Of testing and treatment: Implications of implementing new regimens for multidrug-resistant tuberculosis

Post Date: 
2017-10-01
Publication: 
Clinical Infectious Diseases
Summary: 

A novel, shorter-course regimen for treating multidrug-resistant (MDR) tuberculosis was recently recommended by the World Health Organization. However, the most appropriate use of drug susceptibility testing (DST) to support this regimen is less clear. Implementing countries must therefore often choose between using a standardized regimen despite high levels of underlying drug resistance or require more stringent DST prior to treatment initiation. The former carries a high likelihood of exposing patients to de facto monotherapy with a critical drug class (fluoroquinolones), whereas the latter could exclude large groups of patients from their most effective treatment option. We discuss the implications of this dilemma and argue for an approach that will integrate DST into the delivery of any novel antimicrobial regimen, without excessively stringent requirements. Such guidance could make the novel MDR tuberculosis regimen available to most patients while reducing the risk of generating additional drug resistance.

Citation: 
Dowdy DW, Theron G, Tornheim JA, Warren R, Kendall EA. Of testing and treatment: Implications of implementing new regimens for multidrug-resistant tuberculosis. Clin Infect Dis. 2017 Oct 1;65(7):1206-1211. doi: 10.1093/cid/cix486. PMID: 29554229; PMCID: PMC5850434
Collaborators: 
  • Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
  • DST/NRF Centre of Excellence for Biomedical Tuberculosis Research and SAMRC Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa