Applicability of the shorter 'Bangladesh regimen' in high multidrug-resistant tuberculosis settings

Int J Infect Dis. 2017 Mar;56:190-193. doi: 10.1016/j.ijid.2016.10.021. Epub 2016 Nov 2.

Abstract

In spite of the recent introduction of two new drugs (delamanid and bedaquiline) and a few repurposed compounds to treat multidrug-resistant and extensively drug-resistant tuberculosis (MDR- and XDR-TB), clinicians are facing increasing problems in designing effective regimens in severe cases. Recently a 9 to 12-month regimen (known as the 'Bangladesh regimen') proved to be effective in treating MDR-TB cases. It included an initial phase of 4 to 6 months of kanamycin, moxifloxacin, prothionamide, clofazimine, pyrazinamide, high-dose isoniazid, and ethambutol, followed by 5 months of moxifloxacin, clofazimine, pyrazinamide, and ethambutol. However, recent evidence from Europe and Latin America identified prevalences of resistance to the first-line drugs in this regimen (ethambutol and pyrazinamide) exceeding 60%, and of prothionamide exceeding 50%. Furthermore, the proportions of resistance to the two most important pillars of the regimen - quinolones and kanamycin - were higher than 40%. Overall, only 14 out of 348 adult patients (4.0%) were susceptible to all of the drugs composing the regimen, and were therefore potentially suitable for the 'shorter regimen'. A shorter, cheaper, and well-tolerated MDR-TB regimen is likely to impact the number of patients treated and improve adherence if prescribed to the right patients through the systematic use of rapid MTBDRsl testing.

Keywords: Efficacy; Impact; MDR-TB; Shorter regimen; Treatment duration; XDR-TB.

MeSH terms

  • Antitubercular Agents / therapeutic use*
  • Clinical Protocols*
  • Diarylquinolines
  • Drug Therapy, Combination
  • Ethambutol / pharmacology
  • Fluoroquinolones
  • Humans
  • Isoniazid / pharmacology
  • Moxifloxacin
  • Mycobacterium tuberculosis / drug effects
  • Nitroimidazoles
  • Oxazoles
  • Pyrazinamide / therapeutic use
  • Tuberculosis, Multidrug-Resistant / drug therapy*
  • World Health Organization*

Substances

  • Antitubercular Agents
  • Diarylquinolines
  • Fluoroquinolones
  • Nitroimidazoles
  • OPC-67683
  • Oxazoles
  • Pyrazinamide
  • bedaquiline
  • Ethambutol
  • Moxifloxacin
  • Isoniazid