Multidrug-resistant tuberculosis: long-term treatment outcome in the Netherlands

SETTING: Tuberculosis units (Beatrixoord, Haren; and Dekkerswald, Groesbeek) in the Netherlands. OBJECTIVE: TO study the long-term treatment outcome of patients with multidrug-resistant tuberculosis (MDR-TB). DESIGN: Descriptive analysis of all consecutively admitted patients with MDR-TB between 1 January 1985 and I September 1998, with follow-up until 1 August 1999. RESULTS: Of 44 patients (31 male) enrolled in the study, 33 were foreign born and none were human immunodeficiency virus positive. At diagnosis 38 patients had sputum-smear positive pulmonary TB, and convened culture negative after a mean of 6 weeks, while six convened to negative later (mean 69 weeks). Most patients had micro-organisms resistant to several antimycobacterial drugs (mean = median: 5), including resistance to isoniazid and rifampin. In-patient treatment lasted a mean of 164 days (range 31-481), and patients were treated with six drugs on average. Side effects were common. Treatment lasted for a mean of 608 days (range 268-1626); five patients are still on treatment. Four patients were operated for TB, and two others were operated for post-TB sequelae. During the follow-up Period six patients died, of whom three had active TB; 33 (75%) were considered cured. CONCLUSION: Mortality was only 14% after a mean follow-up period of 53 months. MDR-TB can be successfully treated, but requires much effort from both patients and carers, and the costs may be higher than is affordable in resource-poor countries.