RT Journal Article SR Electronic T1 Outcomes with a shorter multidrug-resistant tuberculosis regimen from Karakalpakstan, Uzbekistan JF ERJ Open Research JO erjor FD European Respiratory Society SP 00537-2020 DO 10.1183/23120541.00537-2020 VO 7 IS 1 A1 Philipp du Cros A1 Atadjan Khamraev A1 Zinaida Tigay A1 Tleubergen Abdrasuliev A1 Jane Greig A1 Graham Cooke A1 Krzysztof Herboczek A1 Tanya Pylypenko A1 Catherine Berry A1 Amrita Ronnachit A1 David Lister A1 Sebastian Dietrich A1 Cono Ariti A1 Khasan Safaev A1 Bern-Thomas Nyang'wa A1 Nargiza Parpieva A1 Mirzagalib Tillashaikhov A1 Jay Achar YR 2021 UL http://openres.ersjournals.com/content/7/1/00537-2020.abstract AB Background In 2016, World Health Organization guidelines conditionally recommended standardised shorter 9–12-month regimens for multidrug-resistant (MDR) tuberculosis (TB) treatment. We conducted a prospective study of a shorter standardised MDR-TB regimen in Karakalpakstan, Uzbekistan.Methods Consecutive adults and children with confirmed rifampicin-resistant pulmonary TB were enrolled between September 1, 2013 and March 31, 2015; exclusions included prior treatment with second-line anti-TB drugs, and documented resistance to ofloxacin or to two second-line injectable agents. The primary outcome was recurrence-free cure at 1 year following treatment completion.Results Of 146 enrolled patients, 128 were included: 67 female (52.3%), median age 30.1 (interquartile range 23.8–44.4) years. At the end of treatment, 71.9% (92 out of 128) of patients achieved treatment success, with 68% (87 out of 128) achieving recurrence-free cure at 1 year following completion. Unsuccessful outcomes during treatment included 22 (17.2%) treatment failures with fluoroquinolone-resistance amplification in 8 patients (8 out of 22, 36.4%); 12 (9.4%) lost to follow-up; and 2 (1.5%) deaths. Recurrence occurred in one patient. Fourteen patients (10.9%) experienced serious adverse events. Baseline resistance to both pyrazinamide and ethambutol (adjusted OR 6.13, 95% CI 2.01; 18.63) and adherence <95% (adjusted OR 5.33, 95% CI 1.73; 16.36) were associated with unsuccessful outcome in multivariable logistic regression.Conclusions Overall success with a standardised shorter MDR-TB regimen was moderate with considerable treatment failure and amplification of fluoroquinolone resistance. When introducing standardised shorter regimens, baseline drug susceptibility testing and minimising missed doses are critical. High rates globally of pyrazinamide, ethambutol and ethionamide resistance raise questions of continued inclusion of these drugs in shorter regimens in the absence of drug susceptibility testing-confirmed susceptibility.A standardised shorter MDR-TB regimen observational study in Uzbekistan showed moderate success, but high treatment failure with significant risk of amplification of fluoroquinolone resistance https://bit.ly/3o8vfJz