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Community-Based Therapy for Multidrug-Resistant Tuberculosis in Lima, Peru
Open accessAbstract
BACKGROUND: Despite the prevalence of multidrug-resistant tuberculosis in nearly all low-income countries surveyed, effective therapy has been deemed too expensive and considered not to be feasible outside referral centers. We evaluated the results of community-based therapy for multidrug-resistant tuberculosis in a poor section of Lima, Peru. METHODS: We describe the first 75 patients to receive ambulatory treatment with individualized regimens for chronic multidrug-resistant tuberculosis in northern Lima. We conducted a retrospective review of the charts of all patients enrolled in the program between August 1, 1996, and February 1, 1999, and identified predictors of poor outcomes. RESULTS: The infecting strains of Mycobacterium tuberculosis were resistant to a median of six drugs. Among the 66 patients who completed four or more months of therapy, 83 percent (55) were probably cured at the completion of treatment. Five of these 66 patients (8 percent) died while receiving therapy. Only one patient continued to have positive cultures after six months of treatment. All patients in whom treatment failed or who died had extensive bilateral pulmonary disease. In a multiple Cox proportional-hazards regression model, the predictors of the time to treatment failure or death were a low hematocrit (hazard ratio, 4.09; 95 percent confidence interval, 1.35 to 12.36) and a low body-mass index (hazard ratio, 3.23; 95 percent confidence interval, 0.90 to 11.53). Inclusion of pyrazinamide and ethambutol in the regimen (when susceptibility was confirmed) was associated with a favorable outcome (hazard ratio for treatment failure or death, 0.30; 95 percent confidence interval, 0.11 to 0.83). CONCLUSIONS: Community-based outpatient treatment of multidrug-resistant tuberculosis can yield high cure rates even in resource-poor settings. Early initiation of appropriate therapy can preserve susceptibility to first-line drugs and improve treatment outcomes.
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Several studies have shown that MDR TB can be cured by a combination of second-line drugs under DOTS-Plus.
“Several studies have shown that MDR TB can be cured by a combination of second-line drugs under DOTS-Plus, the treatment strategy proposed by the World Health Organization to address the management of MDR TB in settings with good control programs (15, 18, 22, 30, 35, 48).”
From Resazurin Microtiter Assay Plate Testing of Mycobacterium tuberculosis Susceptibilities to Second-Line Drugs: Rapid, Simple, and Inexpensive Method (2003) · cites this paper as [30]
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Metadata
- Authors
- Mitnick, C., Bayona, J., Palacios, E., Shin, S., Furin, J., Alcántara, F., Sánchez, E., Sarria, M., Becerra, M., Fawzi, M. C. S., Kapiga, S., Neuberg, D., Maguire, J. H., Kim, J. Y., & Farmer, P.
- Affiliations
- Partners In Health (US)
- Brigham and Women's Hospital (US)
- Harvard University (US)
- ORCID
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2003-01-09
- Volume
- 348
- Issue
- 2
- Pages
- 119-128
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2124127309
- Cited by
- 489
- References
- 0
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 6 · 2023: 10 · 2022: 11 · 2021: 8 · 2020: 10 · 2019: 13 · 2018: 18 · 2017: 17 · 2016: 20 · 2015: 27 · 2014: 34 · 2013: 32 · 2012: 34
- FWCI
- 19.66
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- Funders
- Bill and Melinda Gates Foundation
- Eli Lilly and Company
- National Institute of Allergy and Infectious Diseases (AI 03535)
- Topics
- Health Sciences › Medicine › Infectious Diseases › Tuberculosis Research and Epidemiology
- Health Sciences › Medicine › Infectious Diseases › Infectious Diseases and Tuberculosis
- Health Sciences › Medicine › Epidemiology › Mycobacterium research and diagnosis
- Keywords
- multidrug-resistant tuberculosis, community-based treatment, outpatient care, Mycobacterium tuberculosis, treatment outcomes, predictors of treatment failure, pyrazinamide, ethambutol, hematocrit, body mass index, low-income settings, Lima
- MeSH terms
- Adult, Ambulatory Care, Antitubercular Agents, Community Health Services, Developing Countries, Female, Humans, Male, Microbial Sensitivity Tests, Peru, Retrospective Studies, Proportional Hazards Models, Treatment Outcome, Tuberculosis, Multidrug-Resistant, Directly Observed Therapy
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