Table 5.
Association of treatment success with individual drugs used in treatment by MDR-TB patient group
| MDR-TB susceptible to FQ & INJ (“MDR-TB only”) | MDR-TB+INJr | MDR-TB+FQr | XDR-TB | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| N | aOR | (95%CI) | N | aOR | (95%CI) | N | aOR | (95%CI) | N | aOR | (95%CI) | |
| First-line drugs: | ||||||||||||
| Pyrazinamide | 2480 | 1.3 | (0.8, 2.0) | 474 | 1.2 | (0.8, 1.8) | 171 | 0.8 | (0.4, 1.5) | 174 | 1.1 | (0.6, 2.0) |
| Ethambutol | 1794 | 0.7 | (0.5, 0.9) | 271 | 0.8 | (0.6, 1.2) | 94 | 0.7 | (0.4, 1.3) | 93 | 1.8 | (0.9, 3.5) |
| Injectable drugs: (patients receiving 2 or more injectable drugs excluded from this analysis) | ||||||||||||
| Amikacin or Kanamycin | 2250 | 153 | 135 | 85 | ||||||||
| vs no injectable drug | 1.9 | (1.1, 3.1) | 2.0 | (0.7, 5.4) | 0.8 | (0.1, 5.6) | 2.0 | (0.5, 8.7) | ||||
| vs Capreomycin | 1.1 | (0.6, 1.9) | 1.8 | (0.9, 3.6) | 1.1 | (0.2, 5.9) | 1.2 | (0.3, 5.3) | ||||
| vs Streptomycin | 1.4 | (0.9, 2.3) | 2.4 | (1.1, 5.0) | 1.1 | (0.3, 4.3) | 1.7 | (0.3, 7.9) | ||||
| Capreomycin only | 204 | 435 | 34 | 109 | ||||||||
| vs no injectable drug | 2.2 | (1.1, 4.2) | 0.9 | (0.2, 4.1) | - | - | 2.5 | (0.9, 7.0) | ||||
| vs Streptomycin | 1.4 | (0.6, 3.3) | 0.8 | (0.2, 3.9) | - | - | 1.4 | (0.1, 14) | ||||
| Fluoroquinolones: (patients receiving 2 or more fluoroquinolones excluded from this analysis. Insufficient number of patients received later- generation fluoroquinolones within the MDR-TB patient groups with additional resistance – so not analysed) | ||||||||||||
| Ofloxacin | 2956 | 787 | 197 | 227 | ||||||||
| vs no fluoroquinolone | 2.9 | (1.7, 4.9) | 2.8 | (0.9, 8.6) | 1.1 | (0.5, 2.4) | 0.7 | (0.3, 1.6) | ||||
| vs ciprofloxacin | 1.2 | (0.5, 3.2) | 1.8 | (0.1, 23) | 1.0 | (0.1, 19) | 0.2 | (0.1, 3.6) | ||||
| Group 4 Drugs | ||||||||||||
| Ethionamide or prothionamide | 2973 | 2.2 | (1.5, 3.2) | 689 | 1.6 | (1.0, 2.4) | 258 | 0.8 | (0.4, 1.7) | 253 | 1.0 | (0.5, 2.1) |
| Cycloserine or terizidone | 2007 | 1.8 | (1.4, 2.2) | 822 | 1.7 | (0.8, 3.9) | 292 | 0.9 | (0.3, 3.0) | 284 | 1.3 | (0.5, 3.6) |
| p-aminosalicylic acid (PAS) | 1396 | 1.0 | (0.8, 1.3) | 614 | 1.1 | (0.7, 1.6) | 219 | 1.1 | (0.6, 2.3) | 228 | 1.3 | (0.6, 3.1) |
| Group 5 Drugs (Insufficient number of patients received specific Group 5 drugs within the MDR-TB patient groups with additional resistance so outcomes by individual Group 5 drugs not analysed) | ||||||||||||
| Any one Group 5 drug vs none | 561 | 0.8 | (0.6, 1.2) | 323 | 0.9 | (0.5, 1.6) | 84 | 0.6 | (0.3, 1.4) | 95 | 1.1 | (0.4, 2.9) |
| Two or more Group 5 drugs vs one Group 5 | 135 | 0.5 | (0.2, 0.9) | 111 | 0.6 | (0.3, 1.5) | 55 | 0.8 | (0.3, 1.8) | 58 | 1.2 | (0.5, 3.3) |
MDR-TB = resistance to at least isoniazid and rifampicin
XDR-TB = MDR-TB plus resistance to any fluoroquinolone and any second-line injectable drug (amikacin/kanamycin and/or capreomycin)
MDR-TB+FQr = MDR-TB plus resistance to any fluoroquinolone, but susceptible to amikacin/kanamycin and/or capreomycin (at least one second-line injectable drug tested)
MDR-TB+INJr = MDR-TB plus resistance to amikacin/kanamycin and/or capreomycin, but susceptible to fluoroquinolones
MDR-TB, susceptible to FQ & INJ = MDR-TB, but susceptible to fluoroquinolones, amikacin/kanamycin and capreomycin (at least one second-line injectable drug tested)
N = number of cases that received the drug in question and were included in the specific analysis.
aOR (adjusted odds ratios): odds ratios of treatment success (cure and completion) versus treatment failure/relapse/death adjusted for age, sex, HIV infection, previous TB treatment, previous MDR treatment (treatment for more than 1 month with two or more second-line drugs), and extent of disease. If there were <50 observations no estimate was derived. See Methods and Laserson et al (2005) for treatment outcome definitions.
CI = confidence intervals
Later-generation fluoroquinolone = gatifloxacin, levofloxacin, moxifloxacin, sparfloxacin
Group 5 drugs included amoxicillin/clavulanate, macrolides (azithromycin, clarithromycin, roxithromycin), clofazimine, thiacetazone, imipenem, linezolid, high-dose isoniazid and thioridazine.