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Published on: April 9, 2012
Programmatic management of rifampicin-resistant tuberculosis with standard regimen in Cameroon: a retrospective
Christelle Géneviève Jouego1, Tinne Gils2, Alberto Piubello3
1Cameroon National Tuberculosis Program (NTP), Mballa 2, BP 15 656 Yaoundé, Cameroun; Institute of Tropical Medicine, Department of Clinical Sciences, Unit of HIV and Tuberculosis, Nationalestraat 155, 2000 Antwerp, Belgium; University of Yaoundé 1, Biotechnology centre, Molecular Diagnostic and Research Group, 11864 Yaoundé, Cameroon; Catholic University of Leuven, Laboratory of Clinical Microbiology, Department of Microbiology, Immunology and Transplantation, UZ Herestraat 49, 3000 Leuven, Belgium.
Objectives:
To describe treatment outcomes for rifampicin-resistant tuberculosis (Rr-TB) started on standard regimen and the frequency of acquired drug resistance in patients treated using the standard treatment regimen (STR) in Cameroon between 2015-2019.
Methods:
This is a retrospective cohort study. Rr-TB patients were initiated on the STR, including a fluoroquinolone (FQ), a second-line injectable drug (SLI), and companion drugs. In case of resistance to fluoroquinolones (FQr) at baseline, FQ, SLI and ethionamide were replaced by bedaquiline, delamanid, and linezolid in a modified treatment regimen (mTR), FQr-mTR. In case of resistance to SLI (SLIr) at baseline, SLI was replaced by linezolid (LZD), SLIr-mTR. Logistic regression and competing risk regression were used to estimate predictors of early (first eight weeks) mortality and overall mortality, respectively.
Results:
Of 709 patients started on a standard regimen, treatment success occurred in 84.7% (587/693), 72.7% (8/11) and 100% (10/10) of patients treated with STR, FQr-mTR and SLIr-mTR as final regimens, respectively. Three (0.6%) patients acquired FQr during treatment. Early mortality occurred in 4.1% (29/709) and was associated with being HIV positive, male sex and being underweight. Overall mortality was associated with missing drug-susceptibility testing results at baseline, being HIV positive, age>40 and male sex.
Conclusion:
Programmatic management of Rr-TB, with additional second-line drug resistance treated with mTR, resulted in excellent treatment outcomes.
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