{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T12:08:21Z","timestamp":1784549301362,"version":"3.55.0"},"reference-count":23,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2025,9,12]],"date-time":"2025-09-12T00:00:00Z","timestamp":1757635200000},"content-version":"vor","delay-in-days":11,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T00:00:00Z","timestamp":1756684800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Science Reports"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aims<\/jats:title>\n                    <jats:p>Bhutan first introduced the Shorter Regimen, consisting of a combination of Amikacin, Clofazamine, Ethionamide, Ethambutol, high dose Isoniazid, Moxifloxacin and Pyrazinamide, for the treatment of rifampicin or multidrug resistant tuberculosis (RR\/MDR\u2010TB) in 2018. This study describes the outcome, time to sputum conversion and adverse events of treatment among MDR\u2010TB patients treated with the Shorter Regimen in Bhutan.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was a longitudinal study among patients with RR\/MDR\u2010TB who were treated with the Shorten Regimen between 2018 and 2020. Throughout the treatment period, sputum smear, culture, and blood investigations were monitored.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>There were 52 patients who received the shorter regimen for MDR\u2010TB. Forty\u2010seven patients (90%) had pulmonary TB (PTB) and five (10%) had extra\u2010pulmonary TB (EPTB). Forty\u2010one patients (79%) had confirmed MDR\u2010TB and 11 (21%) had RR\u2010TB. MDR\u2010TB was detected in new cases in 35 patients (69%), while 11 (22%) were cases of TB relapse and five (10%) were cases of treatment failure. There were 40 patients (86%) who achieved sputum smear conversion by the end of 4 months while all patients became culture negative by the end of 3 months. All patients achieved culture conversion by the end of 3 months. The treatment success rate was 94% and there were no deaths. The common side effects were nausea, vomiting, arthralgia, dizziness, sleep disturbances, depressed mood and skin rash. QTc prolongations were observed in six patients, for which five patients needed dose modification of Moxifloxacin. Five patients had hepatitis, and two needed dose modification. Two patients were switched to the longer regimen due to amikacin\u2010induced profound hearing loss and nephrotoxicity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The treatment success rate of MDR\u2010TB was high, with high sputum and culture conversion rates. Adequate monitoring of side effects is important in providing timely intervention.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/hsr2.71241","type":"journal-article","created":{"date-parts":[[2025,9,12]],"date-time":"2025-09-12T09:16:16Z","timestamp":1757668576000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Outcomes and Adverse Events of WHO Shorter Regimen in the Treatment of Multi\u2010Drug Resistant Tuberculosis in Bhutan: A Longitudinal Study"],"prefix":"10.1002","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2434-7151","authenticated-orcid":false,"given":"Gaki","family":"Nima","sequence":"first","affiliation":[{"name":"Department of Internal Medicine Jigme Dorji Wangchuck National Referral Hospital Thimphu Bhutan"},{"name":"Department of Geriatrics and Rehabilitation Medicine Sir Charles Gairdner and Osborne Park Hospital Perth Western Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4932-8704","authenticated-orcid":false,"given":"Thinley","family":"Dorji","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Central Regional Referral Hospital Gelephu Bhutan"},{"name":"Faculty of Postgraduate Medicine Khesar Gyalpo University of Medical Sciences of Bhutan Thimphu Bhutan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chencho","family":"Dorji","sequence":"additional","affiliation":[{"name":"Tuberculosis Unit Gidakom Hospital Thimphu Bhutan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3863-2666","authenticated-orcid":false,"given":"Tandin","family":"Zangpo","sequence":"additional","affiliation":[{"name":"Tuberculosis Unit Gidakom Hospital Thimphu Bhutan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,9,12]]},"reference":[{"key":"e_1_2_13_2_1","unstructured":"World Health Organization \u201cGlobal Tuberculosis Report 2022 \u201d Geneva: World Health Organization published 2022."},{"key":"e_1_2_13_3_1","unstructured":"World Health Organization \u201cGlobal Tuberculosis Report 2024 \u201d Geneva: World Health Organization published 2024."},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-017-4779-5"},{"key":"e_1_2_13_5_1","unstructured":"World Health Organization \u201cThe End Strategy TBT. End TB Strategy \u201d 53 (2015): 1689\u20131699."},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.coph.2018.05.013"},{"key":"e_1_2_13_7_1","volume-title":"Consolidated Guidelines on Tuberculosis Treatment: Drug\u2010Resistant Tuberculosis Treatment","author":"World Health Organization","year":"2020"},{"key":"e_1_2_13_8_1","unstructured":"Ministry of Health \u201cAnnual Health Bulletin\u201d (Thimphu: Royal Government of Bhutan 2018)."},{"key":"e_1_2_13_9_1","unstructured":"Ministry of Health \u201cIntegrated National Guidelines for Management of Tuberculosis in Bhutan\u201d (Thimphu: Ministry of Health Royal Government of Bhutan 2024)."},{"key":"e_1_2_13_10_1","unstructured":"Ministry of Health \u201cNational Strategic Plan To End TB in Bhutan 2017\u20132023. Second\u201d (Ministry of Health Royal Government of Bhutan 2017)."},{"key":"e_1_2_13_11_1","volume-title":"Integrated National Guidelines for Management of Tuberculosis in Bhutan","author":"Ministry of Health","year":"2020"},{"key":"e_1_2_13_12_1","volume-title":"WHO Treatment Guidelines for Drug\u2010Resistant Tuberculosis: 2016 Update","author":"Word Health Organization","year":"2016"},{"key":"e_1_2_13_13_1","volume-title":"WHO Consolidated Guidelines on Drug\u2010Resistant Tuberculosis Treatment","author":"World Health Organization","year":"2020"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.4081\/monaldi.2021.1679"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(22)01883-9"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0263304"},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.4103\/jfmpc.jfmpc_1723_22"},{"key":"e_1_2_13_18_1","doi-asserted-by":"publisher","DOI":"10.1177\/10105395251318112"},{"key":"e_1_2_13_19_1","doi-asserted-by":"publisher","DOI":"10.3126\/nje.v10i3.28397"},{"key":"e_1_2_13_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(22)02078-5"},{"key":"e_1_2_13_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijregi.2022.04.012"},{"key":"e_1_2_13_22_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0241923"},{"key":"e_1_2_13_23_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0236250"},{"key":"e_1_2_13_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.heliyon.2021.e06573"}],"container-title":["Health Science Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/hsr2.71241","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/hsr2.71241","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/hsr2.71241","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T11:42:58Z","timestamp":1784547778000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/hsr2.71241"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9]]},"references-count":23,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2025,9]]}},"alternative-id":["10.1002\/hsr2.71241"],"URL":"https:\/\/doi.org\/10.1002\/hsr2.71241","archive":["Portico"],"relation":{},"ISSN":["2398-8835","2398-8835"],"issn-type":[{"value":"2398-8835","type":"print"},{"value":"2398-8835","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9]]},"assertion":[{"value":"2025-02-13","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-08-12","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-09-12","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e71241"}}