       Document 0420
 DOCN  M9610420
 TI    Treatment of multidrug-resistant tuberculosis.
 DT    9601
 AU    Cohn DL; Denver Disease Control Service, Denver Department of Health
       and; Hospitals, Colorado, USA.
 SO    J Hosp Infect. 1995 Jun;30 Suppl:322-8. Unique Identifier : AIDSLINE
       MED/96035361
 AB    Recent outbreaks of multi-drug-resistant tuberculosis (MDR-TB) have
       resulted in significant morbidity and mortality in patients with AIDS.
       The poor outcomes are attributable to delayed diagnoses, slow reporting
       of antimycobacterial susceptibility results, inadequate treatment
       regimens and profound immunosuppression. There are no prospective
       clinical trials which have evaluated the optimal treatment of MDR-TB. A
       retrospective study has shown that in immunocompetent patients with
       secondary MDR-TB, only 56% responded to prolonged courses of multiple
       drug regimens, and 22% died of TB. In patients with AIDS, even fewer
       patients respond, with median survivals of 2-4 months. In general,
       better responses have been associated with in vitro susceptibility of
       patients' isolates. If possible, patients with MDR-TB should receive at
       least three drugs to which their isolates are susceptible for at least
       24 months; these regimens are likely to include ethambutol,
       pyrazinamide, a quinolone, and an aminoglycoside. Selected patients
       benefit from surgical intervention combined with aggressive
       chemotherapy. MDR-TB is best prevented by directly observed therapy of
       patients with susceptible organisms and rigorous infection control
       practices in areas of high incidence of MDR-TB. Effective treatment
       regimens for MDR-TB await the development of novel compounds which have
       better in vitro activity against MDR-TB than currently available drugs.
 DE    Adolescence  Adult  Aged  Antitubercular Agents/ADMINISTRATION &
       DOSAGE/ADVERSE EFFECTS/  *THERAPEUTIC USE  AIDS-Related Opportunistic
       Infections/DRUG THERAPY  Drug Administration Schedule  Drug Therapy,
       Combination  Female  Human  Male  Middle Age  Time Factors
       Tuberculosis, Multidrug-Resistant/*DRUG THERAPY  JOURNAL ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).

