Management of patients with multidrug-resistant tuberculosis

C. Lange, R. E. Aarnoutse, J. W.C. Alffenaar, G. Bothamley, F. Brinkmann, J. Costa, D. Chesov, R. Van Crevel, M. Dedicoat, J. Dominguez, R. Duarte, H. P. Grobbel, G. Günther, L. Guglielmetti, J. Heyckendorf, A. W. Kay, O. Kirakosyan, O. Kirk, R. A. Koczulla, G. G. KudriashovL. Kuksa, F. Van Leth, C. Magis-Escurra, A. M. Mandalakas, B. Molina-Moya, C. A. Peloquin, M. Reimann, R. Rumetshofer, H. S. Schaaf, T. Schön, S. Tiberi, J. Valda, P. K. Yablonskii, K. Dheda

Research output: Contribution to journalArticlepeer-review

42 Citations (Scopus)

Abstract

The emergence of multidrug-resistant tuberculosis (MDR-TB; defined as resistance to at least rifampicin and isoniazid) represents a growing threat to public health and economic growth. Never before in the history of mankind have more patients been affected by MDRTB than is the case today. The World Health Organization reports that MDR-TB outcomes are poor despite staggeringly high management costs. Moreover, treatment is prolonged, adverse events are common, and the majority of affected patients do not receive adequate treatment. As MDR-TB strains are often resistant to one or more second-line anti-TB drugs, in-depth genotypic and phenotypic drug susceptibility testing is needed to construct personalised treatment regimens to improve treatment outcomes. For the first time in decades, the availability of novel drugs such as bedaquiline allow us to design potent and well-tolerated personalised MDR-TB treatment regimens based solely on oral drugs. In this article, we present management guidance to optimise the diagnosis, algorithm-based treatment, drug dosing and therapeutic drug monitoring, and the management of adverse events and comorbidities, associated with MDRTB. We also discuss the role of surgery, physiotherapy, rehabilitation, palliative care and smoking cessation in patients with MDR-TB. We hope that incorporating these recommendations into patient care will be helpful in optimising treatment outcomes, and lead to more MDRTB patients achieving a relapse-free cure.

Original languageEnglish
Pages (from-to)645-662
Number of pages18
JournalInternational Journal of Tuberculosis and Lung Disease
Volume23
Issue number6
DOIs
Publication statusPublished - 1 Jun 2019

Keywords*

  • MDR-TB
  • personalised treatment
  • RESIST-TB
  • TB
  • TBNET
  • XDR-TB

Field of Science*

  • 3.1 Basic medicine
  • 3.3 Health sciences

Publication Type*

  • 1.1. Scientific article indexed in Web of Science and/or Scopus database

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