Bedaquiline in the treatment of multidrug- and extensively drug-resistant tuberculosis in China

Drug recommendation for optimization on treatment outcome for MDR/RR-TB based on a multi-center, large scale, retrospective cohort study in China

OBJECTIVE

With the change in drug-resistant pattern, MDR/RR-TB was faced with underlying changes in regimens. A multi-center, large-scale, retrospective study performed aims to provide a recommendation of drug selection on optimization of outcome for the patients.

METHOD

The study was conducted in six TB-specialized hospitals in China. Patients were included from 2018-2021 and followed up throughout the treatment. Using a multivarariable and propensity score-matched logistic regression analysis, we evaluated associations between outcomes and drug use, as well as clinical characteritics.

RESULTS

Of 3112 patients, 74.29% had treatment sucess, 14.52% lost to follow-up, 9.67% failure, and 1.51% died. Treatment success was positively associated with Bedaquiline(Bdq), Linezolid(Lzd), and Cycloserin(Cs). Capreomycin(Cm) increased the risk of unfavorable outcomes. other drugs such as Amikacin(Amk) and clofazimine had no significant effect on outcomes. If isolates were susceptible to fluoroquinolones(FQs), FQs could decrease the risk of unfavorable outcomes.

CONCLUSIONS

The recommendation order for the treatment of MDR/RR-TB is Bdq, Lzd, and Cs. FQs were decreased in use intensity. Injection drugs, whether Amk or Cm, are not recommended.

Analysis of efficacy and safety of linezolid-based chemotherapeutic regimens for postoperative multidrug-resistant spinal tuberculosis patients

OBJECTIVES

The study aimed to explore the efficacy and safety of linezolid-based chemotherapeutic regimens for postoperative multidrug-resistant spinal tuberculosis patients.

METHODS

The randomized controlled study included 50 Mycobacterium tuberculosis culture or pathological confirmed multidrug resistant tuberculosis patients who received spinal surgery from January 2018 to February 2020. Twenty-five patients were assigned to the control group and the study group, respectively. Random number method was used for patients allocation and they were treated with levofloxacin, pyrazinamide, thiisonicotinamide enteric-coated tablet, amikacin sulfate injection, and sodium p-amino salicylate injection, accompanied linezolid or not.

RESULTS

The overall effective rate of the study group was higher than that of the control group (88.00% vs. 64.00%, P<0.05). The severity of pain at 3 and 6 months postoperatively was lower in the study group than that the control group (P<0.05). Postoperatively, the study group had higher bone graft fusion rate, shorter mean bone graft fusion time and higher paraspinal cyst absorption rate than the control group (P<0.05). Postoperatively, the study group had lower levels of PCT, ESR and CRP than the control group (P<0.05). All patients had normal hepatic and renal function, and no statistical difference of adverse effects between 2 groups were found.

CONCLUSIONS

Linezolid-based chemotherapeutic regimens can effectively treat postoperative multidrug-resistant spinal tuberculosis patients, but have higher rates of adverse reactions.