Experiences in anti-tuberculosis treatment in patients with multiple previous treatments and its impact on drug resistant tuberculosis epidemics.
BACKGROUND
Tuberculosis (TB) patients with a history of multiple anti-TB treatments are the 'neglected' group to the free anti-TB treatment policy in China.


OBJECTIVE
To understand the experiences of TB patients with multiple previous treatments with regard to bacteriological diagnosis and treatment regimens, especially for second-line anti-TB drugs, and how this might influence the risks of multidrug and extensively drug-resistant TB (M/XDR-TB).


DESIGN
A cross-sectional study was conducted in 10 county/district TB clinics in five provinces of China. The study participants were TB patients that had at least two previous treatment episodes that lasted longer than 1 month each. Face-to-face interviews and drug susceptibility testing (DST) were conducted with the consenting participants.


RESULTS
A total of 328 TB patients were recruited. The proportion of multidrug-resistant tuberculosis (MDR-TB) was 58.2% in the 287 DST-confirmed patients. Forty-two percent of the patients did not complete their first treatment course. About 23.8% of the participants had a history of taking second-line drugs, and more than 77.8% of them were treated in county TB dispensaries where only sputum microscopy was applied. Multivariate analysis found that the use of second-line drugs was significantly associated with frequency of previous treatments (p<0.01), but not with drug resistance profiles of patients.


CONCLUSIONS
Patients with multiple previous treatments are at extremely high risk of MDR-TB in China. The unregulated use of second-line drugs bring about the threat of XDR-TB epidemic. DST-guided treatment and strict regulations of anti-TB treatment should be assured for the high-risk TB patients for the prevention and control of M/XDR-TB.
['Xu|Biao|B|', 'Zhao|Qi|Q|', 'Hu|Yi|Y|', 'Shi|Ying|Y|', 'Wang|Weibing|W|', 'Diwan|Vinod K|VK|']
D000368:Aged D000369:Aged, 80 and over D000995:Antitubercular Agents D002681:China D003430:Cross-Sectional Studies D058872:Epidemics D054908:Extensively Drug-Resistant Tuberculosis D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D015999:Multivariate Analysis D009169:Mycobacterium tuberculosis D015995:Prevalence D012042:Registries
drug resistance tuberculosis China second-line anti-tuberculosis drugs treatment history