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Comprehensive Treatment of XDR-TB Works in Developing Countries BOSTON -- August 6, 2008 -- The death sentence that too often accompanies a diagnosis of extensively drug-resistant tuberculosis (XDR-TB) can be commuted if an individualised outpatient therapy program is followed -- even in countries with limited resources and a heavy burden of TB -- according to a study in the August 7 issue of the New England Journal of Medicine. The study, conducted in Peru between 1999 and 2002, shows that more than 60% of XDR-TB patients not coinfected with HIV were cured after receiving the bulk of their personalised treatment at home or in community-based settings. "It's essential that the world know that XDR-TB is not a death sentence," said lead author Carole Mitnick, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts. "As or even more importantly, our study shows that effective treatment does not require hospitalisation or indefinite confinement of patients." A total of 810 patients with unsuccessfully treated TB were referred for free individualised drug treatment and additional services as needed, including surgery, adverse-event management, and nutritional and psychological support. Sputum culture and drug-susceptibility testing results were available for 651 patients. Based on susceptibility results for 12 anti-TB drugs, clinicians developed regimens that included 5 or more drugs to which the infecting strains were likely to respond. Of the patients, 48 had XDR-TB and 603 had multidrug-resistant TB (MDR-TB). None of the XDR-TB patients were coinfected with HIV. At the end of treatment, 60.4% of patients in the XDR-TB group were cured, while 66.3% in the MDR-TB group were cured. The outcomes among XDR-TB patients were better than most reported from hospital settings in Europe, the United States, and Korea, said Mitnick. Frequent contact with healthcare workers afforded many benefits and was an important element of success. Healthcare workers ensured a high level of treatment adherence and promptly detected circumstances requiring additional attention. Psychosocial needs were also assessed continuously and addressed through a range of interventions. "It's important for people to understand that this ambulatory form of treatment exists, is successful, and can be widely implemented in resource-poor settings," Mitnick said. Community-based interventions also protect hospital patients and staff from transmission of TB and allow TB patients to remain with their families during this protracted treatment. If hospitals have to accommodate only those with serious medical needs, this intervention can be implemented widely and earlier in the disease course. The benefits would be profound, Mitnick says. In addition to reduced morbidity and mortality among patients, an epidemiologic impact could be expected. SOURCE: Harvard Medical School E-mail this page to a friend or colleague! To print, use this version