RESUMEN

Objetivo: Evaluar los resultados del retratamiento estandarizado de segunda línea y medir su eficacia y eficiencia. Métodos: Estudio retrospectivo con información de expedientes clínicos de pacientes con tuberculosis multifarmacorresistente (TB-MDR), ingresados a retratamiento de junio de 2003 a junio de 2005. Descripción de variables sociodemográficas, historial clínico y farmacológico, esquemas de retratamiento y la clasificación de egreso. Resultados: De los 55 pacientes que iniciaron el retratamiento, la media de resistencia a fármacos antituberculosis fue de 3.3, la mediana de fármacos en el retratamiento fue 4 (4-6). Al 91.7% se les vigilaron las reacciones adversas a fármacos (RAFAs), de éstos, el 93.2% tuvo alguna. El 66.7% tuvo probable curación, 18.8% fracaso, 6.3% abandono, 6.3% defunción y en el 2.1% se suspendió el retratamiento por RAFAs severas. La eficiencia fue de 58.2% (32/55) y la eficacia de 80% (32/40). Los pacientes con antecedente de contacto con un enfermo de TB tuvieron mayores resultados favorables que los que no tenían el antecedente. [OR: 3.6 (IC95% 0.95-15.19) p = 0.03]. Los pacientes residentes de Veracruz tuvieron más altas tasas de resultados desfavorables [OR: 6.4 (IC95% 1.46-32.20) p = 0.004]. Conclusión: Los resultados sugieren que el retratamiento estandarizado es eficaz, sobre todo para aquellos pacientes tratados previamente con fármacos de primera línea y es eficiente principalmente en aquellos pacientes tratados bajo la estrategia DOTS/TAES.

PALABRAS CLAVE

Resultados de tratamiento, TB-MDR, resistencias, tuberculosis multidrogorresistente, esquema estandarizado.

REFERENCIAS

1. Abdel AM, Wright A, Laszlo A, De-Muynck A, Portaels F, Van DA, et al. Epidemiology of antituberculosis drug resistance (the Global Project on Anti-tuberculosis Drug Resistance Surveillance): an updated analysis. Lancet 2006; 368: 2142-2154.

2. Espinal MA, Laserson K, Camacho M, Fusheng Z, Kim S J, Tlali E, et al. Determinants of drug-resistant tuberculosis: analysis of 11 countries. Int J Tuberc Lung Dis 2001; 5(10): 887-893.

3. Nettleman MD. Multidrug-resistant tuberculosis news from the front. JAMA 2005; 293(22): 2788-2790.

4. Anti-tuberculosis drug resistance in the world. Third global report. The WHO/IUATLD global project on anti-tuberculosis drug resistance surveillance, 1999-2002. Geneva, World Health Organization, 2004 (WHO/HTM/TB/2004.343).

5. Regional Plan for Tuberculosis control, 2006-2015. Pan American Health Organization Washington, D.C: PAHO, 2006.

6. Dirección General de Epidemiología. Secretaría de Salud, México. Anuarios de Morbilidad 1984-2004 Versión 2.0 (Anuarios de Morbilidad 84-04/DGE/SSA).

7. Global tuberculosis control: surveillance, planning, financing. WHO report 2003. Geneva, World Health Organization, 2003 (WHO/CDC/TB/2003.316).

8. Global tuberculosis control: surveillance, planning, financing. WHO report 2004. Geneva, World Health Organization, 2004 (WHO/HTM/TB/2004.331).

9. Global tuberculosis control: surveillance, planning, financing. WHO report 2005. Geneva, World Health Organization, 2005 (WHO/HTM/TB/2005.349).

10. Global tuberculosis control: surveillance, planning, financing. WHO report 2006. Geneva, World Health Organization, 2006 (WHO/HTM/TB/2006.362).

11. Granich RM, Balandrazo S, Santaella AJ, Binkin NJ, Castro KG, Márquez-Fiol A, et al. Survey of drug resistance of Mycobacterium tuberculosis in 3 Mexican States, 1997. Arch Intern Med 2000; 160: 639-644.

12. Caminero JA. Treatment of multidrug-resistant tuberculosis: evidence and controversies. Int J Tuberc Lung Dis 2006 Aug; 10(8): 829-37.

13. Caminero JA. Management of multidrug-resistant tuberculosis and patients in retreatment. Eur Respir J 2005; 25: 928-936.

14. Guidelines for the programmatic management of drug-resistant tuberculosis. Geneva, World Health Organization, 2006 (WHO/HTM/TB/2006.361).

15. Ward HA, Marciniuk DD, Hoeppner VH, Jones W. Treatment outcome of multidrug-resistant tuberculosis among Vietnamese inmigrants. Int J Tuberc Lung Dis 2005; 9(2): 164-169.

16. Burgos M, Gonzalez LC, Paz EA, Gournis E, Kawamura LM, Schecter G, Hopewell PC, Daley CL. Treatment of Multidrug-Resistant Tuberculosis in San Francisco: An Outpatient-Based Approach. CID 2005; 40 (1 April).

17. Ollé-Goig JE, Sandy R. Outcomes of individualized treatment for multidrug-resistant tuberculosis before DOTS-Plus. Int J Tuberc Lung Dis 2005; 9(7): 765-770.

18. Escudero E, Peña JM, Álvarez-Sala R, Vázquez JJ, Ortega A. Multidrug-resistant tuberculosis without HIV infection: success with individualized therapy. Int J Tuberc Lung Dis 2006; 10(4): 409-414.

19. Flement-Saillour M, Robert J, Jarlier V, Grosset J. Outcome of Multi-drug-resistant Tuberculosis in France A Nationwide Case-Control Study. Am J Respir Crit Care Med 1999; 160: 587-593.

20. Holtz TH, Sternberg M, Kammerer S, Laserson K F, Riekstina V, Zarovska E, et al. Time to sputum culture conversion in multidrug-resistant tuberculosis: Predictors and relationship to treatment outcome. Ann Intern Med 2006; 144: 650-659.

21. Van DA, Hamid SM, Kumar DA, Bastian I, Portales F. Results of a standardized regimen for multidrug-resistant tuberculosis in Bangladesh. Int J Tuberc Lung Dis 2004; 8(5): 560-567.

22. Park SK, Lee WC, Lee DH, Mitnick CD, Han L, Seung KJ. Self-administered, standardized regimens for multidrug-resistant tuberculosis in South Korea. Int J Tuberc Lung Dis 2004; 8(3): 361-368.

23. Guía para la atención de pacientes con tuberculosis multifarmacorresistente. México Secretaría de Salud, 2004 (ISBN: 970-721-175-X).

24. Wai YW, Kuen CC, Hung CC, Ming TC, Chiu LC, Chuen WP, Lee J. Outcomes of patients with multidrug-resistant pulmonary tuberculosis treated with ofloxacin/levofloxacin-containing regimens. CHEST 2000; 117: 744-751.

25. Ferrara G, Richeldi L, Bugiani M, Cirillo D, Besozzi G, Nutini S, et al. Management of multidrug-resistant tuberculosis in Italy. Int J Tuberc Lung Dis 2005; 9(5): 507-513.

26. Park MM, Davis AL, Schluger NW, Cohen H, Rom WN. Outcome of MDR-TB patients, 1983-1993 prolonged survival with appropriate therapy. Am J Respir Crit Care Med 1996; 153: 317-324.

27. Mitnick C, Bayona J, Palacios E, Shin S, Furin J, Alcántara F, et al. Community-based therapy for multidrug-resistant tuberculosis in Lima, Peru. N Engl J Med 2003; 348: 119-128.

28. Leimane V, Riekstina V, Holtz TH, Zarovska E, Skripconoka V, Thorpe LE, et al. Clinical outcome of individualized treatment of multidrug-resistant tuberculosis in Latvia: a retrospective cohort study. Lancet 2005; 365: 318-326.

29. Kim HJ, Hong YP, Kim SJ, Lew WJ, Lee EG. Ambulatory treatment of multidrug-resistant pulmonary tuberculosis patients at chest clinic. Int J Tuberc Lung Dis 2001; 5(12): 1129-1136.

30. Goble M, Iseman MD, Madsen LA, Waite D, Ackerson L, Horsburgh CR. Treatment of 171 patients with pulmonary tuberculosis resistant to isoniazid and rifampin. N Engl J Med 1993; 328: 527-532.

31. Telzak EE, Sepkowitz K, Alpert P, Mannheimer S, Medard F, El-Sadr W, et al. Multidrug-resistant tuberculosis in patients without HIV infection. N Engl J Med 1995; 333: 907-911.

32. Park SK, Tim SD, Song SD. Outcome of chemotherapy in 107 patients with pulmonary tuberculosis resistant to isoniazid and rifampin. Int J Tuberc Lung Dis 1998; 2(11): 877-884.

33. Shin SS, Pasechnikov AD, Gelmanova IY, Peremitin GG, Strelis AK, Andreev YG, et al. Treatment outcomes in an integrated civilian and prison MDR-TB treatment program in Russia. Int J Tuberc Lung Dis 2006; 10(4): 402-409.

34. Chan ED, Laurel V, Strand MJ, Chan JF, Huynh MN, Goble M, Iseman MD. Treatment and outcome analysis of 205 patients with multidrug-resistant tuberculosis. Am J Respir Crit Care Med 2004; 169: 1103-1109.

35. Narita M, Alonso P, Lauzardo M, Hollender ES, Pitchenik AE, Ashkin D. Treatment experience of multidrug-resistant tuberculosis in Florida, 1994-1997. Chest 2001; 120: 343-348.

36. Tahaolu K, Törün T, Sevim T, Ataç G, Kir A, Karasulu L, Özmen I, Kapakli N. The Treatment of multidrug-resistant tuberculosis in Turkey. N Engl J Med 2001; 345: 170-174.

37. Crofton J, Chaulet P, Maher D, et al. Guidelines for the management of drug-resistant tuberculosis. WHO/TB96.210. Geneva, Switzerland: WHO, 1997.

38. Laserson KF, Thorpe LE, Leimane V, Weyer K, Mitnick CD, Riekstina V, et al. Speaking the same language: treatment outcome definitions for multidrug-resistant tuberculosis. Int J Tuberc Lung Dis 2005; 9(6): 640-645.

39. Salazar-Lezama MA, Torres-Cruz A, Valdez-Vázquez R, López-Segundo E, Villarreal-Velarde H, Quiñones-Falconi F y cols. Resultados de tratamiento de tuberculosis resistente en 91 pacientes del Instituto Nacional de Enfermedades Respiratorias: 2001-2003. Rev Inst Nal Enf Resp Mex 2004; 17(1): 15-21.

40. Kritski AL, Rodrigues LS, Andrade M K, Werneck-Barroso E, Monteiro MA, Haffner A, et al. Retreatment tuberculosis cases. Factors associated with drug resistance and adverse outcomes. Chest 1997; 111(5): 1162-1167.

41. Espinal MA, Kim SJ, Suarez PG, Man KK, Khomenko AG, Migliori GB, et al. Standard short-course chemotherapy for drug-resistant tuberculosis. Treatment outcomes in 6 countries. JAMA 2000; 283(19): 2537-2545.

42. DeRiemer K, García-García L, Bobadilla-del-Valle M, Palacios-Martínez M, Martínez-Gamboa A, Small PM, et al. Does DOTS work in populations with drug-resistant tuberculosis? Lancet 2005; 365: 1239-1245.

43. Shin S, Furin J, Bayona J, Mate K, Yong KJ, Farmer P. Community-based treatment of multidrug-resistant tuberculosis in Lima, Peru: 7 years of experience. Social Science & Medicine 2004; 59: 1529-1539.

44. Raviglione M. XDR-TB: entering the post-antibiotic era? Int J Tuberc Lung Dis 10(11):1185-1187.

45. The Global Task Force on XDR-TB (Update February 2007). Stop TB Department. Geneva, World Health Organization.