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Isoniazid-resistant tuberculosis in Birmingham, United Kingdom, 1999-2010.

Munang, M L and Kariuki, M and Dedicoat, Martin (2015) Isoniazid-resistant tuberculosis in Birmingham, United Kingdom, 1999-2010. QJM : monthly journal of the Association of Physicians, 108 (1). pp. 19-25. ISSN 1460-2393. This article is accessible to all HEFT staff and students via NICE journals and databases http://www.nice.org.uk/about/what-we-do/evidence-services/journals-and-databases by using their HEFT Athens login IDs

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Official URL: http://qjmed.oxfordjournals.org/content/108/1/19.l...

Abstract

BACKGROUND

There have been few studies on risk factors and treatment outcomes of isoniazid (H)-resistant tuberculosis (TB), and optimal treatment regimens are debated.

AIM

: To identify risk factors for H-resistant TB, describe treatment regimens and compare these to national guidelines and describe short-term outcomes of H-resistant TB in Birmingham, UK.

DESIGN

Retrospective case series.

METHODS

Cases of H-resistant tuberculosis in Birmingham between January 1999 and December 2010 (n = 89) were compared with drug-susceptible cases (n = 2497). Treatment regimens and outcomes at 12 months from diagnosis were evaluated by case note review.

RESULTS

No independent predictors for H-resistant TB were found. For 76/89 (85%) patients with full treatment details available, median treatment duration was 11 months (interquartile range 9-12 months). Only 27/72 (38%) patients with H-monoresistance were treated in line with national guidelines. A further 14/72 (19%) were treated according to other recognized guidelines. Overall treatment success was 75/89 (84%). Treatment failure occurred in 6/89 (7%) patients, all developed multi-drug resistance. Poor adherence was documented in these patients and use of a non-standard regimen in one patient was not thought to have contributed to treatment failure.

CONCLUSIONS

No discriminating risk factors for early detection of H-resistant TB were found. Treatment regimens in clinical practice were highly varied. H-resistance can drive MDR-TB when there is evidence or suspicion of poor adherence. A low threshold for enhanced case management with directly observed therapy is warranted in this group.

Item Type: Article
Additional Information: This article is accessible to all HEFT staff and students via NICE journals and databases http://www.nice.org.uk/about/what-we-do/evidence-services/journals-and-databases by using their HEFT Athens login IDs
Subjects: WC Communicabable diseases
Divisions: Clinical Support > Infectious Diseases
Related URLs:
Depositing User: Mrs Caroline Tranter
Date Deposited: 31 May 2015 07:21
Last Modified: 31 May 2015 07:21
URI: http://www.repository.heartofengland.nhs.uk/id/eprint/941

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