Pulmonary resection combined with isoniazid- and rifampin-based drug therapy for patients with multidrug-resistant and extensively drug-resistant tuberculosis

• Published in: International journal of infectious diseases 2009-03, Vol.13 (2), p.170-175
• Main Authors: Park, Seung-Kyu, Kim, Jin-Hee, Kang, Hyungseok, Cho, Jeong Su, Smego, Raymond A
• Format: Article
• Language: English
• Subjects: Adult; Antibacterial agents; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antitubercular Agents - pharmacology; Antitubercular Agents - therapeutic use; Biological and medical sciences; Combined Modality Therapy; Drug Administration Schedule; Drug resistance; Drug Resistance, Multiple, Bacterial; Drug Therapy, Combination; Extensively Drug-Resistant Tuberculosis - drug therapy; Extensively Drug-Resistant Tuberculosis - microbiology; Extensively Drug-Resistant Tuberculosis - surgery; Female; Humans; Infectious Disease; Infectious diseases; Isoniazid - pharmacology; Isoniazid - therapeutic use; Korea; Lung - surgery; Male; MDR-TB; Medical sciences; Middle Aged; Mycobacterium tuberculosis - drug effects; Pharmacology. Drug treatments; Pneumonectomy; Pulmonary Surgical Procedures; Pulmonary/Respiratory; Resectional surgery; Rifampin - pharmacology; Rifampin - therapeutic use; Treatment Outcome; Tuberculosis; Tuberculosis, Multidrug-Resistant - drug therapy; Tuberculosis, Multidrug-Resistant - microbiology; Tuberculosis, Multidrug-Resistant - surgery; Tuberculosis, Pulmonary - drug therapy; Tuberculosis, Pulmonary - microbiology; Tuberculosis, Pulmonary - surgery; Young Adult
• ISSN: 1201-9712; 1878-3511
• DOI: 10.1016/j.ijid.2008.06.001

Summary Objective To evaluate the clinical efficacy of pulmonary resection and postoperative use of a first-line drug regimen for patients with well-localized, cavitary pulmonary multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB). Methods This was a prospective case study set in the National Masan Tuberculosis Hospital in Masan, Republic of Korea. From February 1998 to May 2004, 19 patients with well-localized, cavitary pulmonary MDR-TB or XDR-TB were enrolled and followed prospectively through April 2007. After radical surgical resection, patients were treated with anti-tuberculous therapy consisting of isoniazid (H), rifampin (R), ethambutol (E), pyrazinamide (Z), and streptomycin (S) (3HREZS/3HRES/6HRE). Results All recovered isolates of Mycobacterium tuberculosis were resistant to isoniazid and rifampin, and to a mean of 4.7 anti-tuberculous drugs (range 2–8 drugs). Seventeen patients had MDR-TB and two had XDR-TB. Surgical procedures included: lobectomy (14 patients), lobectomy plus segmentectomy or wedge resection (four patients), and pneumonectomy (one patient). The median time to postoperative sputum smear and culture conversion was 2 days (range 1–23 days). Fifteen (78.9%) subjects, including both with XDR-TB, had durable cures (mean follow-up period 53.2 months). One patient failed to convert her sputum and was successfully switched to second-line therapy. Another patient developed active disease again 68 months after cure, likely due to re-infection with a new M. tuberculosis strain. Two patients were lost to follow-up after hospital discharge. Conclusion Resectional lung surgery combined with isoniazid- and rifampin-based anti-tuberculous chemotherapy can be an effective treatment strategy for patients with well-localized, cavitary pulmonary MDR-TB and XDR-TB.