A review of the efficacy of multi-drug resistant tuberculosis regimens used at Charlotte Maxeke Johannesburg academic hospital

Tulloch, Jared
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Background: South Africa has a high burden of drug resistant Tuberculosis (DR-TB) and the impact of the initiation of a new drug resistant therapy regimen with the availability of bedaquiline and linezolid remains to be seen in this setting. Objectives: To describe the drug regimens and outcomes of patients diagnosed with DR-TB treated at Charlotte Maxeke Academic Hospital (CMJAH) TB clinic. Methods: The data was collected retrospectively and inserted into a data sheet. The files used were those of patients residing in central Johannesburg with confirmed drug resistant TB that received one of the drug resistant regimens at the specialist clinic over the period 01 January 2015 to 30 June 2019. Results: There were 105 individuals who satisfied the research criteria, 75% of the group was HIV positive. 72 patients had rifampicin mono-resistant tuberculosis and 33 had multi-drug resistant tuberculosis. Four regimens were identified: old injectable long course (15%), old injectable short course (4%), new bedaquiline long course (2%) and new bedaquiline short course (24%). The remaining 55% received individualized regimens. The overall cure rate for the period under review was 54% with a mortality rate of 9% and loss to follow up of 16%. In the group that received a bedaquiline based regimen 60% achieved cure, 49% of the injectable group and 62% that received a combination of injectable and bedaquiline therapy during their modified regimen achieved cure. Conclusion: The older injectable regimens showed comparable efficacy when cure rate was looked at in isolation. The areas of significant improvement in instituting a drug regimen that has a shorter duration of therapy, fewer side effects and easier administration method will likely reveal itself in years to come.
A research report submitted in partial fulfilment of the requirements for the degree of Master of Medicine in Internal Medicine to the Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, 2021