{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:48:55Z","timestamp":1760147335837,"version":"build-2065373602"},"reference-count":26,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2023,1,27]],"date-time":"2023-01-27T00:00:00Z","timestamp":1674777600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: There is a lack of information regarding the effective duration of treatment necessary to prevent the development of acquired resistance when fluoroquinolones (FQ), and\/or pyrazinamide (Z) resistance has occurred in patients with polydrug-resistant tuberculosis and isoniazid resistance. The management of these kinds of patients should be carried out in experienced centers according to drug susceptibility test results, clinical status of the patient and the extensity of the disease. Materials and Methods: We evaluated treatment regimens, treatment outcomes, and drug adverse effects in seven patients with polydrug-resistant tuberculosis, including those with Z and\/or FQ resistance in a retrospective analysis Results: Regarding the patients with polydrug-resistant tuberculosis in addition to isoniazid (H) resistance, three had Z, two had FQ, and the remaining two had both Z and FQ resistance. In the intensive phase of the treatment, the patients were given at least four drugs according to drug susceptibility tests, and at least three drugs in the continuation phase. The duration of treatment was 9\u201312 months. Two of the patients were foreign nationals, and could not be followed up with due to returning to their home countries. Regarding the remaining five patients, three of them were terminated as they completed treatment, and two as cured. No recurrence was observed in the first year of the treatment. The most common, and serious drug side effect was seen for amikacin. Conclusions: In patients with polydrug-resistant TB, if Z and\/or FQ resistance is detected in addition to H resistance, the treatment of these patients should be conducted on a case-by-case basis, taking into account the patient\u2019s resistance pattern, clinical condition, and disease prognosis. Close monitoring of the side effects will increase the success rate of the treatment.<\/jats:p>","DOI":"10.3390\/medicina59020246","type":"journal-article","created":{"date-parts":[[2023,1,30]],"date-time":"2023-01-30T04:31:27Z","timestamp":1675053087000},"page":"246","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Management of Polydrug-Resistant Tuberculosis"],"prefix":"10.3390","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6106-0080","authenticated-orcid":false,"given":"Mediha Gonenc","family":"Ortakoylu","sequence":"first","affiliation":[{"name":"Department of Pulmonary Medicine, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, University of Health Sciences Turkey, Istanbul 34020, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4969-4512","authenticated-orcid":false,"given":"Isil","family":"Kibar Akilli","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Disease, Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences Turkey, Istanbul 34149, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lutfiye","family":"Kilic","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, Ko\u00e7 University Hospital, Ko\u00e7 University, Istanbul 34010, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Belma","family":"Akbaba Bagci","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, University of Health Sciences Turkey, Istanbul 34020, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Esma Seda","family":"Akalin","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, University of Health Sciences Turkey, Istanbul 34020, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arzu Deniz","family":"Aksan","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, University of Health Sciences Turkey, Istanbul 34020, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sezer","family":"Toprak","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, University of Health Sciences Turkey, Istanbul 34020, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mehdi","family":"Mirsaeidi","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Florida, Jacksonville, FL 32611, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,1,27]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2022). Global Tuberculosis Report 2022, World Health Organization. Available online: https:\/\/www.who.int\/teams\/global-tuberculosis-programme\/tb-reports\/global-tuberculosis-report-2022."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"918","DOI":"10.1164\/ajrccm.156.3.9612016","article-title":"The DATRI 008 Study Group. Early Bactericidal Activity of Isoniazid in Pulmonary Tuberculosis: Optimization of Methodology","volume":"156","author":"Hafner","year":"1997","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_3","unstructured":"World Health Organization (2022, December 25). Global Tuberculosis Report 2019. WHO\/CDS\/TB\/2019.15. Available online: https:\/\/www.who.int\/publications\/i\/item\/9789241565714."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1016\/S1473-3099(16)30407-8","article-title":"Treatment of Isoniazid-Resistant Tuberculosis with First-Line Drugs: A Systematic Review and Meta-Analysis","volume":"17","author":"Gegia","year":"2017","journal-title":"Lancet Infect. Dis."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1016\/S2213-2600(18)30078-X","article-title":"Comparison of Different Treatments for Isoniazid-Resistant Tuberculosis: An Individual Patient Data Meta-Analysis","volume":"6","author":"Fregonese","year":"2018","journal-title":"Lancet Respir. Med."},{"key":"ref_6","unstructured":"WHO (2019). Consolidated Guidelines on Drug-Resistant Tuberculosis Treatment, World Health Organization. Available online: https:\/\/apps.who.int\/iris\/handle\/10665\/311389."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1185","DOI":"10.1016\/S1473-3099(16)30190-6","article-title":"Population-Based Resistance of Mycobacterium tuberculosis Isolates to Pyrazinamide and Fluoroquinolones: Results from a Multicountry Surveillance Project","volume":"16","author":"Zignol","year":"2016","journal-title":"Lancet Infect. Dis."},{"key":"ref_8","unstructured":"Curry International Tuberculosis Center, and California Department of Public Health (2016). Drug-Resistant Tuberculosis: A Survival Guide for Clinicians, Curry International Tuberculosis Center. [3rd ed.]. Available online: http:\/\/www.currytbcenter.ucsf.edu\/products\/drug-resistant-tuberculosis-survivalguide-clinicians-3rd-edition."},{"key":"ref_9","unstructured":"(2022, December 25). WHO Treatment Guidelines for Isoniazid-Resistant Tuberculosis: Supplement to the WHO Treatment Guidelines for Drug-Resistant Tuberculosis. Available online: https:\/\/www.who.int\/publications\/i\/item\/9789241550079."},{"key":"ref_10","unstructured":"(2022, December 25). Republic of Turkey Ministry of Health, Directorate General of the Public Health, Tuberculosis Diagnosis and Treatment Guide, Tuberculosis Guideline in Patients Receiving Anti-TNF Treatment, Ankara, May 2019, Available online: https:\/\/hsgm.saglik.gov.tr\/depo\/birimler\/tuberkuloz_db\/haberler\/Tuberkuloz_Tani_Ve_Tedavi_Rehberi_\/Tuberkuloz_Tani_ve_Tedavi_Rehberi.pdf\/."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1093\/cid\/ciw778","article-title":"Official American Thoracic Society\/Infectious Diseases Society of America\/Centers for Disease Control and Prevention Clinical Practice Guidelines: Diagnosis of Tuberculosis in Adults and Children","volume":"64","author":"Lewinsohn","year":"2017","journal-title":"Clin. Infect. Dis."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1128\/JCM.40.1.150-154.2002","article-title":"Multicenter Evaluation of Fully Automated BACTEC Mycobacteria Growth Indicator Tube 960 System for Susceptibility Testing of Mycobacterium tuberculosis","volume":"40","author":"Bemer","year":"2002","journal-title":"J. Clin. Microbiol."},{"key":"ref_13","unstructured":"WHO (2012). Updated Interim Critical Concentrations for First-Line and Second-Line DST, World Health Organization. Available online: https:\/\/stoptb.org\/wg\/gli\/assets\/documents\/Updated%20critical%20concentration%20table_1st%20and%202nd%20line%20drugs.pdf\/."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1016\/j.diagmicrobio.2017.08.016","article-title":"Laboratory Evaluation of the AnyplexTM II MTB\/MDR and MTB\/XDR Tests Based on Multiplex Real-Time PCR and Melting-Temperature Analysis to Identify Mycobacterium tuberculosis and Drug Resistance","volume":"89","author":"Igarashi","year":"2017","journal-title":"Diagn. Microbiol. Infect. Dis."},{"key":"ref_15","unstructured":"WHO (2013). Definition and Reporting Framework for Tuberculosis-2013 Revision, World Health organization. Available online: https:\/\/cdn.who.int\/media\/docs\/default-source\/hq-tuberculosis\/global-task-force-on-tb-impact-measurement\/meetings\/2013-04\/p19_revised_who_definitions.pdf?sfvrsn=7bae1fe2_3\/."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1177\/0194599811419466","article-title":"Intratympanic Steroids for Sudden Sensorineural Hearing Loss: A Systematic Review","volume":"145","author":"Spear","year":"2011","journal-title":"Otolaryngol. Head Neck Surg."},{"key":"ref_17","unstructured":"TB CARE I (2014). International Standards for Tuberculosis Care, TB CARE I. [3rd ed.]. Available online: https:\/\/theunion.org\/technical-publications\/international-standards-for-tuberculosis-care\/."},{"key":"ref_18","unstructured":"WHO (2020). Consolidated Guidelines on Tuberculosis. Module 3: Diagnosis\u2013Rapid Diagnostics for Tuberculosis Detection, World Health Organization. Available online: https:\/\/apps.who.int\/iris\/handle\/10665\/332862\/."},{"key":"ref_19","unstructured":"WHO (2022, December 25). Treatment Guidelines for Drug-Resistant Tuberculosis, 2016 Update (WHO\/HTM\/TB\/2016.04). Available online: https:\/\/www.who.int\/publications\/i\/item\/9789241549639\/."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Romanowski, K., Campbell, J.R., Oxlade, O., Fregonese, F., Menzies, D., and Johnston, J.C. (2019). The Impact of Improved Detection and Treatment of Isoniazid Resistant Tuberculosis on Prevalence of Multi-Drug Resistant Tuberculosis: A Modelling Study. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0211355"},{"key":"ref_21","first-page":"979","article-title":"Effect of Rifampicin & Isoniazid on the Steady State Pharmacokinetics of Moxifloxacin","volume":"136","author":"Ramachandran","year":"2012","journal-title":"Indian J. Med. Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"101","DOI":"10.2165\/00003088-199732020-00002","article-title":"The Clinical Pharmacokinetics of Levofloxacin","volume":"32","author":"Fish","year":"1997","journal-title":"Clin. Pharmacokinet."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"821","DOI":"10.1016\/S0140-6736(18)31644-1","article-title":"Treatment Correlates of Successful Outcomes in Pulmonary Multidrug-Resistant Tuberculosis: An Individual Patient Data Meta-Analysis","volume":"392","author":"Ahmad","year":"2018","journal-title":"Lancet"},{"key":"ref_24","unstructured":"World Health Organization (WHO) (2022, December 25). Rapid Communication: Key Changes to Treatment of Multidrug- and Rifampicin-Resistant Tuberculosis (MDR\/RR-TB). Available online: https:\/\/www.who.int\/publications\/i\/item\/WHO-CDS-TB-2018.18\/."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1335","DOI":"10.5588\/ijtld.11.0811","article-title":"Predictors of Sputum Culture Conversion among Patients Treated for Multidrug-Resistant Tuberculosis","volume":"16","author":"Kurbatova","year":"2012","journal-title":"Int. J. Tuberc. Lung Dis."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1060","DOI":"10.5588\/ijtld.18.0649","article-title":"What Is the Best Culture Conversion Prognostic Marker for Patients Treated for Multidrug-Resistant Tuberculosis?","volume":"23","author":"Bastard","year":"2019","journal-title":"Int. J. Tuberc. 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