INCREASING THE EFFICIENCY OF PATIENTS WITH PULMONARY TUBERCULOSIS TREATMENT WITH THE USE OF NEW THERAPY REGIMENS

Abstract

Introduction: Improving the effectiveness of treatment of the most difficult category of patients with extensively drug-resistant tuberculosis is still relevant in the present circumstances. Efficacy of therapy is not higher than 35,7%. New therapy regimes with the use of bedaquiline and pyridinium perchlorate were recommended for extended drug resistance treatment. Aim. Aim of the study is to compare efficacy of new regimes of treatment with the use of bedaquiline and pyridinium perchlorate in patients with extended drug resistance of mycobacterium. Material and methods. Retrospective study with analysis of therapy in 150 patients with extended drug resistance tuberculosis, who were treated in the period from 2016 till 2019, divided into three groups: (I-st group, n=80) – standard therapy; (II-nd group, n=47) – regime with pyridinium perchlorate; and III-rd group (n=23) – regime with bedaquiline. Analysis was performed for clinical, laboratory, and radiology assessments. Evaluation of treatment efficacy was done based on criteria defined in the international guidance. Results and discussions. To the end of hospitalization stage of therapy, in the group with bedaquivilin cessation of bacterial excretion in extended drug resistance tuberculosis patients was observed significantly more frequent than in the group of standard therapy without Bq (60,8% (III) vs 30,0% (I), p˂0,01). In the II group of cessation was also significantly more frequent than in the group of standard therapy without pyridinium perchlorate (57,8% (III) vs 30,0% (I), p˂0,01). Efficacy to the end of treatment assessed by positive roentgenologic dynamic was 78,2% и 57,8% (p˂0,0001) for 6-8 months of treatment by bedaquiline and pyridinium perchlorate correspondently, that was significantly more frequent than in the I-st group (25%). Based on performed analysis inclusion of this antituberculosis drugs in therapy of extended drug resistance tuberculosis patients is associated with increase of its efficacy ((р=0,0046, ОР=0,7325, 95%Сl 0,3 – 1,65%, PPV=0,6140, NPV=0,1618). Comparison of general parameters of efficacy demonstrates significantly high percent of treatment efficacy in extended drug resistance tuberculosis patients while addition into therapy new antituberculosis drugs. Significant difference between groups for surveillance, while addition of new antituberculosis drugs, was not observed. Conclusion. Results of the study demonstrate opportunities to increase treatment efficacy with addition of new antituberculosis drugs. Nevertheless, efficacy of treatment limited by 6-8 months, that allows to recommend extension of treatment duration by new antituberculosis drugs, and as well to implement other methods to increase its efficacy.