Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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Treatment of Isoniazid-Resistant Pulmonary Tuberculosis

  • Jhun, Byung Woo (Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Koh, Won-Jung (Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • Received : 2019.08.28
  • Accepted : 2019.09.23
  • Published : 2020.01.31
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Abstract

Tuberculosis (TB) remains a threat to public health and is the leading cause of death globally. Isoniazid (INH) is an important first-line agent for the treatment of TB considering its early bactericidal activity. Resistance to INH is now the most common type of resistance. Resistance to INH reduces the probability of treatment success and increases the risk of acquiring resistance to other first-line drugs such as rifampicin (RIF), thereby increasing the risk of multidrug-resistant-TB. Studies in the 1970s and 1980s showed high success rates for INH-resistant TB cases receiving regimens comprised of first-line drugs. However, recent data have indicated that INH-resistant TB patients treated with only firs-tline drugs have poor outcomes. Fortunately, based on recent systematic meta-analyses, the World Health Organization published consolidated guidelines on drug-resistant TB in 2019. Their key recommendations are treatment with RIF-ethambutol (EMB)-pyrazinamide (PZA)-levofloxacin (LFX) for 6 months and no addition of injectable agents to the treatment regimen. The guidelines also emphasize the importance of excluding resistance to RIF before starting RIF-EMB-PZA-LFX regimen. Additionally, when the diagnosis of INH-resistant TB is confirmed long after starting the first-line TB treatment, the clinician must decide whether to start a 6-month course of RIF-EMB-PZA-LFX based on the patient's condition. However, these recommendations are based on observational studies, not randomized controlled trials, and are thus conditional and based on low certainty of the effect estimates. Therefore, further work is needed to optimize the treatment of INH-resistant TB.

Keywords

References

  1. World Health Organization. Global tuberculosis report 2018 [Internet]. Geneva: World Health Organization; 2018 [cited 2018 Dec 18]. Available from: https://www.who.int/tb/publications/global_report/en/.
  2. Cho KS. Tuberculosis control in the Republic of Korea. Epidemiol Health 2018;40:e2018036. https://doi.org/10.4178/epih.e2018036
  3. Kim JH, Yim JJ. Achievements in and challenges of tuberculosis control in South Korea. Emerg Infect Dis 2015;21:1913-20. https://doi.org/10.3201/eid2111.141894
  4. Getahun H, Matteelli A, Chaisson RE, Raviglione M. Latent Mycobacterium tuberculosis infection. N Engl J Med 2015;372:2127-35. https://doi.org/10.1056/NEJMra1405427
  5. Pai M, Behr MA, Dowdy D, Dheda K, Divangahi M, Boehme CC, et al. Tuberculosis. Nat Rev Dis Primers 2016;2:16076. https://doi.org/10.1038/nrdp.2016.76
  6. Lee SH. Tuberculosis infection and latent tuberculosis. Tuberc Respir Dis 2016;79:201-6. https://doi.org/10.4046/trd.2016.79.4.201
  7. Hoopes AJ, Kammerer JS, Harrington TA, Ijaz K, Armstrong LR. Isoniazid-monoresistant tuberculosis in the United States, 1993 to 2003. Arch Intern Med 2008;168:1984-92. https://doi.org/10.1001/archinte.168.18.1984
  8. Jenkins HE, Zignol M, Cohen T. Quantifying the burden and trends of isoniazid resistant tuberculosis, 1994-2009. PLoS One 2011;6:e22927. https://doi.org/10.1371/journal.pone.0022927
  9. Kim SJ, Bai GH, Hong YP. Drug-resistant tuberculosis in Korea, 1994. Int J Tuberc Lung Dis 1997;1:302-8.
  10. Kim SJ, Hong YP. Drug resistance of Mycobacterium tuberculosis in Korea. Tuber Lung Dis 1992;73:219-24. https://doi.org/10.1016/0962-8479(92)90090-7
  11. Hong YP, Kim SJ, Kwon DW, Chang SC, Lew WJ, Han YC. The sixth Nationwide Tuberculosis Prevalence Survey in Korea, 1990. Tuber Lung Dis 1993;74:323-31. https://doi.org/10.1016/0962-8479(93)90107-9
  12. Bai GH, Park YK, Choi YW, Bai JI, Kim HJ, Chang CL, et al. Trend of anti-tuberculosis drug resistance in Korea, 1994-2004. Int J Tuberc Lung Dis 2007;11:571-6.
  13. Kim J, Park YJ, Lee NY, Chang CL, Lee M, Shin JH. Anti-tuberculosis drug resistant rates in Mycobacterium tuberculosis Isolated from respiratory specimens: a multicenter study in Korea. Ann Clin Microbiol 2013;16:1-7. https://doi.org/10.5145/ACM.2013.16.1.1
  14. Kim H, Mok JH, Kang B, Lee T, Lee HK, Jang HJ, et al. Trend of multidrug and fluoroquinolone resistance in Mycobacterium tuberculosis isolates from 2010 to 2014 in Korea: a multicenter study. Korean J Intern Med 2019;34:344-52. https://doi.org/10.3904/kjim.2018.052
  15. Mahmoudi A, Iseman MD. Pitfalls in the care of patients with tuberculosis: common errors and their association with the acquisition of drug resistance. JAMA 1993;270:65-8. https://doi.org/10.1001/jama.1993.03510010071032
  16. Espinal MA, Kim SJ, Suarez PG, Kam KM, Khomenko AG, Migliori GB, et al. Standard short-course chemotherapy for drugresistant tuberculosis: treatment outcomes in 6 countries. JAMA 2000;283:2537-45. https://doi.org/10.1001/jama.283.19.2537
  17. Menzies D, Benedetti A, Paydar A, Martin I, Royce S, Pai M, et al. Effect of duration and intermittency of rifampin on tuberculosis treatment outcomes: a systematic review and metaanalysis. PLoS Med 2009;6:e1000146. https://doi.org/10.1371/journal.pmed.1000146
  18. Menzies D, Benedetti A, Paydar A, Royce S, Madhukar P, Burman W, et al. Standardized treatment of active tuberculosis in patients with previous treatment and/or with mono-resistance to isoniazid: a systematic review and meta-analysis. PLoS Med 2009;6:e1000150. https://doi.org/10.1371/journal.pmed.1000150
  19. Mitchison DA, Nunn AJ. Influence of initial drug resistance on the response to short-course chemotherapy of pulmonary tuberculosis. Am Rev Respir Dis 1986;133:423-30.
  20. Hong Kong Chest Service/British Medical Research Council. Five-year follow-up of a controlled trial of five 6-month regimens of chemotherapy for pulmonary tuberculosis. Am Rev Respir Dis 1987;136:1339-42. https://doi.org/10.1164/ajrccm/136.6.1339
  21. Gegia M, Cohen T, Kalandadze I, Vashakidze L, Furin J. Outcomes among tuberculosis patients with isoniazid resistance in Georgia, 2007-2009. Int J Tuberc Lung Dis 2012;16:812-6. https://doi.org/10.5588/ijtld.11.0637
  22. Gegia M, Winters N, Benedetti A, van Soolingen D, Menzies D. Treatment of isoniazid-resistant tuberculosis with first-line drugs: a systematic review and meta-analysis. Lancet Infect Dis 2017;17:223-34. https://doi.org/10.1016/S1473-3099(16)30407-8
  23. Blumberg HM, Burman WJ, Chaisson RE, Daley CL, Etkind SC, Friedman LN, et al. American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America: treatment of tuberculosis. Am J Respir Crit Care Med 2003;167:603-62. https://doi.org/10.1164/rccm.167.4.603
  24. World Health Organization. Companion handbook to the WHO guidelines for the programmatic management of drugresistant tuberculosis [Internet]. Geneva: World Health Organization; 2014 [cited 2019 Jun 1]. Available from: https://www.who.int/tb/publications/pmdt_companionhandbook/en/.
  25. World Health Organization. Guidance for national tuberculosis programmes on the management of tuberculosis in children [Internet]. Geneva: World Health Organization; 2006 [cited 2019 Jun 1]. Available from: https://www.who.int/maternal_child_adolescent/documents/htm_tb_2006_371/en/.
  26. World Health Organization. Guidelines for the programmatic management of drug-resistant tuberculosis (emergency update 2008) [Internet]. Geneva: World Health Organization; 2008 [cited 2019 Jun 1]. Available from: https://apps.who.int/iris/handle/10665/43965.
  27. Escalante P, Graviss EA, Griffith DE, Musser JM, Awe RJ. Treatment of isoniazid-resistant tuberculosis in southeastern Texas. Chest 2001;119:1730-6. https://doi.org/10.1378/chest.119.6.1730
  28. Kim YH, Suh GY, Chung MP, Kim H, Kwon OJ, Lim SY, et al. Treatment of isoniazid-resistant pulmonary tuberculosis. BMC Infect Dis 2008;8:6. https://doi.org/10.1186/1471-2334-8-6
  29. Cattamanchi A, Dantes RB, Metcalfe JZ, Jarlsberg LG, Grinsdale J, Kawamura LM, et al. Clinical characteristics and treatment outcomes of patients with isoniazid-monoresistant tuberculosis. Clin Infect Dis 2009;48:179-85. https://doi.org/10.1086/595689
  30. Bang D, Andersen PH, Andersen AB, Thomsen VO. Isoniazidresistant tuberculosis in Denmark: mutations, transmission and treatment outcome. J Infect 2010;60:452-7. https://doi.org/10.1016/j.jinf.2010.03.017
  31. Munang ML, Kariuki M, Dedicoat M. Isoniazid-resistant tuberculosis in Birmingham, United Kingdom, 1999-2010. QJM 2015;108:19-25. https://doi.org/10.1093/qjmed/hcu139
  32. Romanowski K, Chiang LY, Roth DZ, Krajden M, Tang P, Cook VJ, et al. Treatment outcomes for isoniazid-resistant tuberculosis under program conditions in British Columbia, Canada. BMC Infect Dis 2017;17:604. https://doi.org/10.1186/s12879-017-2706-0
  33. Stagg HR, Harris RJ, Hatherell HA, Obach D, Zhao H, Tsuchiya N, et al. What are the most efficacious treatment regimens for isoniazid-resistant tuberculosis? A systematic review and network meta-analysis. Thorax 2016;71:940-9. https://doi.org/10.1136/thoraxjnl-2015-208262
  34. Stagg HR, Lipman MC, McHugh TD, Jenkins HE. Isoniazidresistant tuberculosis: a cause for concern? Int J Tuberc Lung Dis 2017;21:129-39. https://doi.org/10.5588/ijtld.16.0716
  35. Stagg HR, Bothamley GH, Davidson JA, Kunst H, Lalor MK, Lipman MC, et al. Fluoroquinolones and isoniazid-resistant tuberculosis: implications for the 2018 WHO guidance. Eur Respir J 2019;54:1900982. https://doi.org/10.1183/13993003.00982-2019
  36. Fregonese F, Ahuja SD, Akkerman OW, Arakaki-Sanchez D, Ayakaka I, Baghaei P, et al. Comparison of different treatments for isoniazid-resistant tuberculosis: an individual patient data meta-analysis. Lancet Respir Med 2018;6:265-75. https://doi.org/10.1016/S2213-2600(18)30078-X
  37. World Health Organization. WHO consolidated guidelines on drug-resistant tuberculosis treatment [Internet]. Geneva: World Health Organization; 2019 [cited 2019 Jun 1]. Available from: https://www.who.int/tb/publications/2019/consolidated-guidelines-drug-resistant-TB-treatment/en/.
  38. Stewart SM, Crofton JW. The clinical significance of low degrees of drug resistance in pulmonary tuberculosis. Am Rev Respir Dis 1964;89:811-29.
  39. World Health Organization. WHO treatment guidelines for isoniazid-resistant tuberculosis: supplement to the WHO treatment guidelines for drug-resistant tuberculosis [Internet]. Geneva: World Health Organization; 2018 [cited 2019 Jun 1]. Available from: https://www.who.int/tb/publications/2018/WHO_guidelines_isoniazid_resistant_TB/en/.
  40. Zhang Y, Heym B, Allen B, Young D, Cole S. The catalaseperoxidase gene and isoniazid resistance of Mycobacterium tuberculosis . Nature 1992;358:591-3. https://doi.org/10.1038/358591a0
  41. Piatek AS, Telenti A, Murray MR, El-Hajj H, Jacobs WR Jr, Kramer FR, et al. Genotypic analysis of Mycobacterium tuberculosis in two distinct populations using molecular bea cons: implications for rapid susceptibility testing. Antimicrob Agents Chemother 2000;44:103-10. https://doi.org/10.1128/AAC.44.1.103-110.2000
  42. Ramaswamy SV, Reich R, Dou SJ, Jasperse L, Pan X, Wanger A, et al. Single nucleotide polymorphisms in genes associated with isoniazid resistance in Mycobacterium tuberculosis . Antimicrob Agents Chemother 2003;47:1241-50. https://doi.org/10.1128/AAC.47.4.1241-1250.2003
  43. Ramaswamy S, Musser JM. Molecular genetic basis of antimicrobial agent resistance in Mycobacterium tuberculosis : 1998 update. Tuber Lung Dis 1998;79:3-29. https://doi.org/10.1054/tuld.1998.0002
  44. Dalla Costa ER, Ribeiro MO, Silva MS, Arnold LS, Rostirolla DC, Cafrune PI, et al. Correlations of mutations in katG, oxyRahpC and inhA genes and in vitro susceptibility in Mycobacterium tuberculosis clinical strains segregated by spoligotype families from tuberculosis prevalent countries in South America. BMC Microbiol 2009;9:39. https://doi.org/10.1186/1471-2180-9-39
  45. Banerjee A, Dubnau E, Quemard A, Balasubramanian V, Um KS, Wilson T, et al. inhA, a gene encoding a target for isoniazid and ethionamide in Mycobacterium tuberculosis . Science 1994;263:227-30. https://doi.org/10.1126/science.8284673
  46. Canetti G. Present aspects of bacterial resistance in tuberculosis. Am Rev Respir Dis 1965;92:687-703.
  47. Mitchison DA. How drug resistance emerges as a result of poor compliance during short course chemotherapy for tuberculosis. Int J Tuberc Lung Dis 1998;2:10-5.
  48. Patel KB, Belmonte R, Crowe HM. Drug malabsorption and resistant tuberculosis in HIV-infected patients. N Engl J Med 1995;332:336-7. https://doi.org/10.1056/NEJM199502023320518
  49. Moore M, Onorato IM, McCray E, Castro KG. Trends in drugresistant tuberculosis in the United States, 1993-1996. JAMA 1997;278:833-7. https://doi.org/10.1001/jama.1997.03550100059039
  50. Forssbohm M, Loddenkemper R, Rieder HL. Isoniazid resistance among tuberculosis patients by birth cohort in Germany. Int J Tuberc Lung Dis 2003;7:973-9.
  51. Fox L, Kramer MR, Haim I, Priess R, Metvachuk A, Shitrit D. Comparison of isoniazid monoresistant tuberculosis with drug-susceptible tuberculosis and multidrug-resistant tuberculosis. Eur J Clin Microbiol Infect Dis 2011;30:863-7. https://doi.org/10.1007/s10096-011-1167-4
  52. Bass JB Jr, Farer LS, Hopewell PC, O'Brien R, Jacobs RF, Ruben F, et al. Treatment of tuberculosis and tuberculosis infection in adults and children. American Thoracic Society and The Centers for Disease Control and Prevention. Am J Respir Crit Care Med 1994;149:1359-74. https://doi.org/10.1164/ajrccm.149.5.8173779
  53. Chemotherapy and management of tuberculosis in the United Kingdom: recommendations 1998. Joint Tuberculosis Committee of the British Thoracic Society. Thorax 1998;53:536-48. https://doi.org/10.1136/thx.53.7.536
  54. National Collaborating Centre for Chronic Conditions; Centre for Clinical Practice at NICE. Tuberculosis: clinical diagnosis and management of tuberculosis, and measures for its prevention and control. London: National Institute for Health and Clinical Excellence; 2011.
  55. National Institute for Health and Care Excellence. Tuberculosis: NICE guideline (NG33) [Internet]. London: National Institute for Health and Care Excellence; 2016 [cited 2019 Jun 1]. Available from: https://www.nice.org.uk/guidance/ng33.
  56. Tam CM, Chan SL, Lam CW, Leung CC, Kam KM, Morris JS, et al. Rifapentine and isoniazid in the continuation phase of treating pulmonary tuberculosis. Initial report. Am J Respir Crit Care Med 1998;157(6 pt 1):1726-33. https://doi.org/10.1164/ajrccm.157.6.9707037
  57. Bai KJ, Yu MC, Suo J, Chiang CY, Chiang IH, Lin TP, et al. Short-course chemotherapy for isoniazid-resistant pulmonary tuberculosis. J Formos Med Assoc 1998;97:278-82.
  58. Babu Swai O, Aluoch JA, Githui WA, Thiong'o R, Edwards EA, Darbyshire JH, et al. Controlled clinical trial of a regimen of two durations for the treatment of isoniazid resistant pulmonary tuberculosis. Tubercle 1988;69:5-14. https://doi.org/10.1016/0041-3879(88)90035-9
  59. Ormerod LP, Horsfield N, Green RM. Can a nine-month regimen be used to treat isoniazid resistant tuberculosis diagnosed after standard treatment is started? J Infect 2001;42:1-3. https://doi.org/10.1053/jinf.2000.0773
  60. Nolan CM, Goldberg SV. Treatment of isoniazid-resistant tuberculosis with isoniazid, rifampin, ethambutol, and pyrazinamide for 6 months. Int J Tuberc Lung Dis 2002;6:952-8.
  61. A controlled clinical trial of oral short-course regimens in the treatment of sputum-positive pulmonary tuberculosis. Tuberculosis Research Centre. Int J Tuberc Lung Dis 1997;1:509-17.
  62. Seung KJ, Gelmanova IE, Peremitin GG, Golubchikova VT, Pavlova VE, Sirotkina OB, et al. The effect of initial drug resistance on treatment response and acquired drug resistance during standardized short-course chemotherapy for tuberculosis. Clin Infect Dis 2004;39:1321-8. https://doi.org/10.1086/425005
  63. Wang TY, Lin SM, Shie SS, Chou PC, Huang CD, Chung FT, et al. Clinical characteristics and treatment outcomes of patients with low- and high-concentration isoniazid-monoresistant tuberculosis. PLoS One 2014;9:e86316. https://doi.org/10.1371/journal.pone.0086316
  64. Baez-Saldana R, Delgado-Sanchez G, Garcia-Garcia L, Cruz-Hervert LP, Montesinos-Castillo M, Ferreyra-Reyes L, et al. Isoniazid mono-resistant tuberculosis: impact on treatment outcome and survival of pulmonary tuberculosis patients in Southern Mexico 1995-2010. PLoS One 2016;11:e0168955. https://doi.org/10.1371/journal.pone.0168955
  65. Deepa D, Achanta S, Jaju J, Rao K, Samyukta R, Claassens M, et al. The impact of isoniazid resistance on the treatment outcomes of smear positive re-treatment tuberculosis patients in the state of Andhra Pradesh, India. PLoS One 2013;8:e76189. https://doi.org/10.1371/journal.pone.0076189
  66. Koh WJ, Kwon OJ, Park YK, Lew WJ, Bai GH. Development of multidrug resistance during treatment of isoniazid-resistant tuberculosis. Eur Respir J 2005;26:557. https://doi.org/10.1183/09031936.05.00045605
  67. Low rate of emergence of drug resistance in sputum positive patients treated with short course chemotherapy. Int J Tuberc Lung Dis 2001;5:40-5.
  68. Jacobson KR, Theron D, Victor TC, Streicher EM, Warren RM, Murray MB. Treatment outcomes of isoniazid-resistant tuberculosis patients, Western Cape Province, South Africa. Clin Infect Dis 2011;53:369-72. https://doi.org/10.1093/cid/cir406
  69. Lee H, Jeong BH, Park HY, Jeon K, Huh HJ, Lee NY, et al. Treatment outcomes with fluoroquinolone-containing regimens for isoniazid-resistant pulmonary tuberculosis. Antimicrob Agents Chemother 2016;60:471-7. https://doi.org/10.1128/AAC.01377-15
  70. Chien JY, Chen YT, Wu SG, Lee JJ, Wang JY, Yu CJ. Treatment outcome of patients with isoniazid mono-resistant tuberculosis. Clin Microbiol Infect 2015;21:59-68. https://doi.org/10.1016/j.cmi.2014.08.008
  71. Villegas L, Otero L, Sterling TR, Huaman MA, Van der Stuyft P, Gotuzzo E, et al. Prevalence, risk factors, and treatment outcomes of isoniazid- and rifampicin-mono-resistant pulmonary tuberculosis in Lima, Peru. PLoS One 2016;11:e0152933. https://doi.org/10.1371/journal.pone.0152933
  72. Cornejo Garcia JG, Alarcon Guizado VA, Mendoza Ticona A, Alarcon E, Heldal E, Moore DA. Treatment outcomes for isoniazid-monoresistant tuberculosis in Peru, 2012-2014. PLoS One 2018;13:e0206658. https://doi.org/10.1371/journal.pone.0206658
  73. Public Health Agency of Canada. Canadian Tuberculosis Standards. 7th Edition. Chapter 8: Drug-resistant tuberculosis [Internet]. Ottawa: Public Health Agency of Canada; 2014 [cited 2019 Jun 1]. Available from: https://www.canada.ca/en/public-health/services/infectious-diseases/canadiantuberculosis-standards-7th-edition.html.
  74. Dorman SE, Johnson JL, Goldberg S, Muzanye G, Padayatchi N, Bozeman L, et al. Substitution of moxifloxacin for isoniazid during intensive phase treatment of pulmonary tuberculosis. Am J Respir Crit Care Med 2009;180:273-80. https://doi.org/10.1164/rccm.200901-0078OC
  75. Ramachandran G, Hemanth Kumar AK, Srinivasan R, Geetharani A, Sugirda P, Nandhakumar B, et al. Effect of rifampicin & isoniazid on the steady state pharmacokinetics of moxifloxacin. Indian J Med Res 2012;136:979-84.
  76. Fish DN, Chow AT. The clinical pharmacokinetics of levofloxacin. Clin Pharmacokinet 1997;32:101-19. https://doi.org/10.2165/00003088-199732020-00002
  77. Centers for Disease Control and Prevention (CDC). Update: Fatal and severe liver injuries associated with rifampin and pyrazinamide for latent tuberculosis infection, and revisions in American Thoracic Society/CDC recommendations: United States, 2001. MMWR Morb Mortal Wkly Rep 2001;50:733-5.
  78. Lempens P, Meehan CJ, Vandelannoote K, Fissette K, de Rijk P, Van Deun A, et al. Isoniazid resistance levels of Mycobacterium tuberculosis can largely be predicted by high-confidence resistance-conferring mutations. Sci Rep 2018;8:3246. https://doi.org/10.1038/s41598-018-21378-x

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