Multidrug-resistant tuberculosis in patients without HIV infection

E. E. Telzak, K. Sepkowitz, Peter L. Alpert, S. Mannheimer, F. Medard, W. El-Sadr, S. Blum, A. Gagliardi, N. Salomon, G. Turett

Research output: Contribution to journalArticle

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Abstract

Background. Investigations of outbreaks of multidrug-resistant tuberculosis have found low rates of treatment response and very high mortality, and they have mainly involved patients with advanced human immunodeficiency virus (HIV) infection. For patients without HIV infection, one study reported an overall rate of response to treatment of 56 percent, and the mortality from tuberculosis was 22 percent. We investigated treatment response and mortality rates in 26 HIV-negative patients in New York with multidrug-resistant tuberculosis. Methods. We obtained detailed data from seven teaching hospitals in New York City on patients with multidrug- resistant tuberculosis-defined as tuberculosis resistant at least to isoniazid and rifampin-who were HIV-negative on serologic testing. Lengths of times from diagnosis to the initiation of appropriate therapy and from the initiation of appropriate therapy to conversion to negative cultures were assessed. Therapeutic responses were evaluated by both microbiologic and clinical criteria. Results. Between March 1991 and September 1994, 26 HIV- negative patients were identified and treated. Of the 25 patients for whom adequate data were available for analysis, 24 (96 percent) had clinical responses; all 17 patients for whom data on microbiologic response were available had such a response. The median times from diagnosis to the initiation of appropriate therapy and from the initiation of therapy to culture conversion were 44 days (range, 0 to 181) and 69 days (range, 2 to 705), respectively. Side effects requiring the discontinuation of medication occurred in 4 of 23 patients (17 percent) who were treated with second-line antituberculosis medications. The median follow-up for the 23 patients who responded and who received appropriate therapy was 91 weeks (range, 41 to 225). Conclusions. In this report from New York City, HIV-negative patients with multidrug-resistant tuberculosis, contrary to previous reports, responded well to appropriate chemotherapy, both clinically and microbiologically.

Original languageEnglish (US)
Pages (from-to)907-911
Number of pages5
JournalNew England Journal of Medicine
Volume333
Issue number14
DOIs
StatePublished - 1995
Externally publishedYes

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Multidrug-Resistant Tuberculosis
Virus Diseases
HIV
Therapeutics
Mortality
Tuberculosis
Isoniazid
Rifampin
Teaching Hospitals
Disease Outbreaks
Drug Therapy

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Telzak, E. E., Sepkowitz, K., Alpert, P. L., Mannheimer, S., Medard, F., El-Sadr, W., ... Turett, G. (1995). Multidrug-resistant tuberculosis in patients without HIV infection. New England Journal of Medicine, 333(14), 907-911. https://doi.org/10.1056/NEJM199510053331404

Multidrug-resistant tuberculosis in patients without HIV infection. / Telzak, E. E.; Sepkowitz, K.; Alpert, Peter L.; Mannheimer, S.; Medard, F.; El-Sadr, W.; Blum, S.; Gagliardi, A.; Salomon, N.; Turett, G.

In: New England Journal of Medicine, Vol. 333, No. 14, 1995, p. 907-911.

Research output: Contribution to journalArticle

Telzak, EE, Sepkowitz, K, Alpert, PL, Mannheimer, S, Medard, F, El-Sadr, W, Blum, S, Gagliardi, A, Salomon, N & Turett, G 1995, 'Multidrug-resistant tuberculosis in patients without HIV infection', New England Journal of Medicine, vol. 333, no. 14, pp. 907-911. https://doi.org/10.1056/NEJM199510053331404
Telzak, E. E. ; Sepkowitz, K. ; Alpert, Peter L. ; Mannheimer, S. ; Medard, F. ; El-Sadr, W. ; Blum, S. ; Gagliardi, A. ; Salomon, N. ; Turett, G. / Multidrug-resistant tuberculosis in patients without HIV infection. In: New England Journal of Medicine. 1995 ; Vol. 333, No. 14. pp. 907-911.
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AU - Telzak, E. E.

AU - Sepkowitz, K.

AU - Alpert, Peter L.

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AU - Medard, F.

AU - El-Sadr, W.

AU - Blum, S.

AU - Gagliardi, A.

AU - Salomon, N.

AU - Turett, G.

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N2 - Background. Investigations of outbreaks of multidrug-resistant tuberculosis have found low rates of treatment response and very high mortality, and they have mainly involved patients with advanced human immunodeficiency virus (HIV) infection. For patients without HIV infection, one study reported an overall rate of response to treatment of 56 percent, and the mortality from tuberculosis was 22 percent. We investigated treatment response and mortality rates in 26 HIV-negative patients in New York with multidrug-resistant tuberculosis. Methods. We obtained detailed data from seven teaching hospitals in New York City on patients with multidrug- resistant tuberculosis-defined as tuberculosis resistant at least to isoniazid and rifampin-who were HIV-negative on serologic testing. Lengths of times from diagnosis to the initiation of appropriate therapy and from the initiation of appropriate therapy to conversion to negative cultures were assessed. Therapeutic responses were evaluated by both microbiologic and clinical criteria. Results. Between March 1991 and September 1994, 26 HIV- negative patients were identified and treated. Of the 25 patients for whom adequate data were available for analysis, 24 (96 percent) had clinical responses; all 17 patients for whom data on microbiologic response were available had such a response. The median times from diagnosis to the initiation of appropriate therapy and from the initiation of therapy to culture conversion were 44 days (range, 0 to 181) and 69 days (range, 2 to 705), respectively. Side effects requiring the discontinuation of medication occurred in 4 of 23 patients (17 percent) who were treated with second-line antituberculosis medications. The median follow-up for the 23 patients who responded and who received appropriate therapy was 91 weeks (range, 41 to 225). Conclusions. In this report from New York City, HIV-negative patients with multidrug-resistant tuberculosis, contrary to previous reports, responded well to appropriate chemotherapy, both clinically and microbiologically.

AB - Background. Investigations of outbreaks of multidrug-resistant tuberculosis have found low rates of treatment response and very high mortality, and they have mainly involved patients with advanced human immunodeficiency virus (HIV) infection. For patients without HIV infection, one study reported an overall rate of response to treatment of 56 percent, and the mortality from tuberculosis was 22 percent. We investigated treatment response and mortality rates in 26 HIV-negative patients in New York with multidrug-resistant tuberculosis. Methods. We obtained detailed data from seven teaching hospitals in New York City on patients with multidrug- resistant tuberculosis-defined as tuberculosis resistant at least to isoniazid and rifampin-who were HIV-negative on serologic testing. Lengths of times from diagnosis to the initiation of appropriate therapy and from the initiation of appropriate therapy to conversion to negative cultures were assessed. Therapeutic responses were evaluated by both microbiologic and clinical criteria. Results. Between March 1991 and September 1994, 26 HIV- negative patients were identified and treated. Of the 25 patients for whom adequate data were available for analysis, 24 (96 percent) had clinical responses; all 17 patients for whom data on microbiologic response were available had such a response. The median times from diagnosis to the initiation of appropriate therapy and from the initiation of therapy to culture conversion were 44 days (range, 0 to 181) and 69 days (range, 2 to 705), respectively. Side effects requiring the discontinuation of medication occurred in 4 of 23 patients (17 percent) who were treated with second-line antituberculosis medications. The median follow-up for the 23 patients who responded and who received appropriate therapy was 91 weeks (range, 41 to 225). Conclusions. In this report from New York City, HIV-negative patients with multidrug-resistant tuberculosis, contrary to previous reports, responded well to appropriate chemotherapy, both clinically and microbiologically.

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