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Multidrug Resistant Pulmonary Tuberculosis Treatment Regimens and Patient Outcomes: An Individual Patient Data Meta-analysis of 9,153 Patients
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نویسنده
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ahuja s.d. ,ashkin d. ,avendano m. ,banerjee r. ,bauer m. ,bayona j.n. ,becerra m.c. ,benedetti a. ,burgos m. ,centis r. ,chan e.d. ,chiang c.-y. ,cox h. ,d'ambrosio l. ,deriemer k. ,dung n.h. ,enarson d. ,falzon d. ,flanagan k. ,flood j. ,garcia-garcia m.l. ,gandhi n. ,granich r.m. ,hollm-delgado m.g. ,holtz t.h. ,iseman m.d. ,jarlsberg l.g. ,keshavjee s. ,kim h.-r. ,koh w.-j. ,lancaster j. ,lange c. ,de lange w.c.m. ,leimane v. ,leung c.c. ,li j. ,menzies d. ,migliori g.b. ,mishustin s.p. ,mitnick c.d. ,narita m. ,o'riordan p. ,pai m. ,palmero d. ,park s.-k. ,pasvol g. ,peña j. ,pérez-guzmán c. ,quelapio m.i.d. ,ponce-de-leon a. ,riekstina v. ,robert j. ,royce s. ,schaaf h.s. ,seung k.j. ,shah l. ,shim t.s. ,shin s.s. ,shiraishi y. ,sifuentes-osornio j. ,sotgiu g. ,strand m.j. ,tabarsi p. ,tupasi t.e. ,van altena r. ,van der walt m. ,van der werf t.s. ,vargas m.h. ,viiklepp p. ,westenhouse j. ,yew w.w. ,yim j.-j.
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منبع
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plos medicine - 2012 - دوره : 9 - شماره : 8
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چکیده
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Background: treatment of multidrug resistant tuberculosis (mdr-tb) is lengthy,toxic,expensive,and has generally poor outcomes. we undertook an individual patient data meta-analysis to assess the impact on outcomes of the type,number,and duration of drugs used to treat mdr-tb. methods and findings: three recent systematic reviews were used to identify studies reporting treatment outcomes of microbiologically confirmed mdr-tb. study authors were contacted to solicit individual patient data including clinical characteristics,treatment given,and outcomes. random effects multivariable logistic meta-regression was used to estimate adjusted odds of treatment success. adequate treatment and outcome data were provided for 9,153 patients with mdr-tb from 32 observational studies. treatment success,compared to failure/relapse,was associated with use of: later generation quinolones,(adjusted odds ratio [aor]: 2.5 [95% ci 1.1-6.0]),ofloxacin (aor: 2.5 [1.6-3.9]),ethionamide or prothionamide (aor: 1.7 [1.3-2.3]),use of four or more likely effective drugs in the initial intensive phase (aor: 2.3 [1.3-3.9]),and three or more likely effective drugs in the continuation phase (aor: 2.7 [1.7-4.1]). similar results were seen for the association of treatment success compared to failure/relapse or death: later generation quinolones,(aor: 2.7 [1.7-4.3]),ofloxacin (aor: 2.3 [1.3-3.8]),ethionamide or prothionamide (aor: 1.7 [1.4-2.1]),use of four or more likely effective drugs in the initial intensive phase (aor: 2.7 [1.9-3.9]),and three or more likely effective drugs in the continuation phase (aor: 4.5 [3.4-6.0]).conclusions:in this individual patient data meta-analysis of observational data,improved mdr-tb treatment success and survival were associated with use of certain fluoroquinolones,ethionamide,or prothionamide,and greater total number of effective drugs. however,randomized trials are urgently needed to optimize mdr-tb treatment.please see later in the article for the editors' summary. © 2012 ahuja et al.
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آدرس
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bureau of tuberculosis,new york,ny, United States, a.g. holley hospital,lantana,fl, United States, university of toronto,toronto, Canada, mayo clinic,rochester,mn, United States, montreal chest institute,mcgill university,montreal, Canada, the dartmouth center for health care delivery science,hanover,nh, United States, harvard medical school,boston,ma,united states,partners in health,boston,ma, United States, montreal chest institute,mcgill university,montreal, Canada, university of new mexico school of medicine,albuquerque,nm, United States, who collaborating centre for tb and lung diseases,care and research institute,fondazione s. maugeri,tradate, Italy, denver veterans affair medical center,denver,co, United States, wan fang hospital,school of medicine-taipei medical university, Taiwan, médecins sans frontières,capetown, South Africa, who collaborating centre for tb and lung diseases,care and research institute,fondazione s. maugeri,tradate, Italy, uc davis school of medicine,davis,ca, United States, national tb control program,hanoi, Viet Nam, international union against tuberculosis and lung disease,paris, France, world health organization,geneva, Switzerland, mrc laboratories,banjul, Gambia, california department of public health,sacramento,ca, United States, instituto nacional de salud pública,mexico, Mexico, albert einstein college of medicine,bronx,ny, United States, world health organization,geneva, Switzerland, montreal chest institute,mcgill university,montreal, Canada, thailand moph and us cdc collaboration,bangkok, Thailand, national jewish health,denver,co, United States, university of california,san francisco,san francisco, United States, harvard medical school,boston,ma, United States, korea cancer center hospital,seoul, South Korea, samsung medical center,seoul, South Korea, south african medical research council,pretoria, South Africa, medical clinic,tuberculosis center borstel,borstel, Germany, university medical center groningen,groningen, Netherlands, clinic of tuberculosis and lung diseases,riga, Latvia, tuberculosis and chest services, Hong Kong, new york city health and mental hygiene,new york,ny, United States, montreal chest institute,mcgill university,montreal, Canada, who collaborating centre for tb and lung diseases,care and research institute,fondazione s. maugeri,tradate, Italy, tomsk oblast tuberculosis dispensary,tomsk, Russian Federation, harvard medical school,boston,ma, United States, university of washington,seattle,wa, United States, city road medical centre,london, United Kingdom, montreal chest institute,mcgill university,montreal, Canada, hospital f.j. muñiz,buenos aires, Argentina, tb center,seoul, South Korea, imperial college london,london, United Kingdom, universidad autonoma madrid,madrid, Spain, instituto de salud del estado de aguascalientes,mexico, Mexico, tropical disease foundation,makati city, Philippines, instituto nacional de ciencias médicas y de nutrición salvador zubirán,mexico, Mexico, clinic of tuberculosis and lung diseases,riga, Latvia, bactériologie-hygiène - upmc,paris, France, university of california,san francisco,san francisco, United States, stellenbosch university,stellenbosch, South Africa, brigham and women's hospital,boston,ma, United States, montreal chest institute,mcgill university,montreal, Canada, university of ulsan college of medicine,seoul, South Korea, brigham and women's hospital,boston,ma, United States, fukujuji hospital,tokyo, Japan, instituto nacional de ciencias médicas y de nutrición salvador zubirán,mexico, Mexico, university of sassari,sassari, Italy, national jewish health,denver,co, United States, shaheed beheshti medical university,tehran, ایران, tropical disease foundation,makati city, Philippines, university medical center groningen,groningen, Netherlands, south african medical research council,pretoria, South Africa, university medical center groningen,groningen, Netherlands, instituto nacional de enfermedades respiratorias,mexico, Mexico, national institute for health development,tallinn, Estonia, center for infectious diseases-california department of public health,sacramento,ca, United States, grantham hospital, Hong Kong, seoul national university college of medicine,seoul, South Korea
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