Objectives

Drug-resistance represents a major threat in the fight against tuberculosis. Globally, isoniazid-monoresistant tuberculosis (Hr-TB) is twice as common as multidrug/rifampicin-resistant (MDR/RR)-TB. Recently updated WHO guidelines now recommend treatment of Hr-TB with rifampicin, ethambutol, pyrazinamide and levofloxacin for at least six months. Our primary objective was to define the frequency, treatment and outcomes for Hr-TB in Queensland, Australia. We also sought to determine the frequency of fluoroquinolone use and whether its inclusion improved outcomes.

Methods

Retrospective case series of tuberculosis notifications in Queensland between 2000 and 2017 with at least low-level isoniazid resistance and preserved susceptibility to other first-line oral agents.

Results

Hr-TB was identified in 7.2% of all notifications. Where outcomes were assessable (163/198), 76.1% were treated with first-line agents only and 11.0% received at least six months of a fluoroquinolone-containing regimen (consistent with recent WHO guidelines). Favourable outcomes were achieved in 95.7%, comparable to fully susceptible disease (94.9%). Inclusion of a fluoroquinolone did not significantly improve outcomes compared with a regimen containing first-line agents only, although these cases were more likely to have high-level resistance. Previous treatment made an unfavourable outcome more likely.

Conclusions

Hr-TB is prevalent in Queensland. Treatment outcomes in our cohort were comparable to fully susceptible disease. The current WHO-recommended regimen did not confer advantage over an appropriately constructed regimen containing first-line agents only. Our findings suggest that, in a well-resourced setting with good programmatic management, the addition of a fluoroquinolone may not substantially improve outcomes – potentially allowing these agents to be reserved for more extensively resistant disease.

中文翻译：

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澳大利亚昆士兰州异烟肼单抗结核病（Hr-TB）的管理：回顾性病例系列

目标

耐药性是抗击结核病的主要威胁。在全球范围内，异烟肼单抗性结核病（Hr-TB）的发病率是耐多药/利福平（MDR / RR）结核病的两倍。世界卫生组织最近更新的指南现在建议使用利福平，乙胺丁醇，吡嗪酰胺和左氧氟沙星治疗Hr-TB至少六个月。我们的主要目标是确定澳大利亚昆士兰州Hr-TB的发生率，治疗方法和结果。我们还试图确定氟喹诺酮类药物的使用频率，以及氟喹诺酮类药物的使用是否能改善结果。

方法

昆士兰州2000年至2017年间结核病通报的回顾性病例系列，至少具有低水平的异烟肼耐药性，并保留了对其他一线口服药物的敏感性。

结果

在所有通知中，有7.2％的病例是Hr-TB。在可评估结局的情况下（163/198），仅使用一线药物治疗的患者为76.1％，接受至少六个月含氟喹诺酮治疗的患者为11.0％（与最近的WHO指南一致）。与完全易感疾病（94.9％）相当，达到95.7％的良好结果。与仅包含一线药物的方案相比，加入氟喹诺酮类药物并不能显着改善预后，尽管这些病例更可能具有高水平的耐药性。先前的治疗使不良结局的可能性更大。

结论

昆士兰州普遍存在Hr-TB。我们队列中的治疗结果与完全易感疾病相当。世卫组织建议的现行方案与仅含一线药物的适当方案相比并没有优势。我们的研究结果表明，在资源充足且程序管理良好的环境中，添加氟喹诺酮可能不会显着改善治疗效果-可能会使这些药物保留用于更广泛耐药的疾病。