Applicability of the shorter 'Bangladesh regimen' in high multidrug- resistant tuberculosis settings

作者：Sotgiu Giovanni^*; Tiberi Simon; Centis Rosella; D'Ambrosio Lia; Fuentes Zhenia; Zumla Alimuddin; Migliori Giovanni Battista^*

来源：International Journal of Infectious Diseases, 2017, 56: 190-193.

DOI：10.1016/j.ijid.2016.10.021

• MDR-TB
• XDR-TB
• Shorter regimen
• Treatment duration
• Efficacy
• Impact

In spite of the recent introduction of two new drugs (delamanid and bedaquiline) and a few repurposed compounds to treat multidrug-resistant and extensively drug-resistant tuberculosis (MDR-and XDRTB), clinicians are facing increasing problems in designing effective regimens in severe cases. Recently a 9 to 12-month regimen (known as the ` Bangladesh regimen') proved to be effective in treating MDR-TB cases. It included an initial phase of 4 to 6 months of kanamycin, moxifloxacin, prothionamide, clofazimine, pyrazinamide, high-dose isoniazid, and ethambutol, followed by 5months of moxifloxacin, clofazimine, pyrazinamide, and ethambutol. However, recent evidence from Europe and Latin America identified prevalences of resistance to the first-line drugs in this regimen (ethambutol and pyrazinamide) exceeding 60%, and of prothionamide exceeding 50%. Furthermore, the proportions of resistance to the two most important pillars of the regimen-quinolones and kanamycin-were higher than 40%. Overall, only 14 out of 348 adult patients (4.0%) were susceptible to all of the drugs composing the regimen, and were therefore potentially suitable for the ` shorter regimen'. A shorter, cheaper, and well-tolerated MDR-TB regimen is likely to impact the number of patients treated and improve adherence if prescribed to the right patients through the systematic use of rapid MTBDRsl testing.

• 出版日期2017-3