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M9650994.TXT
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1996-03-30
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Document 0994
DOCN M9650994
TI Predictors and outcome of multidrug-resistant tuberculosis.
DT 9505
AU Salomon N; Perlman DC; Friedmann P; Buchstein S; Kreiswirth BN; Mildvan
D; Department of Medicine, Beth Israel Medical Center, New York, New;
York 10003, USA.
SO Clin Infect Dis. 1995 Nov;21(5):1245-52. Unique Identifier : AIDSLINE
MED/96126011
AB We identify early predictors of multidrug-resistant tuberculosis and
describe improved clinical outcomes, including survival, for patients
with human immunodeficiency virus (HIV)-related multidrug-resistant
tuberculosis (MDR-TB) when they are prospectively identified and receive
treatment under direct observation. Analysis by means of a Cox
proportional hazards model revealed that failure to defervesce while
receiving a standard four-drug antituberculous regimen was independently
associated with multidrug resistance (P = .004). When patients with
HIV-related MDR-TB were prospectively identified and treated with at
least two agents that were active in vitro, 100% bacteriologic
conversion and improved survival (> or = 4 months for 88% of patients
and > or = 1 year for 59% of patients) were observed. For patients with
HIV-related tuberculosis, poorer survival was associated with a CD4+
lymphocyte count of < 25 mm3 (P = .03); multidrug resistance was not a
predictor of poor outcome (P = .82). These data suggest that patients
with prolonged fever who are receiving antituberculous therapy may be an
appropriate subgroup to target for broader empirical therapy. The
findings also demonstrate that improved outcomes can be achieved with
HIV-related MDR-TB when patients are prospectively identified and
treated with agents that are active in vitro.
DE Adult Antitubercular Agents/*THERAPEUTIC USE AIDS-Related
Opportunistic Infections/*COMPLICATIONS/*DRUG THERAPY/MICROBIOLOGY
Cohort Studies Drug Resistance, Multiple/GENETICS Female
Fever/COMPLICATIONS/DRUG THERAPY Human Male Middle Age Mycobacterium
tuberculosis/DRUG EFFECTS/GENETICS Polymorphism, Restriction Fragment
Length Proportional Hazards Models Prospective Studies Support,
Non-U.S. Gov't Survival Analysis Treatment Outcome Tuberculosis,
Multidrug-Resistant/*COMPLICATIONS/*DRUG THERAPY/ MICROBIOLOGY JOURNAL
ARTICLE
SOURCE: National Library of Medicine. NOTICE: This material may be
protected by Copyright Law (Title 17, U.S.Code).