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Treatment outcomes among patients with extensively drug-resistant tuberculosis: systematic review and meta-analysis Jacobson KR; Tierney DB; Jeon CY; Mitnick CD; Murray MBClin Infect Dis 2010[Jul]; 51 (1): 6-14BACKGROUND: . The treatment of extensively drug-resistant tuberculosis (XDR TB) presents a major challenge. Second-line antimycobacterial drugs are less effective, more toxic, and more costly than first-line agents, and XDR TB strains are, by definition, resistant to the most potent second-line options: the injectable agents and fluoroquinolones. We conducted a meta-analysis to assess XDR TB treatment outcomes and to identify therapeutic approaches associated with favorable responses. METHODS: We searched PubMed and EMBASE databases to identify studies conducted through May 2009 that report XDR TB treatment outcomes. RESULTS: The search yielded 13 observational studies covering 560 patients, of whom 43.7% (95% confidence interval, 32.8%-54.5%) experienced favorable outcomes, defined as either cure or treatment completion, and 20.8% (95% confidence interval, 14.2%-27.3%) died. Random effects meta-analysis and meta-regression showed that studies in which a higher proportion of patients received a later-generation fluoroquinolone reported a higher proportion of favorable treatment outcomes (P=.012). CONCLUSIONS: This meta-analysis provides the first empirical evidence that the use of later-generation fluoroquinolones for the treatment of XDR TB significantly improves treatment outcomes, even though drug-susceptibility testing demonstrates resistance to a representative fluoroquinolone. These results suggest that the addition of later-generation fluoroquinolones to XDR TB regimens may improve treatment outcomes and should be systematically evaluated in well-designed clinical studies.|Antitubercular Agents/*therapeutic use[MESH]|Drug Therapy, Combination[MESH]|Empirical Research[MESH]|Extensively Drug-Resistant Tuberculosis/*drug therapy[MESH]|Fluoroquinolones/*therapeutic use[MESH]|Humans[MESH]|Mycobacterium tuberculosis/drug effects[MESH]|Treatment Outcome[MESH] |
