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

G. Sotgiu, G. Ferrara, A. Matteelli, M. D. Richardson, R. Centis, S. Ruesch-Gerdes, O. Toungoussova, J. P. Zellweger, A. Spanevello, D. Cirillo, C. Lange, G. B. Migliori

Research output: Contribution to journalArticle

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.

Original languageEnglish
Pages (from-to)871-881
Number of pages11
JournalEuropean Respiratory Journal
Volume33
Issue number4
DOIs
Publication statusPublished - Apr 2009

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Extensively Drug-Resistant Tuberculosis
Epidemiology
Clinical Laboratory Techniques
Therapeutics
Meta-Analysis
Early Diagnosis
Public Health
HIV

Keywords

  • Extensively drug-resistant tuberculosis
  • Microbiological diagnosis
  • Outcomes
  • Systematic review
  • Treatment efficacy

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Epidemiology and clinical management of XDR-TB : A systematic review by TBNET. / Sotgiu, G.; Ferrara, G.; Matteelli, A.; Richardson, M. D.; Centis, R.; Ruesch-Gerdes, S.; Toungoussova, O.; Zellweger, J. P.; Spanevello, A.; Cirillo, D.; Lange, C.; Migliori, G. B.

In: European Respiratory Journal, Vol. 33, No. 4, 04.2009, p. 871-881.

Research output: Contribution to journalArticle

Sotgiu, G, Ferrara, G, Matteelli, A, Richardson, MD, Centis, R, Ruesch-Gerdes, S, Toungoussova, O, Zellweger, JP, Spanevello, A, Cirillo, D, Lange, C & Migliori, GB 2009, 'Epidemiology and clinical management of XDR-TB: A systematic review by TBNET', European Respiratory Journal, vol. 33, no. 4, pp. 871-881. https://doi.org/10.1183/09031936.00168008
Sotgiu, G. ; Ferrara, G. ; Matteelli, A. ; Richardson, M. D. ; Centis, R. ; Ruesch-Gerdes, S. ; Toungoussova, O. ; Zellweger, J. P. ; Spanevello, A. ; Cirillo, D. ; Lange, C. ; Migliori, G. B. / Epidemiology and clinical management of XDR-TB : A systematic review by TBNET. In: European Respiratory Journal. 2009 ; Vol. 33, No. 4. pp. 871-881.
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