Objective:To analyze outcomes of patients with
multidrug-resistant tuberculosis (MDR-TB) treated with
and methods:From February 1990 through June 1997, 63 MDR-TB
patients (with bacillary resistance to at least isoniazid and rifampin
in vitro) were analyzed retrospectively. Twenty-two
patients (34.9%) had had no previous antituberculosis chemotherapy.
Each patient received either ofloxacin (53) or levofloxacin (10) even
though 13 patients had bacilli resistant to ofloxacin in
vitro. The other accompanying drugs mainly included
aminoglycosides, cycloserine, ethionamide/prothionamide, and
pyrazinamide. Sputum smear and culture examinations for acid-fast
bacilli (AFB) were performed monthly for the initial 6 months and then
at 2- to 3-month intervals until the end of treatment. Comparison was
made between clinical successes and failures using univariate and
multiple logistic regression analyses for the following variables: age,
sex, presence of cavitation, extent of disease, sputum smear
positivity, in vitro resistance to ofloxacin, in
vitro resistance to streptomycin and/or ethambutol, treatment
adherence, and the number of drugs per regimen.
Results:Fifty-one patients (81.0%) were cured, nine
patients (14.3%) failed, and three patients (4.7%) died. For the
entire group, the mean duration of treatment was 14.0 months, and the
mean number of drugs was 4.7. Mean durations of chemotherapy in
successful and failed patients were 14.5 and 14.2 months, respectively.
Mean time for sputum smear and culture conversions were 1.7 and 2.1
months, respectively. Only cavitation, resistance to ofloxacin, and
poor adherence were found to be variables independently associated with
adverse outcomes (p < 0.05; odds ratios = 15.9, 13.5, 12.8,
respectively). Negative sputum cultures after 2 and 3 months of therapy
were 100% predictive of cure. Positive sputum cultures after 2 and 3
months were 52.3% and 84.6% predictive of failure, respectively. One
patient (2.1%) relapsed after apparent cure. Twenty-five patients
experienced adverse drug reactions, but only 12 of them needed drug
Conclusion:Most MDR-TB patients can be
treated effectively with ofloxacin/levofloxacin-containing regimens.
Presence of cavitation, resistance to ofloxacin in
vitro, and poor adherence to therapy portend treatment failure.
Monitoring monthly sputum culture for AFB in the initial months of
chemotherapy helps predict clinical