Romanowski Kamila, Chiang Leslie Y, Roth David Z, Krajden Mel, Tang Patrick, Cook Victoria J, Johnston James C
Provincial Tuberculosis Services, BC Centre for Disease Control, Vancouver, BC, Canada.
BC Centre for Disease Control Public Health Laboratory Medicine, University of BC, Vancouver, BC, Canada.
BMC Infect Dis. 2017 Sep 4;17(1):604. doi: 10.1186/s12879-017-2706-0.
Every year, over 1 million people develop isoniazid (INH) resistant tuberculosis (TB). Yet, the optimal treatment regimen remains unclear. Given increasing prevalence, the clinical efficacy of regimens used by physicians is of interest. This study aims to examine treatment outcomes of INH resistant TB patients, treated under programmatic conditions in British Columbia, Canada.
Medical charts were retrospectively reviewed for cases of culture-confirmed INH mono-resistant TB reported to the BC Centre for Disease Control (BCCDC) from 2002 to 2014. Treatment regimens, patient and strain characteristics, and clinical outcomes were analysed.
One hundred sixty five cases of INH mono-resistant TB were included in analysis and over 30 different treatment regimens were prescribed. Median treatment duration was 10.5 months (IQR 9-12 months) and treatment was extended beyond 12 months for 26 patients (15.8%). Fifty six patients (22.6%) experienced an adverse event that resulted in a drug regimen modification. Overall, 140 patients (84.8%) had a successful treatment outcome while 12 (7.2%) had an unsuccessful treatment outcome of failure (n = 2; 1.2%), relapse (n = 4; 2.4%) or all cause mortality (n = 6; 3.6%).
Our treatment outcomes, while consistent with findings reported from other studies in high resource settings, raise concerns about current recommendations for INH resistant TB treatment. Only a small proportion of patients completed the recommended treatment regimens. High quality studies to confirm the effectiveness of standardized regimens are urgently needed, with special consideration given to trials utilizing fluoroquinolones.
每年有超过100万人患上耐异烟肼（INH）肺结核（TB）。然而，最佳治疗方案仍不明确。鉴于其患病率不断上升，医生所采用治疗方案的临床疗效备受关注。本研究旨在调查在加拿大不列颠哥伦比亚省按计划条件治疗的耐INH肺结核患者的治疗结果。
对2002年至2014年向不列颠哥伦比亚省疾病控制中心（BCCDC）报告的培养确诊的INH单耐药肺结核病例的病历进行回顾性审查。分析治疗方案、患者和菌株特征以及临床结果。
165例INH单耐药肺结核病例纳入分析，开出了30多种不同的治疗方案。中位治疗持续时间为10.5个月（四分位间距9 - 12个月），26例患者（15.8%）的治疗时间延长至1年以上。56例患者（22.6%）发生不良事件，导致药物治疗方案调整。总体而言，140例患者（84.8%）治疗成功，12例（7.2%）治疗结果不佳，包括治疗失败（2例；1.2%）、复发（4例；2.4%）或全因死亡（6例；3.6%）。
我们的治疗结果虽然与其他高资源环境研究报告的结果一致，但引发了对当前耐INH肺结核治疗建议的担忧。只有一小部分患者完成了推荐的治疗方案。迫切需要高质量的研究来证实标准化方案的有效性，尤其要考虑使用氟喹诺酮类药物的试验。
