Ambulatory-Based Standardized Therapy for Multi-Drug Resistant Tuberculosis Experience from Nepal, 2005–2006 英文参考文献.docVIP

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Ambulatory-Based Standardized Therapy for Multi-Drug Resistant Tuberculosis Experience from Nepal, 2005–2006 英文参考文献.doc

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Ambulatory-Based Standardized Therapy for Multi-Drug Resistant Tuberculosis Experience from Nepal, 2005–2006 英文参考文献

Ambulatory-BasedStandardizedTherapyforMulti-Drug ResistantTuberculosis:ExperiencefromNepal, 2005–2006 PushpaMalla1,ElisabethEvaKanitz2,MohammadAkhtar3,DennisFalzon2,KnutFeldmann4 ,Christian Gunneberg2,ShyamSundarJha1,BhagwanMaharjan5,MohanKumarPrasai6,BhabanaShrestha5, SharatChandraVerma1,MatteoZignol2* 1National Tuberculosis Centre (NTC), Ministry of Health and Population, Kathmandu, Nepal, 2World Health Organization, Geneva, Switzerland, 3World Health Organization,CountryOffice,Kathmandu,Nepal,4KuratoriumTuberkuloseinderWelt,Gauting,Germany,5GermanNepalTuberculosisProject(GENTUP),Kathmandu, Nepal,6RegionalTuberculosisCenter,Pokhara,Nepal Abstract Objective: The aim of this study was to describe treatment outcomes for multi-drug resistant tuberculosis (MDR-TB) outpatientsonastandardizedregimeninNepal. Methodology: Data on pulmonary MDR-TB patients enrolled for treatment in the Green Light Committee-approved NationalProgrammebetween15September2005and15September2006werestudied.Standardizedregimenwasused (8Z-Km-Ofx-Eto-Cs/16Z-Ofx-Eto-Cs) for a maximum of 32 months and follow-up was by smear and culture. Drug susceptibility testing (DST) results were not used to modify the treatment regimen. MDR-TB therapy was delivered in outpatientfacilitiesforthewholecourseoftreatment.Multivariableanalysiswasusedtoexplainbacteriologicalcureasa functionofsex,age,initialbodyweight,historyofprevioustreatmentandtheregionofreport. Principal Findings: In thefirst 12-months,175 laboratory-confirmed MDR-TB cases (62% males) hadoutcomes reported. MostcaseshadfailedaCategory2first-lineregimen(87%)oraCategory1regimen(6%),2%werepreviouslyuntreated contactsofMDR-TBcasesand5%wereunspecified.Curewasreportedamong70%ofpatients(range38%–93%byRegion), 8%died,5%failedtreatment,and17%defaulted.Unfavorableoutcomeswerenotcorrelatedtothenumberofresistant drugsatbaselineDST.Caseswhodiedhadalowermeanbodyweightthanthosesurviving(40.3kgvs47.2kg,p,0.05). Default was significantly higher in two regions [Easter