Isoniazid-resistant tuberculosis in Birmingham, United Kingdom, 1999-2010.

BACKGROUND There have been few studies on risk factors and treatment outcomes of isoniazid (H)-resistant tuberculosis (TB), and optimal treatment regimens are debated. AIM : To identify risk factors for H-resistant TB, describe treatment regimens and compare these to national guidelines and describe short-term outcomes of H-resistant TB in Birmingham, UK. DESIGN Retrospective case series. METHODS Cases of H-resistant tuberculosis in Birmingham between January 1999 and December 2010 (n = 89) were compared with drug-susceptible cases (n = 2497). Treatment regimens and outcomes at 12 months from diagnosis were evaluated by case note review. RESULTS No independent predictors for H-resistant TB were found. For 76/89 (85%) patients with full treatment details available, median treatment duration was 11 months (interquartile range 9-12 months). Only 27/72 (38%) patients with H-monoresistance were treated in line with national guidelines. A further 14/72 (19%) were treated according to other recognized guidelines. Overall treatment success was 75/89 (84%). Treatment failure occurred in 6/89 (7%) patients, all developed multi-drug resistance. Poor adherence was documented in these patients and use of a non-standard regimen in one patient was not thought to have contributed to treatment failure. CONCLUSIONS No discriminating risk factors for early detection of H-resistant TB were found. Treatment regimens in clinical practice were highly varied. H-resistance can drive MDR-TB when there is evidence or suspicion of poor adherence. A low threshold for enhanced case management with directly observed therapy is warranted in this group.

[1]  D. Mitchison,et al.  Influence of initial drug resistance on the response to short-course chemotherapy of pulmonary tuberculosis. , 2015, The American review of respiratory disease.

[2]  G. Smith,et al.  Whole-genome sequencing for rapid susceptibility testing of M. tuberculosis. , 2013, The New England journal of medicine.

[3]  T. Cohen,et al.  Outcomes among tuberculosis patients with isoniazid resistance in Georgia, 2007-2009. , 2012, The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease.

[4]  A. Orcau,et al.  Control of tuberculosis in large cities in developed countries: an organizational problem , 2011, BMC medicine.

[5]  C. Liao,et al.  Isoniazid-Resistant Tuberculosis, Taiwan, 2000–2010 , 2011, Emerging infectious diseases.

[6]  T. Victor,et al.  Treatment outcomes of isoniazid-resistant tuberculosis patients, Western Cape Province, South Africa. , 2011, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[7]  A. Charlett,et al.  Large outbreak of isoniazid-monoresistant tuberculosis in London, 1995 to 2006: case-control study and recommendations. , 2011, Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin.

[8]  E. Wileyto,et al.  Isoniazid-Resistant Tuberculous Meningitis, United States, 1993–2005 , 2011, Emerging infectious diseases.

[9]  V. Thomsen,et al.  Isoniazid-resistant tuberculosis in Denmark: mutations, transmission and treatment outcome. , 2010, The Journal of infection.

[10]  A. Benedetti,et al.  Standardized Treatment of Active Tuberculosis in Patients with Previous Treatment and/or with Mono-resistance to Isoniazid: A Systematic Review and Meta-analysis , 2009, PLoS medicine.

[11]  Raymund B. Dantes,et al.  Clinical characteristics and treatment outcomes of patients with isoniazid-monoresistant tuberculosis. , 2009, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[12]  J. Kammerer,et al.  Isoniazid-monoresistant tuberculosis in the United States, 1993 to 2003. , 2008, Archives of internal medicine.

[13]  Hojoong Kim,et al.  Treatment of isoniazid-resistant pulmonary tuberculosis , 2008, BMC infectious diseases.

[14]  S. Rüsch-Gerdes,et al.  Antimicrobial susceptibility testing of Mycobacterium tuberculosis (EUCAST document E.DEF 8.1)--report of the Subcommittee on Antimicrobial Susceptibility Testing of Mycobacterium tuberculosis of the European Committee for Antimicrobial Susceptibility Testing (EUCAST) of the European Society of Clin , 2007, Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases.

[15]  S.W.B. Newsom,et al.  Tuberculosis. Clinical diagnosis and management of tuberculosis and measures for its prevention and control , 2006 .

[16]  J. Musser,et al.  Treatment of isoniazid-resistant tuberculosis in southeastern Texas. , 2001, Chest.

[17]  D. Mitchison.  Assessment of new sterilizing drugs for treating pulmonary tuberculosis by culture at 2 months. , 1993, The American review of respiratory disease.

[18]  J. Darbyshire,et al.  Controlled clinical trial of a regimen of two durations for the treatment of isoniazid resistant pulmonary tuberculosis. , 1988, Tubercle.

[19]  L. Praloran.  [Classification of pulmonary tuberculosis]. , 1953, Minerva medica.

[20]  M. Pallen,et al.  Whole-Genome Sequencing for Rapid Susceptibility Testing of M. tuberculosis , 2013 .

[21]  M. Kruijshaar,et al.  Tuberculosis in the UK: Annual report on tuberculosis surveillance in the UK, 2009. , 2009 .

[22]  A. Dhar,et al.  National Institute for Health and Clinical Excellence , 2005 .

[23]  L. P. Ormerod,et al.  Can a nine-month regimen be used to treat isoniazid resistant tuberculosis diagnosed after standard treatment is started? , 2001, The Journal of infection.

[24]  B. Graovac.  [Classification of pulmonary tuberculosis]. , 1956, Tuberkuloza.