Closing the book on Category II: time for individualized regimens for patients with recurrent tuberculosis

• Type of Material: Article
• Authors: Sara Auld, Emory University; Neel Gandhi, Emory University; N. Sarita Shah, Emory University
• Language: English
• Date: 2018-10-01
• Publisher: International Union Against Tuberculosis and Lung Disease
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: 2018 The Union
• Final Published Version (URL): http://dx.doi.org/10.5588/ijtld.18.0569
• Title of Journal or Parent Work: International Journal of Tuberculosis and Lung Disease
• ISSN: 1027-3719
• Volume: 22
• Issue: 10
• Start Page: 1113
• End Page: 1114
• Grant/Funding Information: The authors acknowledge funding support from the National Institute of Allergy and Infectious Diseases at the US National Institutes of Health (K24 AI114444 to NRG, K23 AI134182 to SCA) and the Emory University Center for AIDS Research (P30 AI050409).
• Keywords: Infectious Diseases; Respiratory System; RETREATMENT REGIMEN; MULTIDRUG-RESISTANT TUBERCULOSIS; Science & Technology; Life Sciences & Biomedicine
• Research Categories: Health Sciences, Public Health

Abstract

FOLLOWING THE CLINICAL TRIALS by the Singapore Tuberculosis Service and the British Medical Research Council in the 1970s, the 6-month ‘short-course’ tuberculosis (TB) regimen, based on isoniazid, rifampicin, and pyrazinamide, was widely adopted in the 1980s.1,2 However, for patients undergoing retreatment for TB disease, there was no clear evidence-based treatment regimen. In an effort to fill this gap, in 1991 the World Health Organization (WHO) endorsed the ‘Category II’ regimen, an 8-month regimen with the addition of streptomycin, as a retreatment regimen for patients with TB disease relapse, treatment failure, or treatment after an interruption of at least 2 months.3 Despite this endorsement, it was already recognized that the addition of a single drug to a failing regimen set the stage for the amplification of drug resistance and poor clinical outcomes.4–6 Nearly two decades later, in the face of mounting data pointing to its ineffectiveness, in 2010 the WHO recommended against using the Category II regimen.7 This reversal remains highly relevant for the 19% of retreatment cases estimated to have drug resistance in the context of relapsed or recurrent disease in 2016.