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Successful Treatment of Multidrug-Resistant TB in Peru

Individualized outpatient treatment can work in resource-poor settings, but the developed world may have to pitch in.

Although combination antimicrobial therapy has made tuberculosis (TB) rare in the U.S., TB remains one of the great scourges of mankind. The emergence of multidrug-resistant (MDR) TB in developing countries has raised the frightening possibility that such disease is not only untreatable but could spread globally. Encouragingly, data reported from Turkey last year showed that even these strains of Mycobacterium tuberculosis can be treated in referral hospitals (Journal Watch Infectious Diseases August 24, 2001). Now, a report shows that community-based treatment in a developing country can also succeed.

Between August 1, 1996, and November 30, 1998, 75 patients (median age, 26.8 years) with MDR TB in Lima, Peru, received coordinated ambulatory treatment. Only 1 patient was HIV-positive. Sputum M. tuberculosis isolates were sent to the U.S. for antimicrobial susceptibility testing; the infecting strains were resistant to a median of 6 drugs (range, 2-12). Susceptibility results were used to devise individualized outpatient treatment regimens. Patients who completed therapy received at least 5 drugs for at least 18 months. Among the 66 patients who continued treatment beyond 4 months, 55 (83%) had a probable cure at the end of treatment. Predictors of poor outcome were anemia, a low body-mass index, and resistance to pyrazinamide or ethambutol.

Comment: Although the costs of care were low by U.S. standards, the mean drug cost was still US$15,681 per patient. Replicating this program will therefore require support from the developed world. However, given the great risks posed to the entire globe by MDR TB, supporting such programs seems a wise investment.

— Richard T. Ellison III, MD

Published in Journal Watch Infectious Diseases February 21, 2003

Citation(s):

Mitnick C et al. Community-based therapy for multidrug-resistant tuberculosis in Lima, Peru. N Engl J Med 2003 Jan 9; 348:119-28.

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