Algorithm for the use of 12-month linezolid treatments in patients with pre-XDR tuberculosis

Abstract

The research was aimed to formulate a clear algorithm for the use of short, 12-month, regimens, which consist mainly of linezolid, in patients with pre-XDR, and to develop clear inclusion/exclusion criteria and indications for the use of such on / off algorithms and indications for the use in patients with extensively drug-resistant tuberculosis (pre-XDR TB), based on the study of immediate and remote treatment results. Materials and methods. The “case-control” study included 90 patients with pre- MDR. For the treatment of patients in the main group (35 patients), 6 anti-TB drugs were administered before receiving the result of the TMC: linezolide (Lzd), levofloxacine (Lfx), caproemycine (Cm), protionamide (Pt), cycloserine (Cs), pyrazinamide (Z). In cases of resistance to Ofloxacine (Ofx) or Km/Cm, Lfx was replaced with moxifloxacine (Mfx), with the addition of high dose of isoniazide (H). Such an intensive methodology lasted for a period of 6 months, transitioning to the up-keep phase after a period of 6 months without Cm. Patients in the control group (55 patients) received individual chemotherapy of standard duration - 8 months IF AMBT and 12 months PF AMBT, without linezolid. Results. In patients with pre-MDR, who were administered 12-month shorter regimens, an increase in effective treatment by 41,6 % was found due to a reduction in the «lost of follow-up», «treatment failure» and «die» category. Relapse occurred only in 1,8 % of patients treated with the standard regimen without linzolid. Conclusions. The use of algorithms for the appointment and selection of short, 12-month, regimens of linezolide treatment can improve the outcome of «effective treatment» in patients with pre-MDR by 41,6 % compared to patients, who received standard treatment without linzolid. Key words: pre-XDR, short chemotherapy regimen, effective treatment. For citation: Feshchenko YI, Lytvynenko NA, Pohrebna MV, Senko YO, Protsyk LM, Bororova OL, Chobotar OP, Patiuk YO. algorithm for the use of 12-month linezolid treatments in patients with pre-XDR tuberculosis. Journal of the National Academy of Medical Sciences of Ukraine. 2019;25(3):278–84 The article was received on May 25, 2019 | For review, September 3, 2019 |