A systematic review of clinical outcomes on the WHO Category II retreatment regimen for tuberculosis

OBJECTIVE: To assess the clinical outcomes of patients prescribed the World Health Organization (WHO) Category II retreatment regimen for tuberculosis (TB).DESIGN: A systematic review of the literature was performed by searching Medscape, Embase and Scopus databases for cohort studies and clinical t...

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Bibliographic Details
Published in:The international journal of tuberculosis and lung disease 2018-10, Vol.22 (10), p.1127-1134
Main Authors: Cohen, D. B., Meghji, J., Squire, S. B.
Format: Article
Language:English
Subjects:
Clinical outcomes
Clinical trials
Cure
Drug resistance
HIV
Human immunodeficiency virus
Isoniazid
Literature reviews
Medical research
Original
Patients
Recurrent
Relapse
Streptomycin
Subgroups
Systematic review
Tuberculosis
Viruses
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Summary:OBJECTIVE: To assess the clinical outcomes of patients prescribed the World Health Organization (WHO) Category II retreatment regimen for tuberculosis (TB).DESIGN: A systematic review of the literature was performed by searching Medscape, Embase and Scopus databases for cohort studies and clinical trials reporting outcomes in adult patients on the Category II retreatment regimen.RESULTS: The proportion of patients successfully completing the retreatment regimen varied from 27% to 92% in the 39 studies included in this review. In only 2/39 (5%) studies was the treatment success rate > 85%. There are very few data concerning outcomes in patients categorised as 'other', and outcomes in this subgroup are variable. Of the five studies reporting disaggregated outcomes in human immunodeficiency virus (HIV) positive people, four demonstrated worse outcomes than in HIV-negative people on the retreatment regimen. Only four studies reported disaggregated outcomes in patients with isoniazid (INH) resistance, and treatment success rates varied from 11% to 78%.CONCLUSION: Clinical outcomes on the Category II retreatment regimen are poor across various populations. Improvements in management should consider the holistic treatment of comorbidity and comprehensive approaches to drug resistance in patients with recurrent TB, including a standardised approach for the management of INH resistance in patients who develop recurrent TB in settings without reliable access to comprehensive drug susceptibility testing.
ISSN:1027-3719
1815-7920
DOI:10.5588/ijtld.17.0705