Multidrug-resistant tuberculosis in Russia: clinical characteristics, analysis of second-line drug resistance and development of standardized therapy

  • Y. Balabanova
  • M. Ruddy
  • J. Hubb
  • M. Yates
  • N. Malomanova
  • I. Fedorin
  • F. Drobniewski
Concise Article

Abstract

The aim of the study presented here was to identify patients with multidrug resistant tuberculosis (MDRTB) in the Samara region of Russia and to analyze the susceptibility of their isolates to second-line drugs in order to develop an empirical, standard, second-line treatment regimen. Treatment of MDRTB can be individualized based on in vitro laboratory analysis or standardized. In the latter case there is still a need to ascertain local second-line drug-resistance patterns. Described here are the clinical characteristics of 251 MDRTB patients identified in the study and the second-line drug susceptibility of 69 MDRTB isolates obtained from them. Antimicrobial resistance to the following agents was detected in the isolates: rifabutin (88.2%), streptomycin (42.8%), amikacin (7.2%), doxycycline (7.4%), ciprofloxacin (4.3%), clofazimine (2.9%), cycloserine (7.4%), and prothionamide (1.5%). The results of the study indicate it is possible to develop a standard, effective, clinical treatment regimen using ethambutol, pyrazinamide, prothionamide, a fluoroquinolone and amikacin.

Notes

Acknowledgments

We would like to thank the Samara Regional TB service dispensaries and hospitals for their valuable support in the implementation of the study. We are particularly grateful to the doctors and nurses as well as the patients who took part in the study. This work was funded by the UK Department for International Development (CNTR 00 0134). None of the authors or the sponsor had any conflict of interest in the study

References

  1. 1.
    World Health Organization (2000) Anti-tuberculosis drug resistance in the world. Report no. 2: prevalence and trends. WHO, GenevaGoogle Scholar
  2. 2.
    Kimerling ME, Slavuckij A, Chavers S, Peremtin G, Tonkel T, Sirotkina O, Golubchikova V, Baddeley A (1999) The risk of MDR-TB and polyresistant tuberculosis among the civilian population of Tomsk city, Siberia, 1999. Int J Tuberc Lung Dis 7:866–872Google Scholar
  3. 3.
    Narvskaia OV, Vishnevskii BA, El’kin AV, Mokrousov IV, Limeshchenko EV, Otten TF, Ostashko OM, Ariel BM (2002) Molecular genetic characteristics of Mycobacterium tuberculosis isolated from patients operated on for pulmonary tuberculosis. Probl Tuberk 3:50–53Google Scholar
  4. 4.
    Drobniewski F, Balabanova Y, Coker R (2004) Clinical features, diagnosis, and management of multiple drug-resistant tuberculosis since 2002. Curr Opin Pulm Med 10:211–217Google Scholar
  5. 5.
    Toungoussova S, Caugant DA, Sandven P, Mariandyshev AO, Bjune G (2002) Drug resistance of Mycobacterium tuberculosis strains isolated from patients with pulmonary tuberculosis in Archangels, Russia. Int J Tuberc Lung Dis 6:406–414Google Scholar
  6. 6.
    Viljanen MK, Vyshnevskiy BI, Otten TF, Vyshnevskaya E, Marjamaki M, Soini H, Laippala PJ, Vasilyef AV (1998) Survey of drug-resistant tuberculosis in northwestern Russia from 1984 through 1994. Eur J Clin Microbiol Infect Dis 17:177–183Google Scholar
  7. 7.
    Kherosheva T, Thorpe LE, Kiryanova E, Rybka L, Gerasichev V, Shulgina M, Nemtsova E, Aptekar T, Kluge H, Jakubowiak W, Grzemska M, Aquino G, Wells C, Kazionny B (2003) Encouraging outcomes in the first year of a TB control demonstration program: Orel Oblast, Russia. Int J Tuberc Lung Dis 7:1045–1051Google Scholar
  8. 8.
    Spradling P, Drociuk D, McLaughlin S, Lee LM, Peloquin CA, Gallicano K, Pozsik C, Onorato I, Castro KG, Ridzon R (2002) Drug-drug interactions in inmates treated for human immunodeficiency virus and Mycobacterium tuberculosis infection or disease: an institutional tuberculosis outbreak. Clin Infect Dis 35:1106–1112Google Scholar
  9. 9.
    Drobniewski F (1998) Drug-resistant tuberculosis in adults and its treatment. J R Coll Physicians Lond 32:314–318Google Scholar
  10. 10.
    Mitnick C, Bayona J, Palacios E, Shin S, Furin J, Alcantara F, Sanchez E, Sarria M, Becerra M, Fawzi MC, Kapiga S, Neuberg D, Maguire JH, Kim JY, Farmer P (2003) Community-based therapy for multidrug-resistant tuberculosis in Lima, Peru. N Engl J Med 348:119–128Google Scholar
  11. 11.
    Coker R (2002) Should tuberculosis programmes invest in second-line treatments for multidrug-resistant tuberculosis (MDR-TB)? Int J Tuberc Lung Dis 6:649–650Google Scholar
  12. 12.
    Suarez PG, Floyd K, Portocarrero J, Alarcon E, Rapiti E, Ramos G, Bonilla C, Sabogal I, Aranda I, Dye C, Raviglione M, Espinal MA (2002) Feasibility and cost-effectiveness of standardised second-line drug treatment for chronic tuberculosis patients: a national cohort study in Peru. Lancet 359:1980–1989Google Scholar
  13. 13.
    Canetti G, Fox W, Khomenko A, Mahler HT, Menon NK, Mitchison DA, Rist N, Smelev NA (1969) Advances in techniques of testing mycobacterial drug sensitivity, and the use of sensitivity tests in tuberculosis control programmes. Bull World Health Organ 41:21–43Google Scholar
  14. 14.
    Migliori GB, Espinal M, Danilova ID, Punga VV, Grzemska M, Raviglione MC (2002) Frequency of recurrence among MDR-TB cases ‘successfully’ treated with standardised short-course chemotherapy. Int J Tuberc Lung Dis 6:858–864Google Scholar
  15. 15.
    Espinal MA, Kim SJ, Suarez PG, Kam KM, Khomenko AG, Migliori GB, Baez J, Kochi A, Dye C, Raviglione MC (2000) Standard short-course chemotherapy for drug-resistant tuberculosis: treatment outcomes in 6 countries. JAMA 283:2537–2545Google Scholar
  16. 16.
    Park SK, Kim CT, Song SD (1998) Outcome of chemotherapy in 107 patients with pulmonary tuberculosis resistant to isoniazid and rifampin. Int J Tuberc Lung Dis 2:877–884Google Scholar
  17. 17.
    Goble M, Iseman MD, Madsen LA, Waite D, Ackerson L, Horsburgh CR (1993) Treatment of 171 patients with pulmonary tuberculosis resistant to isoniazid and rifampicin. N Engl J Med 328:527–532Google Scholar
  18. 18.
    Drobniewski F, Eltringham I, Graham C, Magee JG, Smith EG, Watt B. (2002) A national study of clinical and laboratory factors affecting the survival of patients with multiple drug resistant tuberculosis in the UK. Thorax 57:810–816Google Scholar
  19. 19.
    Ruddy M, Balabanova Y, Graham G, Fedorin I, Malomanova N, Elisarova E, Kuznetznov S, Gusarova G, Zakharova S, Melentyev A, Krukova E, Golishevskaya V, Erokhin V, Drobniewski F (2004) Rates of drug resistance and risk factor analysis in civilian and prison patients with tuberculosis in Samara Region, Russia. Thorax (in press)Google Scholar
  20. 20.
    Yew WW, Chan CK, Leung CC, Chau CH, Tam CM, Wong PC, Lee J (2003) Comparative roles of levofloxacin and ofloxacin in the treatment of multidrug-resistant tuberculosis: preliminary results of a retrospective study from Hong Kong. Chest 124:1476–1481Google Scholar
  21. 21.
    Russia Federation Ministry of Health (2003) Prikaz on improving tuberculosis control activities in the Russian FederationGoogle Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Y. Balabanova
    • 1
  • M. Ruddy
    • 2
  • J. Hubb
    • 2
  • M. Yates
    • 2
  • N. Malomanova
    • 1
  • I. Fedorin
    • 1
  • F. Drobniewski
    • 2
  1. 1.Samara TB ServiceSamara Oblast DispensarySamaraRussia
  2. 2.HPA Mycobacterium Reference Unit, Department of Microbiology and InfectionGuy’s King’s and St Thomas’ Medical School, King’s College Hospital (Dulwich)LondonUK

Personalised recommendations