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Therapeutic drug management: is it the future of multidrug-resistant tuberculosis treatment?

2013; European Respiratory Society; Volume: 42; Issue: 6 Linguagem: Inglês

10.1183/09031936.00073213

1399-3003

Shashikant Srivastava, Charles A. Peloquin, Giovanni Sotgiu, Giovanni Battista Migliori,

Pneumonia and Respiratory Infections

Multidrug- and extensively drug-resistant (M/XDR) tuberculosis (TB) are emerging public health concerns [1, 2]. In 2011, the World Health Organization (WHO) estimated 12 million prevalent cases of TB globally, which is equivalent to 170 cases per 100 000 population, out of these an estimated 630 000 cases were affected by MDR Mycobacterium tuberculosis strains [3]. Among the newly diagnosed patients ∼3.7% were infected by MDR-TB strains, but the worrisome fact is that the prevalence of MDR-TB among new cases in some Former Soviet Union countries exceeds 30% [4, 5], XDR-TB has been identified in 84 countries and the average proportion of MDR-TB cases with an XDR-TB pattern is 9.0% [3]. Further adding to the problem are the reports of “totally drug resistant” TB [6, 7], a term currently not recognised by WHO [8, 9]. Treatment of drug resistant TB is more expensive and more toxic if compared with that prescribed for drug-susceptible TB, and currently takes up to 2 years of therapy [10]. The cost per patient to treat MDR-TB cases is incredibly high [11, 12] and, in spite of international public health efforts, the treatment outcome is not very promising [13–15]. Diel et al. [16] showed that direct treatment-related costs of MDR-TB patients can amount to €52 259 in Germany (table 1). View this table: Table 1– Direct costs of multidrug-resistant tuberculosis (MDR-TB) therapy in a European low-income country In the largest MDR-TB cohort analysed to date [13] the proportion of cases treated successfully was 62%, with 7% failing or relapsing, 9% dying and 17% defaulting; in the XDR-TB subgroup 40% achieved treatment success, 22% failed treatment or relapsed, whereas 15% died and 16% defaulted [14, 15]. In this issue of the …