To search for optimal tactics for MDR cavitary tuberculosis

<b>Background:</b> Treatment of cavitary multi-drug resistant (MDR) and extensively drug resistant tuberculosis (XDR) remains to be a very difficult problem. A major issue is that lung cavities contain a great amount of Mycobacterium tuberculosis, and are inaccessible to drug therapies. The aim of this study is to elaborate optimal treatment strategy in cavitary drug resistant tuberculosis by addition of collapse procedures and surgery <b>Methods:</b> The study included 269 patients who completed the treatment during 2015-2017 years. MDR and XDR TB had 171 and 98 patients respectively. The therapy was based on the drug susceptibility test results. The therapy was conducted in accordance with WHO guidelines. If the cavity and/or the perifocal infiltration had not decreased by at least a half of its initial size during 1,5-2 months of the treatment collapse therapy namely artificial pneumothorax (AP) (N=52), and endobronchial valve treatment (EBV) (N=144) was added. Surgery was necessary in 25 cases when lung cavity persisted despite any treatment modes. <b>Results:</b> Overall sputum conversion rate confirmed by culture test was 91.4% (246 of 269 cases). In MDR TB and XDR TB these rates were 97.1% and 81.6% respectively. Chemotherapy only was successful in 51 cases (all MDR TB). Closure of the lung cavities and sputum conversion were achieved after AP and EBV in 96.1% and 86.1% cases respectively. No major complications occurred after surgical interventions. Surgery was successful in 21 of 25 cases (84%). <b>Conclusion:</b> Our data indicate that the prompt change of treatment tactics may give favorable results of treatment. Collapse therapy and surgery appeared to be a good supplementation to the treatment in this hard group of patients.