Universidad Peruana Cayetano Heredia
Treatment outcomes for isoniazid-monoresistant tuberculosis in Peru, 2012-2014
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| dc.contributor.author | Cornejo Garcia, Jose Gabriel | |
| dc.contributor.author | Alarcón Guizado, Valentina Antonieta | |
| dc.contributor.author | Mendoza Ticona, Alberto | |
| dc.contributor.author | Alarcon, Edith | |
| dc.contributor.author | Heldal, Einar | |
| dc.contributor.author | Moore, David Alexander James | |
| dc.date.accessioned | 2019-03-05T15:23:30Z | |
| dc.date.available | 2019-03-05T15:23:30Z | |
| dc.date.issued | 2018 | |
| dc.identifier.uri | https://hdl.handle.net/20.500.12866/5896 | |
| dc.description.abstract | Background: Resistance to isoniazid is the most common form of drug-resistance in tuberculosis. However only a tiny proportion of TB patients in the world have access to isoniazid drug susceptibility testing—the widely implemented Xpert MTB/RIF technology only tests for resistance to rifampicin. Patients with isoniazid mono resistance that is not identified at baseline are treated with a standard regimen that effectively results in rifampicin mono-therapy during the latter four months of the six month treatment course, exposing remaining viable organisms to a single agent and greatly increasing the risk of development of multi drug-resistant TB. Unusually, Peru has pioneered universal pre-treatment drug susceptibility testing with methods that identify isoniazid resistance and has thus identified a large number of individuals requiring tailored therapy. Since 2010, treatment in Peru for isoniazid-resistant tuberculosis without multidrug-resistant tuberculosis (Hr-TB) has been with a standardized nine-month regimen of levofloxacin, rifampicin, ethambutol and pyrazinamide. The objectives of this study were to evaluate the outcomes of treatment for patients with Hr-TB initiating treatment with this regimen between January 2012 and December 2014 and to determine factors affecting these outcomes. Methods: Retrospective cross-sectional study; case data were obtained from the national registry of drug-resistant tuberculosis. Patients diagnosed with isoniazid resistant TB without resistance to rifampicin, pyrazinamide, ethambutol and quinolones as determined by either a rapid drug susceptibility testing (DST) (nitrate reductase test, MODS, Genotype MTBDRplus) or by the proportion method were included. Findings: A total of 947 cases were evaluated (a further 403 without treatment end date were excluded), with treatment success in 77.2% (731 cases), loss to follow-up in 19.7% (186 cases), treatment failure in 1.2% (12 cases), and death in 1.9% (18 cases). Unfavorable outcomes were associated in multivariate analysis with male gender (OR 0.50, 95% CI 0.34–0.72, p<0.05), lack of rapid DST (OR 0.67, 95% CI 0.50–0.91, p = 0.01), additional use of an injectable second-line anti-tuberculous drug (OR 0.46, 95% CI 0.31–0.70, p<0.05), and treatment initiation in 2014 (OR 0.77, 95% CI 0.62–0.94, p = 0.01). Interpretation: The treatment regimen implemented in Peru for isoniazid resistant TB is effective for TB cure and is not improved by addition of an injectable second-line agent. Access to rapid DST and treatment adherence need to be strengthened to increase favorable results. | en_US |
| dc.language.iso | eng | |
| dc.publisher | Public Library of Science | |
| dc.relation.ispartofseries | PLoS ONE | |
| dc.rights | info:eu-repo/semantics/restrictedAccess | |
| dc.rights.uri | https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es | |
| dc.subject | adolescent | en_US |
| dc.subject | adult | en_US |
| dc.subject | aged | en_US |
| dc.subject | antibiotic resistance | en_US |
| dc.subject | antibiotic sensitivity | en_US |
| dc.subject | Article | en_US |
| dc.subject | child | en_US |
| dc.subject | cohort analysis | en_US |
| dc.subject | controlled study | en_US |
| dc.subject | cross-sectional study | en_US |
| dc.subject | death | en_US |
| dc.subject | drug resistant tuberculosis | en_US |
| dc.subject | ethambutol | en_US |
| dc.subject | female | en_US |
| dc.subject | follow up | en_US |
| dc.subject | human | en_US |
| dc.subject | infant | en_US |
| dc.subject | infection risk | en_US |
| dc.subject | isoniazid | en_US |
| dc.subject | lack of drug effect | en_US |
| dc.subject | levofloxacin | en_US |
| dc.subject | major clinical study | en_US |
| dc.subject | male | en_US |
| dc.subject | middle aged | en_US |
| dc.subject | monotherapy | en_US |
| dc.subject | Peru | en_US |
| dc.subject | pyrazinamide | en_US |
| dc.subject | retrospective study | en_US |
| dc.subject | rifampicin | en_US |
| dc.subject | treatment duration | en_US |
| dc.subject | treatment outcome | en_US |
| dc.subject | tuberculostatic agent | en_US |
| dc.subject | young adult | en_US |
| dc.title | Treatment outcomes for isoniazid-monoresistant tuberculosis in Peru, 2012-2014 | en_US |
| dc.type | info:eu-repo/semantics/article | |
| dc.identifier.doi | https://doi.org/10.1371/journal.pone.0206658 | |
| dc.subject.ocde | https://purl.org/pe-repo/ocde/ford#3.01.05 | |
| dc.subject.ocde | https://purl.org/pe-repo/ocde/ford#3.02.07 | |
| dc.relation.issn | 1932-6203 |
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