Volume 89, Issue 2
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



A systematic review of the literature was conducted on the effectiveness of MDR-TB management. A meta-analysis of treatment outcomes of patients treated in hospitals versus ambulatory-based models was performed in accordance with PRISMA guidelines. The pooled treatment success rate was 66.4% (95% confidence interval [CI] 61.4–71.1%), with no statistical difference between ambulatory (65.5%; 55.1–74.6%) and hospital-based models (66.7%; 61.0–72.0%). The pooled death rate was 10.4% (6.3–16.5%), the pooled treatment failure rate was 9.5% (7.3–12.4%), and the defaulter rate was 14.3% (10.5–19.1%). None of the differences between the two models were statistically significant for any of the outcomes considered. This work improves the quality of the evidence available supporting the World Health Organizations (WHO) recommendation that patients be treated using mainly ambulatory care, conditional on infection control measures in the home and clinic, clinical condition of the patient, availability of treatment support to facilitate adherence to treatment, and provisions for backup facility to manage patients who need inpatient treatment care.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. World Health Organization, 2010. Global TB Control: WHO Report 2010. WHO/HTM/TB/2010.7. [Google Scholar]
  2. Nathanson E, Nunn P, Uplekar M, Floyd K, Jaramillo E, Lönnroth K, Weil D, Raviglione M, , 2010. MDR-TB tuberculosis: critical steps for prevention and control. N Engl J Med 363: 10501058.[Crossref] [Google Scholar]
  3. Fitzpatrick C, Floyd K, , 2012. A systematic review of the cost and cost effectiveness of treatment for multidrug-resistant tuberculosis. Available at: http://www.ncbi.nlm.nih.gov/pubmed/22070215. PharmacoEconomics 30: 6380. doi:10.2165/11595340-000000000-00000.[Crossref] [Google Scholar]
  4. Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group, , 2009. Preferred reporting items for Systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6: e1000097.[Crossref] [Google Scholar]
  5. Conn VS, Valentine JC, Cooper HM, Rantz MJ, , 2003. Grey literature in meta-analyses. Nurs Res 52: 256261.[Crossref] [Google Scholar]
  6. Tahaoglu K, Torun T, Atac G, Kir A, Karasulu L, Ozmen I, Kapakli N, , 2001. The treatment of multidrug-resistant tuberculosis in Turkey. N Engl J Med 345: 170174.[Crossref] [Google Scholar]
  7. Bártů V, Hricíková I, Kopecká E, Vasáková M, , 2003. Results of treatment of multiresistant tuberculosis. Cas Lek Cesk 142: 226228. [Google Scholar]
  8. WHO, 2006. Guidelines for the Programmatic Management of Drug-Resistant Tuberculosis. WHO/HTM/TB/2006.361. [Google Scholar]
  9. Goble M, Iseman MD, Madsen LA, Waite D, Ackerson L, Horsburgh CR, Jr, 1993. Treatment of 171 patients with pulmonary tuberculosis resistant to isoniazid and rifampin. N Engl J Med 328: 527532.[Crossref] [Google Scholar]
  10. 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: 877884. [Google Scholar]
  11. Geerligs WA, van Altena R, de Lange WC, van Soolingen D, van der Werf TS, , 2000. Multidrug-resistant tuberculosis: long-term treatment outcome in the Netherlands. Int J Tuberc Lung Dis 4: 758764. [Google Scholar]
  12. Narita M, Alonso P, Lauzardo M, Hollender ES, Pitchenik AE, Ashkin D, , 2001. Tuberculosis in Florida, 1994–1997. Treatment experience of multidrug-resistant. Chest 120: 343348.[Crossref] [Google Scholar]
  13. Samman Y, Krayem A, Haidar M, Mimesh S, Osaba A, Al-Mowaallad A, Abdelaziz M, Wali S, , 2003. Treatment outcome of tuberculosis among Saudi nationals: role of drug resistance and compliance. Clin Microbiol Infect 9: 289294.[Crossref] [Google Scholar]
  14. Palmero DJ, Ambroggi M, Brea A, De Lucas M, Fulgenzi A, Martínez D, Mosca C, Musella R, Natiello M, Gonzalez C, Abbate E, , 2004. Treatment and follow-up of HIV-negative multidrug-resistant tuberculosis patients in an infectious diseases reference hospital, Buenos Aires, Argentina. Int J Tuberc Lung Dis 8: 778784. [Google Scholar]
  15. Park SK, Lee WC, Lee DH, Mitnick CD, Han L, Seung KJ, , 2004. Self-administered, standardized regimens for multidrug-resistant tuberculosis in South Korea. Int J Tuberc Lung Dis 8: 361368. [Google Scholar]
  16. Leimane V, Riekstina V, Holtz TH, Zarovska E, Skripconoka V, Thorpe LE, Laserson KF, Wells CD, , 2005. Clinical outcome of individualized treatment of multidrug-resistant tuberculosis in Latvia: a retrospective cohort study. Lancet 365: 318326.[Crossref] [Google Scholar]
  17. Ollé-Goig JE, Sandy R, , 2005. Outcomes of individualized treatment for multidrug-resistant tuberculosis before DOTS-Plus. Int J Tuberc Lung Dis 9: 765770. [Google Scholar]
  18. Holtz TH, Sternberg M, Kammerer S, Laserson KF, Riekstina V, Zarovska E, Skripconoka V, Wells CD, Leimane V, , 2006. Time to sputum culture conversion in multidrug-resistant tuberculosis: predictors and relationship to treatment outcome. Ann Intern Med 144: 650659.[Crossref] [Google Scholar]
  19. Munsiff SS, Ahuja SD, Li J, Driver CR, , 2006. Public-private collaboration for multidrug-resistant tuberculosis control in New York City. Int J Tuberc Lung Dis 10: 639648. [Google Scholar]
  20. Nathanson E, Lambregts-van Weezenbeek C, Rich ML, Gupta R, Bayona J, Blöndal K, Caminero JA, Cegielski JP, Danilovits M, Espinal MA, Hollo V, Jaramillo E, Leimane V, Mitnick CD, Mukherjee JS, Nunn P, Pasechnikov A, Tupasi T, Wells C, Raviglione MC, , 2006. Multidrug-resistant tuberculosis, management in resource-limited settings. Emerg Infect Dis 12: 13891397.[Crossref] [Google Scholar]
  21. Cox HS, Kalon S, Allamuratova S, Sizaire V, Tigay ZN, Rüsch-Gerdes S, Karimovich HA, Kebede Y, Mills C, , 2007. Multidrug-resistant tuberculosis treatment outcomes in Karakalpakstan, Uzbekistan: treatment complexity and XDR-TB among treatment failures. PLoS ONE 2: e1126.[Crossref] [Google Scholar]
  22. Shin SS, Pasechnikov AD, Gelmanova IY, Peremitin GG, Strelis AK, Mishustin S, Barnashov A, Karpeichik Y, Andreev YG, Golubchikova VT, Tonkel TP, Yanova GV, Yedilbayev A, Rich ML, Mukherjee JS, Furin JJ, Atwood S, Farmer PE, Keshavjee S, , 2007. Adverse reactions among patients being treated for MDR-TB in Tomsk, Russia. Int J Tuberc Lung Dis 11: 13141320. [Google Scholar]
  23. Eker B, Ortmann J, Migliori GB, Sotgiu G, Muetterlein R, Centis R, Hoffmann H, Kirsten D, Schaberg T, Ruesch-Gerdes S, Lange C, German TBNET Group, , 2008. Multidrug- and extensively drug-resistant tuberculosis, Germany. Emerg Infect Dis 14: 17001706.[Crossref] [Google Scholar]
  24. Masjedi MR, Tabarsi P, Chitsaz E, Baghaei P, Mirsaeidi M, Amiri MV, Farnia P, Javanmard P, Mansouri D, Velayati AA, , 2008. Outcome of treatment of MDR-TB patients with standardized regimens, Iran, 2002–2006. Int J Tuberc Lung Dis 12: 750755. [Google Scholar]
  25. Shean KP, Willcox PA, Siwendu SN, Laserson KF, Gross L, Kammerer S, Wells CD, Holtz TH, , 2008. Treatment outcome and follow-up of multidrug-resistant tuberculosis patients, West Coast/Winelands, South Africa, 1992–2002. Int J Tuberc Lung Dis 12: 11821189. [Google Scholar]
  26. Tupasi TE, Gupta R, Quelapio MI, Orillaza RB, Mira NR, Mangubat NV, Belen V, Arnisto N, Macalintal L, Arabit M, Lagahid JY, Espinal M, Floyd K, , 2006. Feasibility and cost-effectiveness of treating multidrug-resistant tuberculosis: a cohort study in the Philippines. PLoS Med 3: e352.[Crossref] [Google Scholar]
  27. Bartu V, Kopecka E, Havelkova M, , 2010. Factors associated with multidrug-resistant tuberculosis: comparison of patients born inside and outside of the Czech Republic. J Int Med Res 38: 11561163.[Crossref] [Google Scholar]
  28. Brust JCM, Gandhi NR, Carrara H, Osburn G, Padayatchi N, , 2010. High treatment failure and default rates for patients with multidrug-resistant tuberculosis in KwaZulu-Natal, South Africa, 2000–2003. Int J Tuberc Lung Dis 14: 413419. [Google Scholar]
  29. Heller T, Lessells RJ, Wallrauch CG, Bärnighausen T, Cooke GS, Mhlongo L, Master I, Newell ML, , 2010. Community-based treatment for multidrug-resistant tuberculosis in rural KwaZulu-Natal, South Africa. Int J Tuberc Lung Dis 14: 420426. [Google Scholar]
  30. Van Deun A, Salim MA, Das AP, Bastian I, Portaels F, , 2004. Results of a standardized regimen for multidrug-resistant tuberculosis in Bangladesh. Int J Tuberc Lung Dis 8: 560567. [Google Scholar]
  31. Van Deun A, Maug AK, Salim MA, Das PK, Sarker MR, Daru P, Rieder HL, , 2010. Short, highly effective, and inexpensive standardized treatment of multidrug-resistant tuberculosis. Am J Respir Crit Care Med 182: 684692.[Crossref] [Google Scholar]
  32. Uffredi ML, Truff-Pernot C, Dautzenberg B, Renard M, Jarlier V, Robert J, , 2007. An intervention programme for the management of multidrug-resistant tuberculosis in France. Int J Antimicrob Agents 29: 434439.[Crossref] [Google Scholar]
  33. Kim HJ, Hong YP, Kim SJ, Lew WJ, Lee EG, , 2001. Ambulatory treatment of multidrug-resistant pulmonary tuberculosis patients at a chest clinic. Int J Tuberc Lung Dis 5: 11291136. [Google Scholar]
  34. Ward HA, Marciniuk DD, Hoeppner VH, Jones W, , 2005. Treatment outcome of multidrug-resistant tuberculosis among Vietnamese immigrants. Int J Tuberc Lung Dis 9: 164169. [Google Scholar]
  35. Malla P, Kanitz EE, Akhtar M, Falzon D, Feldmann K, Gunneberg C, Jha SS, Maharjan B, Prasai MK, Shrestha B, Verma SC, Zignol M, , 2009. Ambulatory-based standardized therapy for multi-drug resistant tuberculosis: experience from Nepal, 2005–2006. PLoS ONE 4: e8313.[Crossref] [Google Scholar]
  36. Thomas A, Ramachandran R, Rehaman F, Jaggarajamma K, Santha T, Selvakumar N, Krishnan N, Mohan NS, Sundaram V, Wares F, Narayanan PR, , 2007. Management of multi drug resistance tuberculosis in the field: tuberculosis research centre experience. Indian J Tuberc 54: 117124. [Google Scholar]
  37. Mitnick C, Bayona J, Palacios E, Shin S, Furin J, Alcantara F, Sanchez E, Sarria M, Becerra M, Smith MC, Fawzi S, 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: 119128.[Crossref] [Google Scholar]
  38. Saravia JC, Appleton SC, Rich ML, Sarria M, Bayona J, Becerra MC, , 2005. Retreatment management strategies when first-line tuberculosis therapy fails. Int J Tuberc Lung Dis 9: 421429. [Google Scholar]
  39. Orenstein EW, Basu S, Shah NS, Andrews JR, Friedland GH, Moll AP, Gandhi NR, Galvani AP, , 2009. Treatment outcomes among patients with multidrug-resistant tuberculosis: systematic review and meta-analysis. Lancet Infect Dis 9: 153161.[Crossref] [Google Scholar]
  40. WHO, 2011. Choosing Interventions that Are Cost-Effective. Available at: http://www.who.int/choice/country/country_specific/en/index.html. [Google Scholar]
  41. Gelmanova IY, Keshavjee S, Golubchikova VT, Berezina VI, Strelis AK, Yanova GV, Atwood S, Murray M, , 2007. Barriers to successful tuberculosis treatment in Tomsk, Russian Federation: non-adherence, default and the acquisition of multidrug resistance. Bull World Health Organ 85: 703711.[Crossref] [Google Scholar]
  42. Crudu V, Arnadottir T, Laticevschi D, , 2003. Resistance to anti-tuberculosis drugs and practices in drug susceptibility testing in Moldova, 1995–1999. Int J Tuberc Lung Dis 7: 336342. [Google Scholar]

Data & Media loading...


  • Received : 02 Jan 2013
  • Accepted : 04 Apr 2013
  • Published online : 07 Aug 2013

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error