Table 1.
Association of Clinical Characteristics and Outcomes With Injectable Agents Given (Simple Pooling)
| Characteristic | No Injectable | Streptomycin | Amikacin | Kanamycin | Capreomycin | ≥ 2 Injectables | ||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Clinical characteristics | ||||||||||||
| No. in analysis | 613 | … | 1554 | … | 2275 | … | 4330 | … | 2401 | … | 857 | … |
| Mean age, y | 41.3 | … | 41.2 | … | 37.9 | … | 37.1 | … | 38.1 | … | 38.0 | … |
| Male sex | 361 | (59%) | 1079 | (69%) | 1320 | (58%) | 2700 | (62%) | 1571 | (65%) | 555 | (65%) |
| HIV positive | 86 | (16%) | 92 | (8%) | 509 | (23%) | 519 | (16%) | 471 | (21%) | 156 | (22%) |
| AFB smear positive | 366 | (62%) | 1172 | (79%) | 1779 | (80%) | 1346 | (80%) | 1346 | (70%) | 670 | (79%) |
| CXR cavitary | 264 | (54%) | 948 | (63%) | 1300 | (65%) | 1364 | (59%) | 986 | (63%) | 493 | (64%) |
| Prior treatment with first-line drugsa | 383 | (68%) | 625 | (75%) | 1335 | (80%) | 3508 | (83%) | 1717 | (73%) | 650 | (77%) |
| Prior treatment with second-line drugsb | 157 | (35%) | 97 | (15%) | 151 | (10%) | 351 | (12%) | 734 | (34%) | 128 | (17%) |
| DST results | ||||||||||||
| Fluoroquinolone resistance on DST | 193 | (36%) | 123 | (18%) | 320 | (26%) | 400 | (11%) | 952 | (42%) | 176 | (24%) |
| Streptomycin resistance | 398 | (72%) | 131 | (9%) | 1340 | (68%) | 2618 | (63%) | 1760 | (93%) | 467 | (62%) |
| Amikacin/kanamycin resistance | 238 | (45%) | 118 | (16%) | 153 | (12%) | 231 | (6%) | 1302 | (58%) | 192 | (26%) |
| Capreomycin resistance | 146 | (34%) | 73 | (13%) | 100 | (11%) | 120 | (7%) | 322 | (19%) | 122 | (20%) |
| Any second-line injectable resistance | 248 | (46%) | 124 | (17%) | 181 | (15%) | 265 | (7%) | 1314 | (57%) | 202 | (27%) |
| XDR-TBc | 135 | (26%) | 65 | (10%) | 81 | (7%) | 103 | (3%) | 795 | (35%) | 102 | (14%) |
| Average number of pyrazinamide + ethambutol resistance | 1.1 | … | 0.7 | … | 1.1 | … | 1.2 | … | 1.4 | … | 1.2 | … |
| Average number of WHO group 4 drugs resistantd | 0.8 | … | 0.5 | … | 0.5 | … | 0.5 | … | 0.6 | … | 0.6 | … |
| Treatment given | ||||||||||||
| Later-generation fluoroquinolone givene | 445 | (73%) | 1293 | (83%) | 1461 | (64%) | 1705 | (39%) | 1431 | (60%) | 444 | (52%) |
| Capreomycin given | 0 | … | 0 | … | 0 | … | 0 | … | 2401 | (100%) | 525 | (61%) |
| Linezolid given | 205 | (33%) | 40 | (3%) | 287 | (13%) | 131 | (3%) | 277 | (12%) | 71 | (8%) |
| Average number of WHO group 4 drugs givend | 1.7 | … | 1.5 | … | 1.5 | … | 2.1 | … | 2.4 | … | 2.3 | … |
| Average number of WHO group 5 drugs givenf | 0.9 | … | 0.2 | … | 0.4 | … | 0.1 | … | 0.8 | … | 0.5 | … |
| Average number of possibly effective drugsg | 3.0 | … | 3.2 | … | 3.2 | … | 3.7 | … | 3.4 | … | 3.8 | … |
| Outcomes | ||||||||||||
| Success | 406 | (66%) | 1079 | (69%) | 1531 | (67%) | 2675 | (62%) | 1175 | (49%) | 480 | (56%) |
| Fail/relapse | 49 | (8%) | 76 | (5%) | 115 | (5%) | 415 | (10%) | 251 | (10%) | 111 | (13%) |
| Died | 78 | (13%) | 130 | (8%) | 301 | (13%) | 528 | (12%) | 547 | (23%) | 145 | (17%) |
| Lost | 80 | (13%) | 269 | (17%) | 328 | (15%) | 712 | (16%) | 428 | (18%) | 121 | (14%) |
Data are presented as no. (%).
Abbreviations: AFB, acid-fast bacilli; CXR, chest radiograph; DST, drug susceptibility testing; HIV, human immunodeficiency virus; TB, tuberculosis; WHO, World Health Organization; XDR, extensively drug-resistant.
aFirst-line drugs: isoniazid, rifampicin, pyrazinamide, ethambutol, and streptomycin.
bSecond-line drugs: fluoroquinolones, amikacin, kanamycin, capreomycin, ethionamide/prothionamide, cycloserine/terizidone, and para-aminosalicylic acid.
cXDR-TB defined as multidrug-resistant TB with additional resistance to a fluoroquinolone and a second-line injectable drug.
dWHO group 4 drugs: ethionamide, prothionamide, cycloserine, terizidone, and para-aminosalicylic acid.
eLater-generation fluoroquinolones: levofloxacin, moxifloxacin, and gatifloxacin.
fWHO group 5 drugs: amoxicillin/clavulanic acid, monobactams, and macrolides.
gPossibly effective drugs: all drugs with susceptibility testing results showing susceptibility or as defined in the Methods when test results not available, plus linezolid, clofazimine, bedaquiline, and delamanid.