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Epidemiology and clinical management of XDR-TB: a systematic review by TBNET

Sotgiu, Giovanni and Ferrara, G. and Matteelli, Alberto and Richardson, Morgan D’Arcy and Centis, Rosella and Ruesch Gerdes, S. and Toungoussova, O. and Zellweger, Jean-Pierre and Spanevello, Antonio and Cirillo, Daniela M. and Lange, Christoph and Migliori, Giovanni Battista (2009) Epidemiology and clinical management of XDR-TB: a systematic review by TBNET. European Respiratory Journal, Vol. 33 (4), p. 871-881. eISSN 1399-3003. Article.

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DOI: 10.1183/09031936.00168008

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Abstract

Extensively drug-resistant tuberculosis (XDR-TB) is present in all regions and poses serious challenges for public health and clinical management. Laboratory diagnosis is difficult and little evidence exists to guide clinicians in treating people with XDR-TB effectively. To summarise the available data on diagnosis and treatment, the current authors performed a systematic review on 13 recent studies of the epidemiology and clinical management of XDR-TB.
Studies that met inclusion criteria were reviewed, in order to assess methodology, treatment regimens and treatment outcomes.
Meta-analysis of currently available data is not possible because of inconsistent definitions and methodologies. Data show that XDR-TB can be successfully treated in up to 65% of patients, particularly those who are not co-infected with HIV. However, treatment duration is longer and outcomes are in general poorer than for non-XDR TB patients.
To strengthen the evidence for extensively drug-resistant tuberculosis diagnosis, treatment and prevention, future studies should: 1) be prospective in design; 2) adopt standardised, internationally accepted definitions; 3) use quality-assured laboratory testing for all first- and second-line drugs; and 4) collect data on an agreed-upon set of standard variables, allowing for comparisons across studies. Early diagnosis and aggressive management of extensively drug-resistant tuberculosis provide the best chance of positive outcome, but prevention is still paramount.

Item Type:Article
ID Code:7954
Status:Published
Refereed:Yes
Uncontrolled Keywords:Extensively drug-resistant tuberculosis, microbiological diagnosis, outcomes, systematic review, treatment efficacy
Subjects:Area 06 - Scienze mediche > MED/01 Statistica medica
Divisions:001 Università di Sassari > 01 Dipartimenti > Scienze biomediche
Publisher:European Respiratory Society
eISSN:1399-3003
Deposited On:17 Sep 2012 12:53

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