Treatment outcomes of pre- and extensively drug-resistant tuberculosis in Johannesburg, South Africa

Background Extensively drug-resistant tuberculosis (XDR-TB) has a poor treatment success rate and high mortality. Multidrug-resistant TB (MDR-TB) has worse outcomes when there is added resistance to second-line injectable drugs (pre-XDR-TB SLID ) or fluoroquinolones (pre-XDR-TB FQ ). Objectives Treatment outcomes in patients with pre-XDR-TB and XDR-TB in a high HIV prevalence area were compared. Methods A retrospective medical record review was conducted of patients with pulmonary pre-XDR-TB and XDR-TB managed from 2008 to 2010 at Sizwe Tropical Disease Hospital, Johannesburg, South Africa. Standardised MDR-TB treatment was instituted and was subsequently individualised when further second-line susceptibility results became available. Results Of 86 patients studied, 95% were sputum smear-positive at baseline, 73% had sputum culture conversion, and 65% were human immunodeficiency virus (HIV) infected, with a median CD4 count of 201 cells/mm³. Of 53 patients with XDR-TB, 26 with pre-XDR-TB FQ and 7 with pre-XDR-TB SLID , respectively 13%, 12% and 29% were cured, 21%, 23% and 57% had a favourable outcome, and 26%, 23% and 14% died. Clofazimine ( P P = 0.044) impacted on favourable outcomes. Conclusion Patients with pre-XDR-TB FQ did not have better outcomes than those with XDR-TB. In countries with standardised regimens for resistant TB, patients with pre-XDR-TB FQ may need to receive XDR-TB treatment.