Effectiveness and safety of a modified short-term regimen of antimycobacterial therapy to treat rifampicin-resistant tuberculosis in elderly patients with concomitant diabetes (a clinical case)
Keywords:modified short course regimen, antimycobacterial therapy, rifampicin-resistant tuberculosis, elderly, diabetes mellitus
Aim. To analyze the effectiveness and safety of a modified short-term regimen (mSTR) of antimycobacterial therapy (AMBT) for rifampicin-resistant tuberculosis (RR-TB) in a 71-year-old patient with type 2 diabetes mellitus (T2DM) on the clinical case example of own observation.
Materials and methods. A clinical case from own observation of the patient who was treated at the clinical base of the Department of Phthisiology and Pulmonology of Zaporizhzhia State Medical University – Pulmonary Tuberculosis Department No. 2 of the Communal Non-profit Organization “Zaporizhzhia Regional Phthisio-Pulmonology Clinical Treatment and Diagnostic Center” is presented.
Results. The presented case demonstrates the high safety and efficacy of all oral mSTR, including Lfx-Bdq-Lzd-Cfz-Cs, in the elderly person with RR-TB and concomitant decompensated T2DM who was smear-negative after 4 months as a result of treatment with 9-month mSTR AMBT (Lfx, Bdq, Lzd, Cfz, Сs). Positive radiological dynamics were observed all the time and residual changes in the lungs after tuberculosis were diagnosed at the end of the treatment course. These results complement indications for the use of mSTR, including Lfx-Bdq-Lzd-Cfz-Cs, in RR-TB patients.
Conclusions. mSTR AMBT (Lfx, Bdq, Lzd, Cfz, Сs) is effective and safe in elderly patients with RR-TB and concomitant decompensated type 2 diabetes mellitus when adequate treatment of diabetes and timely correction of antimycobacterial drug side effects are undertaken.
Zhdanova, E., Goncharova, O., Davtyan, H., Alaverdyan, S., Sargsyan, A., Harries, A. D., & Maykanaev, B. (2021). 9-12 months short treatment for patients with MDR-TB increases treatment success in Kyrgyzstan. Journal of infection in developing countries, 15(9.1), 66S-74S. https://doi.org/10.3855/jidc.13757
Han, W. M., Mahikul, W., Pouplin, T., Lawpoolsri, S., White, L. J., & Pan-Ngum, W. (2021). Assessing the impacts of short-course multidrug-resistant tuberculosis treatment in the Southeast Asia Region using a mathematical modeling approach. PloS one, 16(3), e0248846. https://doi.org/10.1371/journal.pone.0248846
Bada, F. O., Blok, N., Okpokoro, E., Dutt, S., Akolo, C., Dakum, P., & Abimiku, A. (2020). Cost comparison of nine-month treatment regimens with 20-month standardized care for the treatment of rifampicin-resistant/multi-drug resistant tuberculosis in Nigeria. PloS one, 15(12), e0241065. https://doi.org/10.1371/journal.pone.0241065
Avaliani, T., Sereda, Y., Davtyan, H., Tukvadze, N., Togonidze, T., Kiria, N., Denisiuk, O., Gozalov, O., Ahmedov, S., & Hovhannesyan, A. (2021). Effectiveness and safety of fully oral modified shorter treatment regimen for multidrug-resistant tuberculosis in Georgia, 2019-2020. Monaldi archives for chest disease, 91(1), 10.4081/monaldi.2021.1679. https://doi.org/10.4081/monaldi.2021.1679
Mahardani, P. N., Wati, D. K., Siloam, A., Savitri, N. P. A., & Manggala, A. K. (2022). Effectiveness and Safety of Short-term Regimen for Multidrug-resistant Tuberculosis Treatment: A Systematic Review of Cohort Studies. Oman medical journal, 37(1), e337. https://doi.org/10.5001/omj.2021.64
Soeroto, A. Y., Nurhayati, R. D., Purwiga, A., Lestari, B. W., Pratiwi, C., Santoso, P., Kulsum, I. D., Suryadinata, H., & Ferdian, F. (2022). Factors associated with treatment outcome of MDR/RR-TB patients treated with shorter injectable based regimen in West Java Indonesia. PloS one, 17(1), e0263304. https://doi.org/10.1371/journal.pone.0263304
Kokebu, D. M., Ahmed, S., Moodliar, R., Chiang, C. Y., Torrea, G., Van Deun, A., Goodall, R. L., Rusen, I. D., Meredith, S. K., & Nunn, A. J. (2022). Failure or relapse predictors for the STREAM Stage 1 short regimen for RR-TB. The international journal of tuberculosis and lung disease, 26(8), 753-759. https://doi.org/10.5588/ijtld.22.0073
Nie, Q., Tao, L., Li, Y., Chen, N., Chen, H., Zhou, Y., Wang, Y., Chen, H., Tang, Q., Wang, X., Huang, C., & Yang, C. (2022). High-dose gatifloxacin-based shorter treatment regimens for MDR/RR-TB. International journal of infectious diseases : IJID, 115, 142-148. https://doi.org/10.1016/j.ijid.2021.11.037
Kendall, E. A., Fojo, A. T., & Dowdy, D. W. (2017). Expected effects of adopting a 9 month regimen for multidrug-resistant tuberculosis: a population modelling analysis. The Lancet. Respiratory medicine, 5(3), 191-199. https://doi.org/10.1016/S2213-2600(16)30423-4
Trauer, J. M., Achar, J., Parpieva, N., Khamraev, A., Denholm, J. T., Falzon, D., Jaramillo, E., Mesic, A., du Cros, P., & McBryde, E. S. (2016). Modelling the effect of short-course multidrug-resistant tuberculosis treatment in Karakalpakstan, Uzbekistan. BMC medicine, 14(1), 187. https://doi.org/10.1186/s12916-016-0723-2
Schwœbel, V., Trébucq, A., Kashongwe, Z., Bakayoko, A. S., Kuaban, C., Noeske, J., Harouna, S. H., Souleymane, M. B., Piubello, A., Ciza, F., Fikouma, V., Gasana, M., Ouedraogo, M., Gninafon, M., Van Deun, A., Tagliani, E., Cirillo, D. M., Koura, K. G., & Rieder, H. L. (2020). Outcomes of a nine-month regimen for rifampicin-resistant tuberculosis up to 24 months after treatment completion in nine African countries. EClinicalMedicine, 20, 100268. https://doi.org/10.1016/j.eclinm.2020.100268
Kohler, S., Sitali, N., Achar, J., & Paul, N. (2022). Programme costs of longer and shorter tuberculosis drug regimens and drug import: a modelling study for Karakalpakstan, Uzbekistan. ERJ open research, 8(1), 00622-2021. https://doi.org/10.1183/23120541.00622-2021
Souleymane, M. B., Decroo, T., Soumana, A., Maman Lawan, I., Gagara-Issoufou, A., Halidou-Moussa, S., Ortuño-Gutiérrez, N., Adehossi, E., Mamadou, S., Van Deun, A., & Piubello, A. (2022). Safety, effectiveness, and adherence of a short and all-oral treatment regimen for the treatment of rifampicin-resistant tuberculosis in Niger: a study protocol of a pragmatic randomised clinical trial with stratified block randomisation. Trials, 23(1), 1011. https://doi.org/10.1186/s13063-022-06912-7
How to Cite
LicenseAuthors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access)