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Multidrug-resistant TB in Eastern region of the EU: is the shorter regimen an exception or a rule?
  1. Yanina Balabanova1,2,3,
  2. Lena Fiebig3,
  3. Olga Ignatyeva4,
  4. Vija Riekstina5,
  5. Manfred Danilovits6,
  6. Kaadri Jaama6,
  7. Edita Davidaviciene7,
  8. Birute Radiulyte7,
  9. Christina Marcela Popa8,
  10. Vladyslav Nikolayevskyy1,2,9,
  11. Francis Drobniewski1,2
  1. 1 Blizard Institute, Queen Mary, University of London, London, UK
  2. 2 Department of Infectious Diseases, Imperial College London, London, UK
  3. 3 Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
  4. 4 N.V. Postnikov Samara Region Clinical Tuberculosis Dispensary, Samara, Russia
  5. 5 Department of Mycobacteriology, State Agency “Infectology Center of Latvia,” Clinic for Tuberculosis and Lung Diseases, “Upeslejas” Stopinunovads, Riga, Latvia
  6. 6 United Laboratory, Department of Mycobacteriology, Tartu University Hospital, Tartu, Estonia
  7. 7 National Tuberculosis and Infectious Diseases University Hospital, Vilnius, Lithuania
  8. 8 Marius Nasta Institute of Pneumology, Bucharest, Romania
  9. 9 National Mycobacterium Reference Service South, Public Health England, London, UK
  1. Correspondence to Dr Yanina Balabanova, Blizard Institute, Queen Mary, University of London, London W12 0NN, UK; yanina.lenz{at}


WHO recently recommended the use of a shorter multidrug-resistant TB (MDR-TB) regimen under programmatic conditions. We assessed eligibility for this regimen in a cohort of 737 adult patients with MDR-TB from Latvia, Lithuania, Estonia and Bucharest city recruited in 2007 and 2009. Only 4.2% of the patients were eligible for this regimen. Ethambutol (64%), pyrazinamide resistance (58%) and previous exposure to second-line TB drugs were major reasons for non-eligibility. High-level resistance to isoniazid is expected due to widespread prevalence of katG mutations. In Eastern Europe, the use of the shorter regimen might be an exception rather than a rule.

  • Tuberculosis

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  • YB and LF contributed equally

  • Contributors YB and LF drafted the manuscript; all authors reviewed and edited the manuscript. All authors participated in the study design. YB, OI, VN and FD supervised the project. BR, MD, KJ, ED, BR and CMP conducted the study. LF and OI conducted the statistical analysis.

  • Funding The research leading to these results has received funding from the European Community’s Seventh Framework Programme (FP7/2007–2013) under grant agreement FP7–223681. LF received a research grant from the not-for profit organisations Oskar-Helene-Heim and Günther Labes. The funders had no role in the design or analysis of the study.

  • Competing interests None declared.

  • Ethics approval The ‘TB-PAN-NET’ project was reviewed and approved by the Ethics Review Committees of the University of Tartu and Riga Stradins University and received a waiver of informed consent as anonymised data were used. Local Ethics Committees exempted the study from an ethics review in Lithuania and Romania. The study was approved by Queen Mary College Research Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement We agree to share the data from this research.

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