Traditional and Short Course Treatment for Multidrug-Resistant Tuberculosis: A Comparative Study in National Referral Centers

Baghaei, Parvaneh; Campbell, Johnathon R; Mahdavian, Amirmohsen; Abtahian, Zahra; Marjani, Majid; Moniri, Afshin; Varahram, Mohammad; Kazempour, Mehdi; Tabarsi, Payam

Traditional and Short Course Treatment for Multidrug-Resistant Tuberculosis: A Comparative Study in National Referral Centers

Document Type : Original Article

Authors

Parvaneh Baghaei ¹

Johnathon R Campbell ²

Amirmohsen Mahdavian ¹

Zahra Abtahian ¹

Majid Marjani ¹

Afshin Moniri ¹

Mohammad Varahram ³

Mehdi Kazempour ⁴

Payam Tabarsi ¹

¹ Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

² Department of Epidemiology, Biostatistics, and Occupational Health, Faculty of Medicine, McGill University, Montreal, Canada

³ Mycobacteriology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran

⁴ Department of Biostatistics, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran

Abstract

Background: Treatment of multidrug-resistant tuberculosis (MDR-TB) is difficult, expensive, and requires prolonged periods of time. Recent studies recommended short-course therapy (shorter regimen) for 9 months to one year. This study aimed to evaluate the response of the short-course therapy compared with traditional treatment in MDR-TB patients.
Materials and Methods: From all 94 referred MDR-TB cases, 48 patients were included in this study. Shorter regimen consisted of Moxifloxacin, Prothionamide, Amikacin, Clofazimine, Linezolid, Ethambutol, Pyrazinamide, and Cycloserine, and longer regimens consisted of the mentioned drugs, except Clofazimine and Linezolid, were prescribed randomly: in equal (24 in each group). The patients were monitored and evaluated for any complications and were followed for five years for relapse.
Results: The median age was 39 years. The median interval for smear conversion was 30 days (20- 58 days) and was shorter in the short-course group (36 vs. 49 days). Also, the mean interval of sputum culture conversion in the shorter group and standard was 32 and 56 days, respectively, which is not related to the outcome of treatment. Eight of twelve patients who developed severe adverse effects were in shorter regimen. There was no difference between the two groups for the outcome of TB treatment. There is no relation between the outcome and other factors. None of them relapsed after three years following the end of the treatment.
Conclusion: Shorter treatment can increase the cure rate and cooperation and adherence of the patients. It would be better to consider a shorter regimen in the national TB program for strengthening favorable treatment.

Keywords

Multidrug resistant

Shorter treatment

Adverse effects

Outcome

Subjects