2012
The management of tuberculosis cases in the European Union (EU) is not meeting international standards, according to new research.

New WHO guidelines call for more evidence on drug-resistant TB

August 4, 2011
The European Respiratory Journal is today (04 August 2011) publishing the updated guidelines of the World Health Organization (WHO) that aim to help manage drug-resistant tuberculosis (TB).

Trial for new drug-resistant TB treatment to begin

March 19, 2012
A global health alliance Monday unveiled plans for the first clinical tests of a new treatment regimen for tuberculosis, including for patients with resistance to existing multidrug programs.

Recommended for you

Groundbreaking investigative effort identifies gonorrhea vaccine candidates

September 19, 2017
Researchers at Oregon State University have identified a pair of proteins that show promise as the basis for a gonorrhea vaccine.

Snail fever progression linked to nitric oxide production

September 14, 2017
Bilharzia, caused by a parasitic worm found in freshwater called Schistosoma, infects around 200 million people globally and its advance can lead to death, especially in children in developing countries.

Systems analysis points to links between Toxoplasma infection and common brain diseases

September 13, 2017
More than 2 billion people - nearly one out of every three humans on earth, including about 60 million people in the United States - have a lifelong infection with the brain-dwelling parasite Toxoplasma gondii.

Study clears important hurdle toward developing an HIV vaccine

September 13, 2017
An international team of researchers has demonstrated a way of overcoming one of the major stumbling blocks that has prevented the development of a vaccine against HIV: the ability to generate immune cells that stay in circulation ...

As 'flesh-eating' Leishmania come closer, a vaccine against them does, too

September 13, 2017
Parasites that ulcerate the skin, can disfigure the face, and may fatally mutilate its victim's internal organs are creeping closer to the southern edges of the United States.

Promising clinical trial results could give doctors a new tool against drug-resistant strains of malaria parasite

September 13, 2017
Tulane University researchers have developed a new drug that is effective against non-severe cases of malaria, according to results from an FDA-supervised clinical trial published in the latest issue of The Lancet Infectious ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.