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Previous Volume 333:907-912 October 5, 1995 Number 14 Next

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ABSTRACT

Background Investigations of outbreaks of multidrug-resistant tuberculosis have found low rates of treatment response and very high mortality, and they have mainly involved patients with advanced human immunodeficiency virus (HIV) infection. For patients without HIV infection, one study reported an overall rate of response to treatment of 56 percent, and the mortality from tuberculosis was 22 percent. We investigated treatment response and mortality rates in 26 HIV-negative patients in New York with multidrug-resistant tuberculosis.

Methods We obtained detailed data from seven teaching hospitals in New York City on patients with multidrug-resistant tuberculosis — defined as tuberculosis resistant at least to isoniazid and rifampin — who were HIV-negative on serologic testing. Lengths of times from diagnosis to the initiation of appropriate therapy and from the initiation of appropriate therapy to conversion to negative cultures were assessed. Therapeutic responses were evaluated by both microbiologic and clinical criteria.

Results Between March 1991 and September 1994, 26 HIV-negative patients were identified and treated. Of the 25 patients for whom adequate data were available for analysis, 24 (96 percent) had clinical responses; all 17 patients for whom data on microbiologic response were available had such a response. The median times from diagnosis to the initiation of appropriate therapy and from the initiation of therapy to culture conversion were 44 days (range, 0 to 181) and 69 days (range, 2 to 705), respectively. Side effects requiring the discontinuation of medication occurred in 4 of 23 patients (17 percent) who were treated with second-line antituberculosis medications. The median follow-up for the 23 patients who responded and who received appropriate therapy was 91 weeks (range, 41 to 225).

Conclusions In this report from New York City, HIV-negative patients with multidrug-resistant tuberculosis, contrary to previous reports, responded well to appropriate chemotherapy, both clinically and microbiologically.

Source Information

From the Bronx–Lebanon Hospital Center, Bronx, N.Y. (E.E.T., S.B., G.T.); St. Clare's Hospital and Health Center, New York (K.S.); New York Hospital–Cornell Medical Center, New York (K.S., S.M.); Harlem Hospital Center, New York (F.M., W.E.-S.); Montefiore Medical Center and North Central Bronx Hospital, Bronx, N.Y. (P.A.); St. Vincent's Medical Center, New York (A.G.); and Beth Israel Medical Center, New York (N.S.).

Address reprint requests to Dr. Telzak at the Division of Infectious Diseases, Bronx–Lebanon Hospital Center, Albert Einstein College of Medicine, 1650 Grand Concourse, Bronx, NY 10457.

Full Text of this Article

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Extract | Full Text  
N Engl J Med 1996; 334:267-269, Jan 25, 1996. Correspondence

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