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Journal Article
|Research

Impact of pyrazinamide resistance on multidrug-resistant tuberculosis in Karakalpakstan, Uzbekistan

Kuhlin J, Smith C, Khaemraev A, Tigay Z, Parpieva N, Tillyashaykhov M, Achar J, Hajek J, Greig J, du Cros PAK, Moore DAJ
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Impact of pyrazinamide resistance on multidrug-resistant tuberculosis in Karakalpakstan, Uzbekistan | Journal Article / Research | MSF Science Portal
Abstract
SETTING
The World Health Organization (WHO) recommends the inclusion of pyrazinamide (PZA) in treatment regimens for multidrug-resistant tuberculosis (MDR-TB) unless resistance has been confirmed.

OBJECTIVE
To investigate the association between PZA susceptibility and MDR-TB treatment outcome among patients treated with a PZA-containing regimen and whether the duration of the intensive phase of the PZA-containing regimen affected treatment outcome.

DESIGN
We conducted a retrospective cohort study including all eligible MDR-TB patients starting treatment in 2003-2013 in the TB programme in Karakalpakstan, Uzbekistan. PZA drug susceptibility testing (DST) using liquid culture was performed, and outcomes were classified according to the WHO 2013 definitions.

RESULTS
Of 2446 MDR-TB patients included, 832 (34.0%) had an available baseline PZA DST result, 612 (73.6%) of whom were PZA-resistant. We found no association between treatment success and PZA susceptibility (adjusted odds ratio [aOR] 0.86, 95%CI 0.51-1.44, P = 0.6) in patients treated with PZA. Furthermore, among patients with no baseline PZA DST result, no evidence was seen of an association between treatment success and PZA treatment duration (aOR 0.86, 95%CI 0.49-1.51, P = 0.6).

CONCLUSION
Treatment of MDR-TB with a standard PZA regimen does not appear to improve treatment outcomes, regardless of PZA susceptibility or duration of treatment.

Countries

Uzbekistan

Subject Area

antibiotic resistancetuberculosisantimicrobial resistance

Languages

English
DOI
10.5588/ijtld.17.0483
Published Date
01 May 2018
PubMed ID
29663960
Journal
International Journal of Tuberculosis and Lung Disease
Volume | Issue | Pages
Volume 22, Issue 5, Pages 544-550
Issue Date
2018-05-01
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