Epidemiology and clinical management of XDR-TB: a systematic review by TBNET.

Abstract

Extensively drug-resistant tuberculosis (XDR-TB) is present in all regions and poses serious challenges for public health and clinical management. Laboratory diagnosis is difficult and little evidence exists to guide clinicians in treating people with XDR-TB effectively. To summarise the available data on diagnosis and treatment, the current authors performed a systematic review on 13 recent studies of the epidemiology and clinical management of XDR-TB. Studies that met inclusion criteria were reviewed, in order to assess methodology, treatment regimens and treatment outcomes. Meta-analysis of currently available data is not possible because of inconsistent definitions and methodologies. Data show that XDR-TB can be successfully treated in up to 65% of patients, particularly those who are not co-infected with HIV. However, treatment duration is longer and outcomes are in general poorer than for non-XDR TB patients. To strengthen the evidence for extensively drug-resistant tuberculosis diagnosis, treatment and prevention, future studies should: 1) be prospective in design; 2) adopt standardised, internationally accepted definitions; 3) use quality-assured laboratory testing for all first- and second-line drugs; and 4) collect data on an agreed-upon set of standard variables, allowing for comparisons across studies. Early diagnosis and aggressive management of extensively drug-resistant tuberculosis provide the best chance of positive outcome, but prevention is still paramount.

• Authors: G Sotgiu, G Ferrara, A Matteelli, M D Richardson, R Centis, S Ruesch-Gerdes, O Toungoussova, J-P Zellweger, A Spanevello, D Cirillo, C Lange, G B Migliori
• Journal: The European respiratory journal (Eur Respir J) Vol. 33 Issue 4 Pg. 871-81 (Apr 2009) ISSN: 1399-3003 [Electronic] England
• PMID: 19251779 (Publication Type: Journal Article, Review, Systematic Review)

Chemical References

• Antitubercular Agents

Topics

• Antitubercular Agents (therapeutic use)
• Extensively Drug-Resistant Tuberculosis (diagnosis, drug therapy, epidemiology)
• Global Health
• Humans