Bedaquiline microheteroresistance after cessation of tuberculosis treatment
Date
2019-05-30
Journal Title
Journal ISSN
Volume Title
Publisher
Massachusetts Medical Society
Abstract
ENGLISH ABSTRACT: Bedaquiline improves survival among persons with multidrug-resistant tuberculosis (MDR-TB).1 We report the case of a 65-year-old South African man who was negative for human immunodeficiency virus and in whom MDR-TB was diagnosed in 2013 (resistant to rifampin and isoniazid; phenotypically susceptible to a fluoroquinolone and amikacin). A baseline radiograph showed changes consistent with bilateral tuberculosis with left apex cavitation. He started standardized treatment that included moxifloxacin, pyrazinamide, kanamycin, ethionamide, isoniazid, and terizidone. After initial sputum culture conversion (at month 3) and clinical improvement, the patient again became culture-positive, and bilateral cavitation developed. After detection of phenotypic resistance to fluoroquinolones (at month 6), his treatment was revised (at month 8) to include high-dose isoniazid, ethambutol, pyrazinamide, terizidone, linezolid, paraaminosalicylic acid, and kanamycin (Figure 1 and the Supplementary Appendix, available with the full text of this letter at NEJM.org). Bedaquiline was added 22 days later and was administered for 6 months.2 The patient remained culture-positive (treatment failure), and treatment was stopped 15 months after revision of the regimen. The patient died 7 months later.
Description
CITATION: de Vos, M. et al. 2019. Bedaquiline microheteroresistance after cessation of tuberculosis treatment. New England Journal of Medicine, 380(22):2178-2180. doi:10.1056/NEJMc1815121
The original publication is available at https://www.nejm.org/
The original publication is available at https://www.nejm.org/
Keywords
Tuberculosis, Bedaquiline Microheteroresistance, Multidrug-resistant tuberculosis -- Treatment, Mycobacterium tuberculosis