Community based outpatient treatment of multidrug-resistant tuberculosis
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* K Dheda

▴ Mitnick C, Bayona J, Palacios E, *et al*. Community-based therapy for multidrug-resistant tuberculosis in Lima, Peru. N Engl J Med2003;348:119–28

[CrossRef](http://thorax.bmj.com/lookup/external-ref?access_num=10.1056/NEJMoa022928&link_type=DOI) 

[PubMed](http://thorax.bmj.com/lookup/external-ref?access_num=12519922&link_type=MED&atom=%2Fthoraxjnl%2F58%2F4%2F347.atom) 

[Web of Science](http://thorax.bmj.com/lookup/external-ref?access_num=000180263900004&link_type=ISI) 

Treatment for multidrug-resistant tuberculosis (MDR-TB) is virtually non-existent in developing countries because of limited resources and infrastructure. This study assesses treatment feasibility and identifies predictors of poor outcome in patients receiving community based outpatient treatment for MDR-TB in a poor section of Lima. Seventy five patients (median age 27 years, one seropositive for HIV) with longstanding disease had received a median of three previous anti-TB regimens and harboured highly resistant strains (resistant to a median of six drugs). Of 66 patients who completed ≥4 months of individualised regimens, 55 (83%) were probably cured at the completion of treatment. Five of the 66 patients (8%) died while receiving treatment. Predictors of poor outcome (treatment failure or death) were low haematocrit (present in 12 patients, five of whom died) and low body mass index (present in 32, eight of whom died). The six most commonly used drugs were fluoroquinolones, cycloserine, PAS, ethionamide, amoxicillin-clavulanic acid, and capreomycin. The mean cost of treatment was £9565 per patient.

These results indicate that community based outpatient treatment of MDR-TB is feasible and can yield surprisingly high cure rates even in resource poor settings. The high costs of treatment will continue to be a major obstacle to implementation in developing countries. Further studies are needed to determine outcomes in developing countries with a high prevalence of HIV.