Category II treatment
|
Poor outcome / total outcomes
|
Univariate OR [95%CI]
|
p-value
|
Multivariate OR [95%CI]
|
p-value
|
None
|
50/155 (32.3%)
|
Reference
|
-
|
Reference
|
-
|
Pre-DST only
|
15/26 (57.7%)
|
2.9 [1.2, 6.7]
|
0.02
|
2.5 [1.1, 6.4]
|
0.05
|
Post-DST / full treatment course
|
4/9 (44.4%)
|
1.7 [0.4, 6.5]
|
0.45
|
2.8 [0.7, 11.6]
|
0.16
|
CI = confidence interval; DST = drug susceptibility testing; OR = odds ratio
Source: Lam et al. (2014)
The third study, a British cohort study by Drobniewski et al. (2002), showed survival curves comparing MDR-TB patients treated with three drugs to which the bacterium was susceptible on DST results and those treated with fewer agents, also with demonstrable susceptibility. In the first group (n=62) the median survival period was 2,066 days or 5.66 years (95%CI 1336, 2515), and in the second group (n=13) this was 599 days or 1.64 years (95%CI 190, 969). Although this study did not meet the PICO criteria for inclusion, the authors reported that those who received appropriate treatment would have a longer median survival time and a lower chance of death, with an estimated risk ratio of 0.06 (95%CI 0.01, 0.23). Furthermore, those in whom culture results were available within 30 days were less likely to die, with a risk ratio of 0.23 (95%CI 0.06, 0.86), indicating the importance of accurate DST data in the clinical management of patients.
These 3 studies suggest that patients with rifampicin-resistant TB who receive rifampicin-containing anti-TB regimens have a slightly worse prognosis than those who receive other regimens. However, the reports are of limited applicability as they did not meet the PICO criteria.
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