The effectiveness of the main course of chemotherapy for drug-resistant tuberculosis

Abstract

The article is devoted to the effectiveness of treatment of tuberculosis with MDR-TB and XDR-TB mycobacteria after the main course of chemotherapy. The treatment of tuberculosis with multiple and broad MD MBT is a complex and urgent task. Prescribing the latest generation of drugs (thioureidoiminomethylpyridinium perchlorate, bedaquiline, linezolid) in the complex composition of tuberculosis therapy with MDR and XDR-MBT significantly increases the effectiveness of the main course of treatment, compared with the control group, respectively (85.0% and 65.8%). Мaterials and methods. The main course of chemotherapy was completed by 119 patients with pulmonary tuberculosis with drug-resistant pathogen, who were diagnosed for the first time, treated in anti-tuberculosis hospitals in St. Petersburg and on an outpatient basis in St. Petersburg “Inter-district Petrograd-
Primorsky TB dispensary № 3”. Clinical, radiological, and laboratory data are presented. All patients were identified with Mycobacterium tuberculosis with multiple and broad drug resistance MBT. The patients were divided into 2 groups: the main group (OG) — 40 people, received the latest generation drugs; 79 patients (KG) — received standard therapy without the inclusion of the latest generation of drugs. Half of the patients in all age groups were identified during a preventive examination (50.4%), a third when applying for complaints (31.9%), and one — when examining for contact with a patient with tuberculosis. 

Infiltrative tuberculosis was most often diagnosed in 75 (63.0%), disseminated tuberculosis was detected in 20 (16.8%), and fibrocavernous pulmonary tuberculosis — in 24 (20.2%). The decay phase was diagnosed in 88 (73.9%) patients. Three-quarters of the studied patients had 90 comorbidities (75.6%). Results and discussion. The groups are comparable in terms of clinical, radiological, and bacteriological parameters. By the fourth month of the therapy, the cessation of bacterial excretion was significantly more often determined in patients taking bedaquiline, thioureidoiminomethylpyridinium perchlorate,
linezolid as part of HT, compared with the group not receiving the above drugs 47.5% and 35.4%, respectively, (p<0.05); by the end of the intensive phase of treatment, the cessation of bacterial excretion occurred in OG in 92.0%, KG — 57.0% (p<0.001). Conclusions. The inclusion of drugs thioureidoiminomethylpyridinium perchlorate, bedaquiline, linezolid in the complex chemotherapy of tuberculosis with multi-resistant tuberculosis increases the effectiveness of the main course of treatment compared to the KG.