Skip to main content

Advertisement

SpringerLink
Log in

Multidrug-resistant tuberculosis in Russia: clinical characteristics, analysis of second-line drug resistance and development of standardized therapy

  • Concise Article
  • Published:
European Journal of Clinical Microbiology and Infectious Diseases Aims and scope Submit manuscript

Abstract

The aim of the study presented here was to identify patients with multidrug resistant tuberculosis (MDRTB) in the Samara region of Russia and to analyze the susceptibility of their isolates to second-line drugs in order to develop an empirical, standard, second-line treatment regimen. Treatment of MDRTB can be individualized based on in vitro laboratory analysis or standardized. In the latter case there is still a need to ascertain local second-line drug-resistance patterns. Described here are the clinical characteristics of 251 MDRTB patients identified in the study and the second-line drug susceptibility of 69 MDRTB isolates obtained from them. Antimicrobial resistance to the following agents was detected in the isolates: rifabutin (88.2%), streptomycin (42.8%), amikacin (7.2%), doxycycline (7.4%), ciprofloxacin (4.3%), clofazimine (2.9%), cycloserine (7.4%), and prothionamide (1.5%). The results of the study indicate it is possible to develop a standard, effective, clinical treatment regimen using ethambutol, pyrazinamide, prothionamide, a fluoroquinolone and amikacin.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. World Health Organization (2000) Anti-tuberculosis drug resistance in the world. Report no. 2: prevalence and trends. WHO, Geneva

  2. Kimerling ME, Slavuckij A, Chavers S, Peremtin G, Tonkel T, Sirotkina O, Golubchikova V, Baddeley A (1999) The risk of MDR-TB and polyresistant tuberculosis among the civilian population of Tomsk city, Siberia, 1999. Int J Tuberc Lung Dis 7:866–872

    Google Scholar 

  3. Narvskaia OV, Vishnevskii BA, El’kin AV, Mokrousov IV, Limeshchenko EV, Otten TF, Ostashko OM, Ariel BM (2002) Molecular genetic characteristics of Mycobacterium tuberculosis isolated from patients operated on for pulmonary tuberculosis. Probl Tuberk 3:50–53

    Google Scholar 

  4. Drobniewski F, Balabanova Y, Coker R (2004) Clinical features, diagnosis, and management of multiple drug-resistant tuberculosis since 2002. Curr Opin Pulm Med 10:211–217

    Google Scholar 

  5. Toungoussova S, Caugant DA, Sandven P, Mariandyshev AO, Bjune G (2002) Drug resistance of Mycobacterium tuberculosis strains isolated from patients with pulmonary tuberculosis in Archangels, Russia. Int J Tuberc Lung Dis 6:406–414

    Google Scholar 

  6. Viljanen MK, Vyshnevskiy BI, Otten TF, Vyshnevskaya E, Marjamaki M, Soini H, Laippala PJ, Vasilyef AV (1998) Survey of drug-resistant tuberculosis in northwestern Russia from 1984 through 1994. Eur J Clin Microbiol Infect Dis 17:177–183

    Google Scholar 

  7. Kherosheva T, Thorpe LE, Kiryanova E, Rybka L, Gerasichev V, Shulgina M, Nemtsova E, Aptekar T, Kluge H, Jakubowiak W, Grzemska M, Aquino G, Wells C, Kazionny B (2003) Encouraging outcomes in the first year of a TB control demonstration program: Orel Oblast, Russia. Int J Tuberc Lung Dis 7:1045–1051

    Google Scholar 

  8. Spradling P, Drociuk D, McLaughlin S, Lee LM, Peloquin CA, Gallicano K, Pozsik C, Onorato I, Castro KG, Ridzon R (2002) Drug-drug interactions in inmates treated for human immunodeficiency virus and Mycobacterium tuberculosis infection or disease: an institutional tuberculosis outbreak. Clin Infect Dis 35:1106–1112

    Google Scholar 

  9. Drobniewski F (1998) Drug-resistant tuberculosis in adults and its treatment. J R Coll Physicians Lond 32:314–318

    Google Scholar 

  10. Mitnick C, Bayona J, Palacios E, Shin S, Furin J, Alcantara F, Sanchez E, Sarria M, Becerra M, Fawzi MC, Kapiga S, Neuberg D, Maguire JH, Kim JY, Farmer P (2003) Community-based therapy for multidrug-resistant tuberculosis in Lima, Peru. N Engl J Med 348:119–128

    Google Scholar 

  11. Coker R (2002) Should tuberculosis programmes invest in second-line treatments for multidrug-resistant tuberculosis (MDR-TB)? Int J Tuberc Lung Dis 6:649–650

    Google Scholar 

  12. Suarez PG, Floyd K, Portocarrero J, Alarcon E, Rapiti E, Ramos G, Bonilla C, Sabogal I, Aranda I, Dye C, Raviglione M, Espinal MA (2002) Feasibility and cost-effectiveness of standardised second-line drug treatment for chronic tuberculosis patients: a national cohort study in Peru. Lancet 359:1980–1989

    Google Scholar 

  13. Canetti G, Fox W, Khomenko A, Mahler HT, Menon NK, Mitchison DA, Rist N, Smelev NA (1969) Advances in techniques of testing mycobacterial drug sensitivity, and the use of sensitivity tests in tuberculosis control programmes. Bull World Health Organ 41:21–43

    Google Scholar 

  14. Migliori GB, Espinal M, Danilova ID, Punga VV, Grzemska M, Raviglione MC (2002) Frequency of recurrence among MDR-TB cases ‘successfully’ treated with standardised short-course chemotherapy. Int J Tuberc Lung Dis 6:858–864

    Google Scholar 

  15. Espinal MA, Kim SJ, Suarez PG, Kam KM, Khomenko AG, Migliori GB, Baez J, Kochi A, Dye C, Raviglione MC (2000) Standard short-course chemotherapy for drug-resistant tuberculosis: treatment outcomes in 6 countries. JAMA 283:2537–2545

    Google Scholar 

  16. Park SK, Kim CT, Song SD (1998) Outcome of chemotherapy in 107 patients with pulmonary tuberculosis resistant to isoniazid and rifampin. Int J Tuberc Lung Dis 2:877–884

    Google Scholar 

  17. Goble M, Iseman MD, Madsen LA, Waite D, Ackerson L, Horsburgh CR (1993) Treatment of 171 patients with pulmonary tuberculosis resistant to isoniazid and rifampicin. N Engl J Med 328:527–532

    Google Scholar 

  18. Drobniewski F, Eltringham I, Graham C, Magee JG, Smith EG, Watt B. (2002) A national study of clinical and laboratory factors affecting the survival of patients with multiple drug resistant tuberculosis in the UK. Thorax 57:810–816

    Google Scholar 

  19. Ruddy M, Balabanova Y, Graham G, Fedorin I, Malomanova N, Elisarova E, Kuznetznov S, Gusarova G, Zakharova S, Melentyev A, Krukova E, Golishevskaya V, Erokhin V, Drobniewski F (2004) Rates of drug resistance and risk factor analysis in civilian and prison patients with tuberculosis in Samara Region, Russia. Thorax (in press)

  20. Yew WW, Chan CK, Leung CC, Chau CH, Tam CM, Wong PC, Lee J (2003) Comparative roles of levofloxacin and ofloxacin in the treatment of multidrug-resistant tuberculosis: preliminary results of a retrospective study from Hong Kong. Chest 124:1476–1481

    Google Scholar 

  21. Russia Federation Ministry of Health (2003) Prikaz on improving tuberculosis control activities in the Russian Federation

Download references

Acknowledgments

We would like to thank the Samara Regional TB service dispensaries and hospitals for their valuable support in the implementation of the study. We are particularly grateful to the doctors and nurses as well as the patients who took part in the study. This work was funded by the UK Department for International Development (CNTR 00 0134). None of the authors or the sponsor had any conflict of interest in the study

Author information

Authors and Affiliations

  1. Samara TB Service, Samara Oblast Dispensary, Samara, Russia

    Y. Balabanova, N. Malomanova & I. Fedorin

  2. HPA Mycobacterium Reference Unit, Department of Microbiology and Infection, Guy’s King’s and St Thomas’ Medical School, King’s College Hospital (Dulwich), East Dulwich Grove, London, SE22 8QF, UK

    M. Ruddy, J. Hubb, M. Yates & F. Drobniewski

Authors
  1. Y. Balabanova
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Ruddy
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. Hubb
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. Yates
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. N. Malomanova
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. I. Fedorin
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. F. Drobniewski
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to F. Drobniewski.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Balabanova, Y., Ruddy, M., Hubb, J. et al. Multidrug-resistant tuberculosis in Russia: clinical characteristics, analysis of second-line drug resistance and development of standardized therapy. Eur J Clin Microbiol Infect Dis 24, 136–139 (2005). https://doi.org/10.1007/s10096-004-1268-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10096-004-1268-4

Keywords

Search

Navigation