Aminoglycosides and Capreomycin in the Treatment of Multidrug-resistant Tuberculosis: Individual Patient Data Meta-analysis of 12 030 Patients From 25 Countries, 2009–2016
Clinical Infectious Diseases·
- DOI
- 10.1093/cid/ciaa621
- PMID
- 33124668
- PMCID
- PMC8653626
- OpenAlex
- W3095788911
- Study type
- Meta-analysis
- Publisher
- Oxford University Press (OUP)
- Article type
- journal-article
- Integrity
- current
Why this research matters now
The findings suggest that streptomycin and amikacin should be preferred over kanamycin or capreomycin when drug susceptibility testing supports their use, potentially improving treatment success rates for MDR-TB patients worldwide.
Structured evidence summary
Research question
This individual patient data meta-analysis evaluated the comparative effectiveness of injectable drugs (amikacin, kanamycin, capreomycin, streptomycin) used in treating multidrug-resistant tuberculosis, addressing the need to reevaluate their roles as new MDR-TB drugs emerge.
Study design
This was an individual patient data meta-analysis combining patient-level data from multiple studies of pulmonary MDR-TB across 25 countries during 2009-2016. The analysis employed random-effects logistic regression with propensity score matching, comparing treatment outcomes across injectable drug regimens and no-injectable regimens.
Population and setting
The study included 12,030 patients with pulmonary multidrug-resistant tuberculosis from 25 countries, with data collected from published studies during 2009-2016. Treatment outcomes were analyzed according to the specific injectable agent received, limited to patients whose isolates demonstrated susceptibility to the drug administered.
Main findings
Treatment with streptomycin or amikacin was associated with significantly higher cure rates and lower mortality compared to kanamycin or capreomycin. Specifically, streptomycin yielded 7 additional cures and 5 fewer deaths per 100 patients versus kanamycin, and 10 additional cures and 10 fewer deaths per 100 patients versus capreomycin. Notably, patients receiving kanamycin or capreomycin did not demonstrate superior outcomes compared to those receiving no injectable drugs.
Public-health relevance
The findings suggest that streptomycin and amikacin should be preferred over kanamycin or capreomycin when drug susceptibility testing supports their use, potentially improving treatment success rates for MDR-TB patients worldwide.
Important limitations
This summary is limited to the supplied single-article abstract/metadata. The abstract does not explicitly report limitations of the study. Key considerations for interpretation include the reliance on published data from 2009-2016, potential variability in treatment protocols across contributing countries, and the restriction to patients with drug-susceptible isolates, which may limit generalizability to all MDR-TB cases.
GIDS interpretation
This study contributes evidence on comparative effectiveness of injectable agents for MDR-TB treatment. The findings provide quantitative outcome differences that may inform treatment optimization when susceptibility results are available. This evidence supports drug selection decisions but does not constitute surveillance data for signal detection.
Related GIDS surveillance
Literature context does not validate, explain, or change a surveillance signal. Exact and contextual relationships are shown separately.
Evidence relationships
This article has 7 auditable classifier relationships to diseases, places, topics, and study design.