Universität zu Köln

Gunther, Gunar, Heyckendorf, Jan, Zellweger, Jean Pierre, Reimann, Maja, Claassens, Mareli, Chesov, Dumitru ORCID: 0000-0001-6203-5020 and van Leth, Frank ORCID: 0000-0002-5490-8968 (2021). Defining Outcomes of Tuberculosis (Treatment): From the Past to the Future. Respiration, 100 (9). S. 843 - 853. BASEL: KARGER. ISSN 1423-0356

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Abstract

Untreated active tuberculosis (TB) has a very high long-term mortality. Treatment of TB reduces mortality dramatically and should maximize cure, preventing ongoing transmission and TB sequelae. However, predicting the risk of failure and relapse is crucial for the management of individual patients and for the evaluation of effectiveness of programs. Various outcome definitions for drug-sensitive and drug-resistant TB were developed, implemented, and endorsed since introduction of TB chemotherapy by the World Health Organization (WHO), mostly based on culture and smear results. They should be applicable for individual patient care, surveillance, and research. Definitions with focus on program evaluation differ from definitions to evaluate the efficacy and effectiveness of regimens. Lack of sputum production at the later stage of treatment reduces the easy applicability of current definitions. Definitions of failure and cure are sometimes difficult to apply. Alternative approaches suggest culture positivity at 6 months or more of treatment as an indicator for failure. New definitions for cure including a relapse-free period posttreatment and reduced number of culture and smear results are considered. Increasing variation and individualization of treatment and its duration urgently require new approaches using pathogen- or host-specific biomarkers, which indicate risk of failure and define cure. Such biomarkers are under evaluation but still far from translation in clinical routine practice.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Gunther, Gunar UNSPECIFIED UNSPECIFIED UNSPECIFIED Heyckendorf, Jan UNSPECIFIED UNSPECIFIED UNSPECIFIED Zellweger, Jean Pierre UNSPECIFIED UNSPECIFIED UNSPECIFIED Reimann, Maja UNSPECIFIED UNSPECIFIED UNSPECIFIED Claassens, Mareli UNSPECIFIED UNSPECIFIED UNSPECIFIED Chesov, Dumitru UNSPECIFIED orcid.org/0000-0001-6203-5020 UNSPECIFIED van Leth, Frank UNSPECIFIED orcid.org/0000-0002-5490-8968 UNSPECIFIED
URN:	urn:nbn:de:hbz:38-599816
DOI:	10.1159/000516392
Journal or Publication Title:	Respiration
Volume:	100
Number:	9
Page Range:	S. 843 - 853
Date:	2021
Publisher:	KARGER
Place of Publication:	BASEL
ISSN:	1423-0356
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language MULTIDRUG-RESISTANT TUBERCULOSIS; SPUTUM CULTURE CONVERSION; TREATMENT COMPLETION; COST-EFFECTIVENESS; CHRONIC EXCRETORS; BACILLARY LOAD; FOLLOW-UP; DEFINITIONS; REGIMEN; MOXIFLOXACIN Multiple languages Respiratory System Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/59981