An assessment of nucleic acid amplification testing for active mycobacterial infection

Component	A Excellent	B Good	C Satisfactory
D Poor
Evidence-base^a				Level IV studies, or level I to III studies/SRs with a high risk of bias
Consistency^b	All studies consistent
Clinical impact				Slight or restricted
Generalisability			Population(s) studied in body of evidence differ to target population for guideline but it is clinically sensible to apply this evidence to target population
Applicability		Applicable to Australian healthcare context with few caveats

SR = systematic review

^a Level of evidence determined from the NHMRC evidence hierarchy (see Table ).

Source: Adapted from NHMRC (2009)

A study by Meyssonnier et al. (2014) reported the outcomes of a retrospective cohort of rifampicin mono-resistant TB patients in France. At the time of TB diagnosis 83% (25/30) received rifampicin-containing regimens (Table ). The remaining 5 patients did not receive rifampicin due to suspected resistance because of a previous treatment history or the first-line DST results from other countries or contacts. However, when DST results to first-line drugs were available in the study population, 3 patients did not have any modification of the rifampicin-containing regimen. Two of these patients were considered cured after 9 months of treatment and a 2-year follow-up (2 months of standard four-drug regimen and 7 months of rifampicin and isoniazid). The third patient died after 9 months of standard treatment, but also had a Kaposi sarcoma related to HIV co-infection. Of the patients receiving antibiotic treatment other than rifampicin, 13 (52%) received fluoroquinolone-containing regimens without aminoglycoside, 4 (16%) received amikacin-containing regimens without fluoroquinolone and 8 (32%) received both fluoroquinolones and amikacin.

Table Association between treatment characteristics and health outcomes among rifampicin-resistant TB patients