Successful '9-month Bangladesh regimen' for multidrug-resistant tuberculosis among over 500 consecutive patients

Int J Tuberc Lung Dis. 2014 Oct;18(10):1180-7. doi: 10.5588/ijtld.14.0100.


Setting: Tuberculosis (TB) program, Damien Foundation Projects, Bangladesh.

Objective: To summarize the outcome and its determinants of the first treatment for multidrug-resistant TB using a standardized regimen consisting of a minimum 9 months.

Design: This was a prospective, observational study of a gatifloxacin (GFX) based directly observed regimen, mainly with initial hospitalization. The 4-month intensive phase was extended until sputum smear conversion. Patients were monitored using culture for up to 2 years after treatment completion.

Results: Of the 515 patients who met the study inclusion criteria and were successively enrolled from 2005 to 2011, 84.4% had a bacteriologically favorable outcome. Due to extensive disease with delayed sputum conversion, only half of the patients completed treatment within 9 months; however, 95% were able to complete treatment within 12 months. Eleven patients failed or relapsed, and 93.1% of the 435 patients who were successfully treated completed at least 12 months post-treatment follow-up. The strongest risk factor for a bacteriologically unfavorable outcome was high-level fluoroquinolone (FQ) resistance, particularly when compounded by initial pyrazinamide (PZA) resistance. Low-level FQ resistance had no unfavorable effect on treatment outcome. Amplification of drug resistance occurred only once, in a patient strain that was initially only susceptible to kanamycin and clofazimine.

Conclusion: The excellent outcome of the Bangladesh regimen was largely maintained. Bacteriological treatment failures and relapses were rare, except among patients with high-level GFX resistance, notably in the presence of PZA resistance.

Publication types

  • Observational Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Anti-Bacterial Agents / therapeutic use*
  • Bangladesh
  • Child
  • Clofazimine / therapeutic use
  • Dose-Response Relationship, Drug
  • Drug Resistance, Multiple, Bacterial
  • Female
  • Fluoroquinolones / therapeutic use*
  • Follow-Up Studies
  • Gatifloxacin
  • Humans
  • Kanamycin / therapeutic use
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Mycobacterium tuberculosis / drug effects
  • Prospective Studies
  • Pyrazinamide / therapeutic use
  • Risk Factors
  • Sputum / microbiology
  • Treatment Outcome
  • Tuberculosis, Multidrug-Resistant / drug therapy*
  • Young Adult


  • Anti-Bacterial Agents
  • Fluoroquinolones
  • Pyrazinamide
  • Kanamycin
  • Clofazimine
  • Gatifloxacin