Peculiarities and results of treatment in XDR pulmonary tuberculosis (PTB)

Objectives. There is no a single approach to the treatment of XDR PTB so the results of treatment are still unsatisfactory. The aims of the study are to examine its features and find optimal way of the treatment. Materials and methods. Between 2004 and 2011, 58 patients completed the treatment. Average age was 30,6 years. Close contact with PTB was in 30 (51,7%). All the patients were with failure of previous treatment. There has been resistance to at least H,R,Fq and one of injectional second-line drugs. Initially MDR was in 17 patients, XDR in 8 (all from household death contact!). Amplification of drug resistance to XDR has been formed over three years. All patients received individualized therapy based on DST for at least 2 years. Later–generation fluoroquinolones – Lfx or Mfx. When resistance to Km we used Cm. Of oral bacteriostatic 2nd –line Pto, Cs, PAS. Of drug group 5 - Amx/Clv, Clr. Artificial pneumothorax and pneumoperitoneum was applied in 26 patients, surgery was performed in16. Results. Sputum culture conversion was achieved in 37 (63,7%) patients including those subjected to collapse therapy and/or surgery. Late results were followed in 50 cases. Culture remains negative in 32 (64%) of patients including 22 of 26 after collapse therapy and 14 of 16 after surgery. That was confirmed by multiple sputum culture examination in terms of more than a year. Conclusion. The development of XDR PTB resulted from close household contact, low adherence and lack of proper initial treatment. Application of collapse therapy and surgery along with individualized therapy can improve the outcome.