Tuberculosis Treatment Success Rate In Europe Falls Short Of WHO Targets

Main Category: Tuberculosis
Article Date: 28 Aug 2005 - 19:00 PDT

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The resurgence of tuberculosis (TB) in western countries since 1986 has been attributed to the HIV epidemic, immigration and drug resistance.

The WHO defined a strategy to fight this trend, including a standardised therapy specifying appropriate drugs, doses, and timing of therapy, and set the target of treatment success in 85% of infectious TB cases.

Annunziata Faustini (Local Health Agency RME, Rome, Italy) and her British and Italian colleagues conducted a systematic review of published reports to estimate TB treatment outcomes in European countries and identify the determinant factors. Twenty-six papers, regarding 13 European countries during the period 1988-2001, were included in the review.

The factors analysed were age, gender, immigrant status, and multidrug-resistance (MDR), defined as resistance to the isoniazid and rifampicin. This last factor presents a serious challenge to TB control, because standardised therapy is less effective in these patients; moreover, MDR has a particular significance in public health as it is usually due to a previous inadequate treatment of TB.

On average, the studies found that 74.4% of outcomes were "successful", falling short of the 85% target. Patients were treated "unsuccessfully" 12.3% of the time, and 6.8% of treated patients died. Populations with at least 10% MDR had the worst treatment success rates.

Surprisingly, no relationship was found between TB treatment outcomes and immigrant status, perhaps because all immigrants were aggregated together regardless of country of origin.

These results suggest clinical and public health implications. Firstly, since successful TB treatment outcomes are below the 85% threshold, enhancement of national TB control programmes is desirable in most European countries. Secondly, MDR is the most important obstacle in the successful control of TB. Thirdly, analysing immigrants by specific country of origin, timing of immigration and previous treatment would help define the risk of MDR-TB associated with immigrants. And finally, treatment characteristics not analysed in the above papers need to be more consistently reported in order to identify and correct the factors related to inadequate treatment of TB in Europe.

The European Respiratory Journal is the peer-reviewed scientific publication of the European Respiratory Society (more than 7,000 specialists in lung diseases and respiratory medicine in Europe, the United States and Australia).

http://erj.ersjournals.com

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