Journal Article

Clinical Characteristics and Treatment Outcomes of Patients with Isoniazid-Monoresistant Tuberculosis

Adithya Cattamanchi, Raymund B. Dantes, John Z. Metcalfe, Leah G. Jarlsberg, Jennifer Grinsdale, L. Masae Kawamura, Dennis Osmond, Philip C. Hopewell and Payam Nahid

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 48, issue 2, pages 179-185
Published in print January 2009 | ISSN: 1058-4838
Published online January 2009 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/595689
Clinical Characteristics and Treatment Outcomes of Patients with Isoniazid-Monoresistant Tuberculosis

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Background.Risk factors and treatment outcomes under program conditions for isoniazid (INH) monoresistant tuberculosis have not been well described.

Methods.Medical charts were retrospectively reviewed for all cases of culture-confirmed, INH-monoresistant tuberculosis (n=137) reported to the San Francisco Department of Public Health Tuberculosis Control Section from October 1992 through October 2005, and those cases were compared with a time-matched sample of drug-susceptible tuberculosis cases (n=274).

Results.In multivariate analysis, only a history of treatment for latent tuberculosis (odds ratio [OR], 3.1; 95% confidence interval [CI], 1.5 6.4; P=.003) or for active tuberculosis (OR, 2.7; 95% CI, 1.4 5.0; P=.002) were significantly associated with INH-monoresistant tuberculosis. Of the 119 patients who completed treatment, 49 (41%) completed a 6-month treatment regimen. Treatment was extended to 7 12 months for 53 (45%) of the patients and to >12 months for 17 (14%). Treatment was most commonly extended because pyrazinamide was not given for the recommended 6-month duration (35 patients [29%]). Despite variation in treatment regimens, the combined end point of treatment failure or relapse was uncommon among patients with INH-monoresistant tuberculosis and was not significantly different for patients with drug-susceptible tuberculosis (1.7% vs. 2.2%; P=.73).

Conclusions.A history of treatment for latent or active tuberculosis was associated with subsequent INH monoresistance. Treatment outcomes for patients with INH-monoresistant tuberculosis were excellent and were no different from those for patients with drug-susceptible tuberculosis. However, new, short-course regimens are needed because a small proportion of patients completed the 6-month treatment regimen recommended by the American Thoracic Society, Centers for Disease Control and Prevention, and Infectious Diseases Society of America, primarily because of pyrazinamide intolerance.

Journal Article.  3554 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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