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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
Full text not available from this repository.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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